A harm reduction approach
Someone in the family has been using an illicit drug for some time. They are now heavily dependent and problems are increasing in their life, and therefore yours too. They know they have a problem. You’ve supported them through counseling and detox over and over again, encouraged by promises to never use again, then hope is dashed within days yet again. The family has tried being soft, hard, angry, and pleading to no effect. It may be time to start thinking outside of the square…
Despite the anger, frustration and fear, you don’t want to give up on a loved one trapped within their drug use. Where do you set limits when a family member won’t give up a heavy destructive drug habit? Do you keep caring until you fall apart yourself? Should you kick them out of home when it becomes too much, or is this being heartless? Counselors may say that this leaves drug users to face the consequences of their actions but it still hurts you. Faced with chronic drug use, families often resign themselves to being unable to force changes, but still wanting to provide support in a meaningful way. The philosophy of harm minimization is one way to do this.
Harm minimization
Harm minimization has been the Government’s approach since 1986. According to the National Drug Strategic Plan 1993-1997, “harm minimization is an approach that aims to reduce the adverse health, social and economic consequences of alcohol and other drugs by minimizing or limiting the harms and hazards of drug use for both the community and the individual without necessarily eliminating use”.
There are three integrated strategies involved:
• Harm reduction: strategies designed to reduce drug-related harm for particular individuals and communities
• Supply reduction: strategies designed to disrupt the production and supply of illicit drugs
• Demand reduction: strategies designed to prevent the uptake of harmful drug use, including abstinence-based strategies to reduce drug use.
This approach acknowledges that some people may use illicit drugs for a long time before quitting, and that many strategies can be put in place to minimize the risks of overdose and health problems. Some families often go through much anguish as a family member develops a high level of dependency on a drug. This can be a painful time as the family realizes that yelling, recriminations, support and all the love in the world may make no difference.
It may take a long time before someone even admits they have a serious problem, then it can take more time before they actually do something about it. Even then, the majority of people may find it takes repeated attempts to successfully stop their drug use before managing to stay clean. Families can often feel powerless and frustrated as usually there only aim is to see their loved one free of drugs.
The good news is that families can still play a key role in reducing potential harms of illicit drug use. With a good understanding of the nature of addiction, and the slow nature of the process of change, family members can instead focus on harm minimization strategies until the individual is ready to make changes in their drug use. This can be very empowering as the family has something constructive to do — minimize the negative impact of the illicit drug use until change occurs.
Harm reduction
Harm reduction represents a shift from use-prevention philosophies. It acknowledges that people always have, and always will use drugs of some kind. This strategy also acknowledges that prohibitionist approaches have failed, and in some cases, worsened drug problems and resulted in needless deaths. For example, the spread of HIV and Hepatitis C is very high in countries that aim purely at eradicating drugs, and not providing clean injecting equipment to existing users. This also places the community at risk from the spread of these viruses.
Harm reduction strategies have been employed in a number of guises for several years. Drink driving campaigns, which accept the necessity of transport for people who are intoxicated, encourage a “designated driver” to remain sober. This is one example of a harm reduction strategy.
Needle & Syringe Programs
Needle and Syringe Programs (NSPs) are part of the harm reduction strategy. They provide sterile injecting equipment and disposal containers for those injecting drugs, which reduces many health issues including vein damage, transmission of blood-borne viruses and bacterial infections. NSPs also offer counsellings, information and education aimed these issues, and referral services to other welfare organizations as required. NSPs can also provide comprehensive information on counselling and detox services when an individual wants to stop or reduce their drug use. Staff have a non-judgmental approach to illicit drug use, enabling them to build positive relationships with drug users that can help to provide links to other services.
