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People use substances for many reasons. Use may start out as experimentation or peer pressure, but if using continues and becomes problematic, there are reasons.
People can, and often do, make rational choices while using drugs.
New findings in neurobiology support the fact that people, especially those with physical, mental, or emotional illness, get significant relief from street drugs.
Incremental change is normal.
All behavior change (leaving a relationship, changing sexual habits, going on a diet, getting psychological treatment) requires a process of decision-making for successful implementation of a change plan.
Ambivalence toward change is fundamental to the human condition.
Ambivalence and resistance to change are “human.” They are a psychological, and not drug-related, phenomena, useful to all of us at different times. It is our job to work with someone’s ambivalence, explore it, and not confront it.
The term “denial” is often used to describe clients hiding out from the truth, and is usually a result of shame and punitive sanctions.
Harm reduction is collaborative.
Client and therapist develop a hierarchy of needs, and they work together to plan solutions.
Harm reduction therapy is a process, not an outcome.
The relationship is the intervention. It is where individuals find the space to reflect on their behavior.
This is the ground out of which choices to change may be made.
Abstinence is one of many harm reduction goals, not the only goal, nor is it often the first goal.
Substances are sometimes the last thing to go, if they go at all.
Success is any positive change, any step in the direction toward health. Using episodes will happen and our job is to plan for them, and to help people stay connected to us during these episodes.
Start where the client is at instead of where we want them to get to go.
It’s unreasonable to expect a person to get over their problem (using alcohol and drugs) before they are allowed in the door.
Harm Reduction “widens the net” of people willing to come to treatment.
We can work with people before their problems become more severe. “Hitting bottom” is not motivating for most people, especially those who have emotional problems in addition to drug misuse.
Many people don’t just hit bottom, but they “adjust to the bottom.”
Harm reduction psychotherapy also incorporates the following starting points with individuals who use substances
Harm Reduction Psychotherapy recognizes that change occurs slowly and gradually, through stages.
There may be setbacks.
We do not refuse to treat people when they don’t follow our recommendations.
We do not treat people with alcohol and drug concerns any differently from how we treat people with other types of health-related behavior challenges.
Harm Reduction says it’s ok to have complicated relationships with substances.
This means seeing substance use disorders as a complex biopsychosocial phenomenon. There is no ‘one
size fits all’ form of treatment that has been proven to work.
Each person’s use is different and unique, no matter what the similarities with other might be.
Abstinence can be a Harm Reduction strategy, but it doesn’t have to be.
This may be abstinence from one drug or several.
Harm Reduction Therapy redefines recovery.
Instead of beginning when the person is willing to be abstinent. recovery begins when the person is willing to be worried or concerned.
Focus on strength, promote choice, remain genuinely curious, increase safety, decrease harm, support and self-efficacy.
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