The harm reduction philosophy or model takes the pragmatic stance that people have always engaged in risky behaviors, such as taking drugs and alcohol or refusing necessary treatment, and will probably always continue to do so. Here, the strategy is one of decreasing risk, while acknowledging that one can never fully eliminate it, after all, we’re all going to die someday. Some often-cited examples of harm reduction strategies include methadone or buprenorphine programs for people who are dependant on opiates.
With these programs, the risks of transmitting deadly viruses such as HIV and hepatitis are significantly diminished as is the risk for accidental overdose with heroin. Seatbelt laws and safety seats for children are also harm reduction strategies, as they increase the chances of surviving an automobile accident. In bipolar disorder, in which substance abuse and issues around taking medications and following treatment recommendations may be problematic, a harmreduction approach is useful in assessing the overall risk and trying to diminish it.
Key components of a harm reduction approach include:
• Meeting the person where they’re at. If you, your loved one, family member, or patient is unwilling to take medication and actively abusing drugs and alcohol, this is where you need to start.
• Radical acceptance and honesty. This goes along with the previous bullet point. It basically means that whatever the reality of a particular situation is, it must be acknowledged before any change can occur. Wishing things were different, or denying what’s actually happening, doesn’t allow for progress.
• Empathy. For the person with the harmful behavior, this means cutting yourself some slack and not beating yourself up over the issue. If you had a relapse with drugs or alcohol, it’s being able to pick yourself up and say, “Today is a new day, and I’m not going to use today.” For loved ones and professionals it’s about showing your genuine care and concern.
• Being nonjudgmental. This includes respecting the individual’s personal beliefs and choices.
• Supporting all positive change. “You cut down; that’s tremendous!” “You’ve decided that the lithium helps you focus better; that’s great!”
• Weighing the pros and cons. This is where a person might actually sit down and do an accounting of everything they like and dislike about the behavior in question.