Running header:Harm Reduction

Harm Reduction
SW2280
Fall 2015
Bruce Chandler
Tom Fightmaster

Running header:Harm Reduction

Harm reduction is about policies and practices that are used to help addicts and
alcoholics who want to reduce the harm related to the addiction from psychoactive
drugs and alcohol. The main aspect is the prevention of harm a main focus on the
addict or user.
Harm reduction was founded as a new way to affect the lives of addicts who
were infected with HIV. Since its inception many other programs have followed along
the path of treatment, with respect of a wide range use of other drugs. In addition harm
reduction looks to help with or reduce the amount of drugs used.
The idea is that people continually use psychoactive drugs in spite of the
powerful tactics to help them stop using. In harm reduction there is an acceptance of the
user and their addiction as an illness. A large majority of people who are drug users may
not need any treatment and in fact they may only need maintenance . This is a positive
step to help as opposed with the higher risk approach of locking people up .
Often we need options to help people in order to minimize risks from continual
use as well as a reduction of harm to themselves and others. So it becomes a primary
goal to offer services and also interventions to those in need therefore keeping people
safe and secure . On the other hand letting people suffer and die is not an option. (1)
In British Columbia physicians have tried for forty years to control the spread of
drug use and the suffering associated along with abuse. In Vancouver there has been
an ongoing effort to offer another approach that is more practical solution by funding
harm reduction therapy. Through the efforts on the part of the government and

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communities they are leading the introduction of harm reduction in North America.
In the communities there are strategies for using harm reduction to reduce
the overall cost of addiction as well as helping with families and also focusing on the
crime aspect. There are in place a set of goals that are gone through one at a time that
if implemented will lead to a better lifestyle for the drug user. This is beneficial to all
involved and the community becomes healthier.
History has shown that the practical approach to drug use through harm
reduction has worked in the prevention of HIV/AIDS as well as overdoses and a
decrease in the overall open drug use. It has also been shown that large scale police
drug enforcement was ineffective in controlling drug street prices as well as illicit use.
In fact drug users just relocated to other areas, which just shifted the problem.
Vancouver took a new approach and created the Four Pillars Drug Strategy
which focuses on prevention, treatment, harm reduction, and enforcement. As of now
harm reduction has become a social policy and it has spread to Europe and the United
States. Some programs in Vancouver are l methadone maintenance , as well as drug
courts, and also needle exchange programs. Along with these are , supervised injection
clinics, and neighbor hood outreach. There is a complete community outreach with
medical providers and counselors as well as welfare support services all working
together to reduce the personal harm as well as any harm to the local communities and
illegal substances (2)

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The first priority of Harm Reduction is to decrease the negative consequences of

drug use. In North America our drug policy was or is focused on the amount of and
availability of drug use. Harm Reduction wants to take another approach
and select a series of goals with the most important and achievable ones first and then
working to a high risk free usage, and abstinence as an end goal.
In Harm Reduction there are obvious drawbacks, beginning with the fact that
addicts get easier access to drugs and that they will have relapses and overdoses
occasionally. Another fact is that addicts could get adjusted to using without any help. It
will possibly prolong their addiction as well. Addicts who are not given the other aspects
of treatment such as therapy or physical health care will suffer longer. So it's clearly
case of follow up and therapy. Addicts must at some point face their own addiction. But
if you cannot get access to them you stand little or chance of helping them. In the
following description I will give a personal testimony of my experience in working with
women in Harm Reduction. 3
While Living in Albuquerque, New Mexico I was fortunate to have volunteered for
Mayas Place a congregant living center and shelter for women. In New Mexico the
women at Crossroads for Women are homeless and suffering from mental illness and
substance addictions. They are survivors of childhood sexual and physical abuse and
are frequent victims of domestic violence and recurring trauma on the streets. Most
come from an impoverished, abusive, and substance using family background and have
not learned the life skills needed for community living.

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Crossroads has developed comprehensive programs to meet needs that other

organizations cannot. The supportive housing programs of The Crossroads and Mayas
Place provide therapeutic services that address past trauma and tailor intensive case
management, and educational, vocational, and parenting support plans to the specific
needs of each woman.
Crossroads has developed comprehensive programs to meet needs that other
organizations cannot. The supportive housing programs of The Crossroads and Mayas
Place provide therapeutic services that address past trauma and tailor intensive case
management, and educational, vocational, and parenting support plans to the specific
needs of each woman.
Although challenged by many barriers, the women also come to Crossroads for
Women with many strengths. They are most often resilient, resourceful, and interested
in helping others, particularly women in similar circumstances. They are open to
learning, responding positively to therapy, and are very determined to make progress.
Recognizing and building upon these and other client strengths is a fundamental
philosophy of Crossroads for Women. Crossroads for Women offers women an
opportunity to change the direction of their lives.
I interviewed Rebecca Lillywhite a former Director of Mayas Place and also an
employer of Crossroads. She said that her population consisted mostly of Hispanic
women with some woman who were Hispanic/Native American mix. The ages went from
as young as 16 up to 60 years of age. In the beginning Harm Reduction was very

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hard to implement because the women were just of the street and in need of intensive
care and a lot of them were still coming off drugs. At Mayas there were as many as
15 apartments with two to three women in each apartment. She went on to say that at
Crossroads the woman who had graduated from Mayas and were on their way to
recovery were proactive in their own programs. In the infancy of the program many staff
left because Harm Reduction was hard to accept and it was a program that was going
to take an extremely long time to put into place and see any results.
However, it is paying off according to Ms. Lillywhite. She went on to add
that released women are expected to comply with conditions of probation or parole,
achieve financial stability, access health care, attempt to reunite with their families,
obtain employment, find safe and drug free housing, and in many cases, maintain
recovery from addiction and mental illness. However, most women find themselves
either homeless or in dangerous environments and without support. Many of the
systems designed to assist individuals get back on their feet exclude those with criminal
records. She told me that Mayas place was a six month program and upon graduation
the women would move to Crossroads where they would continue on with their care.
Although Harm Reduction is a new approach here in North America, it should be
stated that the methadone program, an earlier form of harm reduction has been in
existence since the 1960s. Methadone maintenance was mainly used for crime
reduction and helping an individual to stay in a workforce. I would like to add that we
also do surgeries on people to reduce the size of their stomachs, another form of Harm
Reduction. Somehow I feel we need to follow up with life changing skills.

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So how exactly does harm reduction work in a real situation? Harm reduction
principles are designed around the commitment to public health and the individuals
personal human rights. Harm reduction looks at the causes and the effects of drug use.
Next it is important to identify the harms, and causes and then make decisions about
any interventions that are helpful in the assessment process. A complete program is
designed to help the individual in their treatment.
The modality of harm reduction lends itself to a very sensible and effective
treatment plan as well as being very cost effective. It has been shown that harm
reduction is very safe. Harm reduction is a very heavily evidence based policy. In terms
of cost harm reduction is a lot more inexpensive that other programs and has a better all
impact on the persons and the community at large.
In harm reduction a great deal is placed on a positive outcome approach when
dealing with an individuals life. And any interventions that do happen are met with a
positive support rather than punitive, and the individual is taken in to account always.
So as such it is totally the client centered approach and where that person is in
their place and time. A client in harm reduction is always seems as someone with a
back ground and a family so therefore therapist accept the client for who they are. This
is a sense of compassion that reaches out to encompass the person and the community
as well. Stigmas such as drug user and junkie and anything that brings about a negative
aspect of that person just furthers a feeling of ill will. Language should always bring
about a positive feeling.

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Harm reduction seeks to have an open forum and a healthy debate among
everyone who are involved in policy creation and those who enforce the policies. Many
people from the community need to be apart of this debate in order for it to happen
effectively, and that should include the users of the drugs and families and counselors.

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Bibliography:
1.

What is Harm Reduction? Harm Reduction International. 2015

2.

Bayes,Shawn, Making the Case for Harm Reduction. Behavior Health Care. July,
2007

3.

Stockard, Fiona, Harm Reduction: Helping or Hurting Addicts? , Lighthouse

Recovery Institute, November 17, 2014

4.

Margaret Rebecca Lillywhite, BFA, MSW, LCSW Program Director, Mayas Place
and Crossroads . Currently with the US NAVY.