Harm Reduction Copy

In recent years considerable discussion has occurred on alternative approaches to the abstinence model of substance abuse counselling. There is a growing movement promoting the concept of reducing harm as a means of reducing the impact of drug use on individuals, families and society.

Many people will engage in high-risk activities, so help provided to young people with respect to drug use must be flexible and individualized – aiming to first decrease those behaviours that are potentially most harmful. The clinician who fails to recognize the need for a flexible approach may alienate the youth and increase the likelihood of disengagement. Families often struggle with issues around drug use, so they must be brought into the treatment plan as soon as possible.

In the area of early psychosis intervention, there is considerable agreement by clinicians and researchers that alcohol abuse and the use of any form of street drugs presents risk to the young person’s mental state and reduces the likelihood of recovery. However, there is little research to suggest that the traditional abstinence approach is realistic among a group in which peer pressure and substance use are seen as normative.

Simply put, the harm reduction approach is based on a number of principles that are consistent with best practice approaches to early intervention in early psychosis treatment. Harm reduction is based on an individualized approach where the client sets the priority for problem solving. In addition, there needs to be a low threshold for receipt of services. If it was a requirement that young people stop all use of drugs and alcohol prior to seeking early intervention services not only would a significant proportion of our clients be ineligible but also other youth may be reticent to share their use or the symptoms they are experiencing for which they use substances as a means of coping. It is important from the outset of working with youth and their families to discuss the role and pressure to use drugs and alcohol in our culture and to be realistic in expectations. Ensure that there is an understanding that this topic will be addressed during treatment and psychoeducation.

Find and review the educational materials on Drugs and Alcohol in the care pathway page.

A harm reduction approach allows for differing theoretical orientations and clinical styles as it is understood that substance use is a complex biopsychosocial phenomenon and often associated with adaptive behaviours. The role of the engagement process is particularly critical when discussing the reasons underlying use of drugs or alcohol. It may be difficult to determine if the use of substances was a feature of a client’s premorbid personality and behaviours or a response to emerging symptoms.

With early psychosis clients it is essential to discuss on the interaction of street drugs with prescribed medications. To read a one-page document detailing potential interactions between medications and alcohol and drug use, click here.

Coping with peer pressure and the need to socialize are important developmental milestones for teenagers. Clients will often report that the only commonality they share with their peers is drug use. Altenative means of maintaining social supports is essential if a reduction of use is to be achieved. Use of the concept of the hierarchy of need is common in harm reduction treatment. Physical health, ability to sleep and eat regularly can be appealing goals to a young person who has been coping with the onset of psychosis. Motivation to change substance use patterns may be found in respect to these goals.

David – A Case Study

Click here to download the continuation of the case study with David. You should print out and read this before continuing.

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