Harm Reduction: Releasing Shame and Enabling Change

What is Harm Reduction?

We all know that driving can be dangerous. When we get behind the wheel, we take certain precautions to ensure our safety such as strapping our seatbelts on, putting away our phones, wearing sunglasses, and driving the speed limit. By taking these safety measures, we are reducing our risk of harm to ourselves and others while partaking in a dangerous activity. This is called harm reduction.

Everyday examples of harm reduction include:

  • Having working airbags in your car
  • Taking an Uber instead of drinking and driving
  • Using condoms
  • Eating before drinking alcohol
  • Using nicotine gum/patches/vapes instead of smoking cigarettes

In the behavioral health field, harm reduction is associated with reducing the risks of substance use so people can engage in a recovery journey as they define it.


Why is abstinence not enough?

When life takes a turn, substance use can be an escape from trauma, mental health challenges, housing instability, and family conflict. With repeated use, our brain’s chemistry is altered, making it harder to stop the use.

A big behavioral change, such as stopping use,
is hard because:

  • The behavior meets some kind of need.
  • The cycle of guilt and shame when stopping and resuming use.
  • Big changes are overwhelming.
  • Co-occurring disorders complicate change.
  • Drugs alter our brain chemistry.

Recovery is not a one-size-fits all model.
When trying to help, we need to ask:

  • What does wellness look like to you?
  • Does it look like abstinence?
  • Does it look like reduced or safer use?

Once we have those answers, we can work with the person to find the right route for healing.


How does harm reduction support recovery?

While drugs can change the brain, time and treatment can change it as well. Stigma-free harm reduction practices increase trust to raise the likelihood of sustained recovery as defined by the individual.

Requiring us to put judgment aside, it helps us address the social and environmental conditions that lead to use, along with the use itself, and gets to the root of the issue. Harm reduction is about meeting people ‘where they are at’.

This can mean:

  • Finding ways for safer use like providing access to sterile needles and fentanyl testing strips.
  • Distributing naloxone (Narcan) to help prevent overdoses and save lives.
  • Connecting people with recovery resources, such as Medication-Assisted Treatment (MAT) and counseling.

By meeting people ‘where they are at’ with realistic expectations about the winding path of recovery, we can support the whole person through individual-centered treatment.

Harm Reduction is not the opposite of recovery, it is just the more patient and sustainable route.” - Harm Reduction Action Center


Is harm reduction the same as enabling?

One of the loudest oppositions to harm reduction is that it simply functions to enable those who use drugs to continue to use more drugs. Here’s how one harm reduction advocate sees it:

"I got into harm reduction to enable people who use drugs. I enable them to feel like they have someone to talk to, someone who cares, someone who respects them and their humanity. I enable them to ask for help and to help others in turn. I enable them to find drug treatment and health care, to reconnect with their families, to rebuild their lives. And I enable people who use drugs to take personal responsibility for their health and their futures. If that makes me an enabler, I’m proud to claim that term."

- Daniel Raymond, former Deputy Director of Planning and Policy, National Harm Reduction Coalition

Recovery and wellness look different for everyone. Harm reduction acknowledges that each person’s wellness begins at a different starting point. This life-saving approach releases shame surrounding substance use and enables people to create lasting change.


To learn more:

National Harm Reduction Coalition

Harm Reduction Action Center

Meeting People Who Use Drugs Where They Are - An episode of “Changing the Conversation” podcast

Person First Language Guide

Next month, we'll discuss Narcan as a tool to save lives.

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