Substance AbuseMost importantly, when I work with clients struggling with substance use, I accept them where they are. This is a fundamental precept of the Harm Reduction model which is an effective, but lesser known method for approaching substance use/abuse as compared to the more popular abstinence theories. Whether my client is involved in the twelve steps, and is abstinent, or is just thinking about "cutting down”, I meet my clients where they are and work with them accordingly.
Principles of Harm ReductionThe first tenet of Harm reduction is to accept a client where he or she is. This is based on the belief that behavior change is a stepwise process and that people find themselves in different places in their lives throughout their struggle. This acceptance involves taking the whole person into account and factoring in their emotional, interpersonal, physical, historical and financial realities which contribute to the individual's behavior. In addition, Harm Reduction believes that risky and dangerous behavior occur along a continuum from minimally dangerous to extreme and there is often a great deal of ambivalence associated with change. Whereas one individual may drink excessively, but limits it to the weekends, another person may be injecting speed on a daily basis. This continuum combined with the belief that change is a process culminate in working with clients to reduce the amount of harm brought to themselves and others. By focusing on positive change instead of relapse, there is a reduction of shame, guilt, and isolation that often accompanies feelings of failure associated with relapse.
How much a person changes and which changes occur result from the client being given the opportunity and space to find their own internal motivation, discover the causes of their drinking and/or using and aligning their behaviors with their values. Abstinence is not always the goal because it is a reality and desire many people don't hold, or cannot sustain, and as a consequence, these people find themselves without resources and services because most recovery models work with people who are only "ready to quit now". And if they aren't "ready to quit", they are often labeled as "being in denial". Whether a person wants to quit entirely, cut down, or make simple changes such as not driving while drinking, Harm Reduction accepts each person and asks them "what do you want?" The purpose of Harm Reduction is any positive change, and I believe when given an accepting environment free of judgment, a person will search and find what is best for them, connect with others who want the best for them and feel confident enough to begin implementing the steps necessary for that change.