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HARM REDUCTION THEORY AND PRACTICE

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					HARM REDUCTION:
THEORY AND PRACTICE

                        PRESENTATION BY:
                         JOANNA RYNSKA
               YMCA OF GREATER TORONTO
EVOLVING MODELS OF DRUG TREATMENT
 Moral model – use seen as personal choice,
  change can come about by exercise of will power
 Medical model – responsibility of resolving
  problem does not rest with client, change comes
  from acknowledging loss of control, adhering to
  medical prescription and participating in self-
  help groups (Alcoholics Anonymous)
 Spiritual model – use in attempt to fill spiritual
  emptiness and meaningless, solution is spritual
  journey involving connection with Higher Power
EVOLVING MODELS OF DRUG TREATMENT
 Psychological model – problematic use results from
  deficits in learning, emotional dysfunction or
  psychopathology, concurrent disorders, change
  comes if reinforcers are outweighted or replaced by
  negative consequences and client learns to apply
  strategies for coping with situations that lead to use
 Sociocultural model – use affected by social and
  cultural contexts, solution to sort out ethical
  dilemmas and opportunities for spiritual growth to
  reduce shame, guilt and regret about harm inflicted
  on self and others
 Bio-psycho-social-spiritual model – recognizes
  importance of many interacting influences, works
  will areas and prioritizes goals
HARM REDUCTION DEFINITION

 Set of strategies that encourages drug
  consumers to reduce the harm done to
  themselves and their communities by their
  use of illicit/licit substances

“If person is not willing to give up his or her drug
   use, we should assist them in reducing the
   harm to himself or herself and others”
                                Ernst Buning
HISTORY OF HARM REDUCTION

 Began as movement in England and
  Netherlands with small group of public health
  officials dealing with HIV and illicit drug users
 Goal to spread of disease associated with
  substance use
 Earliest forms in North America through
  methadone clinics for injection users
 Shifted to include adverse consequences of use
  among this population
 Included as part of Canada’s Drug Strategy
  among prevention and medical treatment
    HARM REDUCTION THEORY
   Practioner accepts user’s decision to use, does not indicate support of
    activity
   Non-judgemental approach needed to establish rapport and build safety
   User treated with dignity as normal human being
   Recognition of users competency to make choices and changes
    (strength-based perspective)
   Neutral intervention, guided by goals of the user and pace that is most
    comfortable
    (assess using stages of change)
   Used in many different contexts (sexual health, mental health, etc.)
   Before removing drug use, important to stabilize and replace with new
    coping strategies
   Abstinence as one of goals
   Enagage client in political process of changing policies to empower client to
    be part of the change process on macro levels
EXAMPLES OF HARM REDUCTION

 Wearing seatbelts when travelling by car
 Sexual health education and use of condoms and
  birth control pills
 Reducing drug use (amounts, weekends only,
  method of use)
 Learn about substances and their effects to
  become a responsible users
 Needle Exchange programs
 Methadone clinics
 Prevention through education
DRUG USE CONTINUUM

 Non-users
 Experimental/recreational users
 Irregular users
 Regular users
 Dependent users/addiction


Important to assess where the user is at to
begin treatment plan
STAGES OF CHANGE
   Precontemplation
   Contemplation
   Preparation
   Action
   Maintenance
   Relapse and Recycle

-   Circular process
-   Gain of new experience with each cycle
-   Relapse as natural part of the change process
PRACTICE OF HARM REDUCTION
 Assess client’s readiness for change, even if low,
    internal motivation (stages of change)
   Establish and prioritize client’s goals
   Create mutual treatment plan with client, important
    that client feels empowered in being part of process
   Start with realistic and measurable short-term goals,
    evaluate regularly to demonstarte progress
   Exlore reasons for use (coping, boredom, cravings)
    and provide alternative strategies to replace use
   Assist client in establishing a strong support network
   Provide education around substance use using
    creative methods (quiz, game, informal
    conversation)
PRACTICE OF HARM REDUCTION
CONTINUED…
 Increase client’s motivation through different stratgies
 Encourage change of enviornment to reduce triggers (places,
    people, presence of drug) and to take up new interests (art
    program, exercise, travel, volunteer work)
   Explore underlying issues (mental health, trauma, abuse) and
    provide support or refer to experts in areas to resolve issues that
    perpetuate the drug use
   Evaluate process frequently and adapt to needs of client,
    increase level of change gradually
   Accept relapse as normal part of change process, empower and
    motivate client to continue despite setbacks
   Celebrate success in client’s achievements, even if small
   Include termination of treatment when appropriate to assist
    client in recognition of own strengths, encourage to come back if
    additional support is needed
QUESTIONS?

				
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posted:9/21/2011
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