anon-y-mouse said:
off-topic a bit, but I have always been curious about 'harm reduction' practices. it is one thing to give addicts clean needles (for example), but would you at the same time encourage these people to reduce their drug use / dangerous/high-risk behaviors? (rehab and so on). I mean, horrible consequences exist for a reason, so is it really effective to keep putting band-aids on people's problems and feed their vicious cycle? I'm genuinely curious, since I have little first-hand experience with this segment of the population.
aahhh, Harm Reduction...HR is so dear to my heart....
first, it's important to note that not all users are addicts. that there are a lot of people who manage all sorts of drug use in ways that do not otherwise impact their lives. they are in control, not the drug, and it's just like someone who drinks socially.
and also that harm reduction applies to all sorts of things, from substance use to managing an abusive relationship to minimizing risk in sexual relationships to people who exercize too much for their own good.
the basis of HR is the acceptance of everyone involved that people don't change unless they want to, and even if they want to, until they are ready to change. that the motive force has to come from the individual, not any external. it is the anti-intervention. it's based on prochaska's "stages of behavior change," which i reccommend highly. basically, people are at some stage in the cycle (with relapse as a natural and accepted part of it) and all a practicioner can do is to try to plant a seed of thought that might help the person move to the next step. sometimes that is giving them referrals to rehab, if that's where they are and what they want (and not just what they think you want them to want), and sometimes that's asking open ended, non-judging questions about what they are doing, because just articulating it out loud without the need for the inherent defensiveness that comes from discussing "risky" behavior with someone who you know thinks it's bad can help speople to start to see their self-destruction, and that's the first step. or there's the person who doesn't really know all the risks, and you teach them about it.
in addition, when it comes to disease/health risk, there's the "action" component, where in one helps people to find safer ways to keep doing the behavior, so that while the behavior is the same, the risk of health effects is less. with injection drug use, that's clean needles and supplies, vein care education, overdose prevention education, etc. with sex that's alternate practices, barrier use, negotiation strategies, etc.
it's really empowering for the client, and a lot of these behaviors develop because people feel powerless and/or lack other coping strategies. just becasue i don't suggest cutting down or rehab to every client doesn't mean that i'm not trying to help them be healthy. i'm just recognizing their own rights and power to make their own decisions, and often the act of that can really help them help themselves.
i reccommend prochaska.