“Just don’t die.”
Those are the words I used to say to clients struggling with substance use who left the programs I’ve worked in over the years.
“If you die, we can’t help you anymore.”
We can’t control how ready our clients are to make a change in their lives. From unwilling to unable there are just too many factors. It was heartbreaking to watch someone sick walk out the door, but I always sent them with that same message. Just don’t die.
These words touch at the heart of the principles behind harm reduction, keeping someone alive long enough to find treatment that works. In the United States, drug overdose deaths are 3.5 times higher than 17 other western countries. People with substance use issues are dying and you can’t help someone who’s dead.
Substance use problems are often viewed today as individual moral failings and their only solution abstinence through sheer triumph of will, an extension of America’s infatuation with the Protestant work ethic. While America looks down its nose at those in need, families of every race, color, creed and socioeconomic status lose their loved ones every day at ever increasing rates.
Enter harm reduction. Harm reduction refers to policies, programs or practices that are aimed at reducing or eliminating negative health, social and legal impacts associated with substance use. Contrary to popular belief, harm reduction does not entail enabling addiction but rather focuses on minimizing the impact that these disorders have at an individual, family and community level. Harm reduction focuses on positive change and doesn’t require people stop their use as a presupposition for support. At its heart, harm reduction is about recognizing the inherent dignity and worth of human life.
Harm reduction is about one more thing. Evidence. There is a strong and growing body of evidence that shows that harm reduction strategies are safe, cost-effective and practical. These practices have been shown not only to reduce drug over-dose but also the comorbidities often associated with substance use. A longitudinal study was run in New York from 1990 to 2002 examining the impact of needle and syringe programs on the HIV rate and recorded a decrease from 50% down to 17%. The District of Columbia instituted a similar program in 2016 and has recorded a 70% decrease.
Other “taboo” approaches to substance use include decriminalizing drug offenses, which has been shown not only to be a major economic boon to the taxpayer but also a remarkably effective strategy for getting substance users the support they need. Portugal is the poster child for this approach. While the country formerly had an opioid addiction rate of 1 in 100 people and sky-high HIV infection rates, they have since decriminalized personal drug possession and replaced the penalty with a small fine and a referral to substance use services. The result? A 60% increase in access to drug treatment programs, an 80% reduction in drug overdose fatalities and a 60% reduction of drug related incarceration. All in just four years.
Support for the harm reduction approach to treating substance abuse is gaining momentum in the United States on both state and federal levels. Groups like the National Harm Reduction Coalition work to effect policy change and provide trainings on evidence-based practices to help smaller organizations launch, and eventually thrive, at a local level.
Unfortunately, harm reduction still faces major hurdles in our country and the shame and stigma substance users experience still abounds. Mental health providers of Salt Lake want to see harm reduction tactics thriving in our local communities so that more fathers, mothers, sons and daughters can keep coming home to their families safe and alive.
If caring for your community in this way speaks to you, I urge you to reach out to your local harm reduction chapter such as the Utah Harm Reduction Coalition to find out how you can get involved.
A California transplant, Aaron Quigley has been working in the therapeutic industry in Utah for more than seven years as a wilderness therapy guide, life coach, youth mentor and finally a therapist intern at Odyssey House and an master of social work student at the University of Utah.