1. Harm Reduction Practice: Substance Use Conversations Part 3 of 3 Challenges, strategies, and resources

2. Challenges Myths and assumptions –Harm reduction enables/supports drug use –Drug users are not concerned with health –Safety of other residents/women –Triggers re: violence for other survivors –Young women users –Using moms

3. Dominant ideologies Broaching the subject of drug or alcohol use

4. Transferable Skills Non-judgmental Unconditional positive regard Belief that she is deserving of safety and support Safety planning Coping skills

5. Counselling Themes Trauma -chaotic, long term, unwanted use is most often linked to surviving complex childhood trauma and/or trauma in adulthood -Self medication, managing emotional pain -Building safety by developing a range of grounding and flashback management skills -Resolving childhood trauma, addressing self worth and making sense of what has happened Can you work through trauma while using drugs?

6. Counselling Themes Grief and loss -Long term or chaotic drug use often results in a number of losses -The overlay of stigma creates further barriers in getting support to work through these losses -Support a woman to talk about her grief and loss, normalize, acknowledge and sit with the emotions -Storying memories can be helpful and can be done informally. -Support to do or access rituals, spiritual rites -Themed user positive groups (ie. child welfare)

7. Counselling Themes Health -Physical and emotional health while using (OD prevention, safety planning, auto injection) -Access and education re: safer use supplies “Works” -Access to non-judgemental health services to address abcesses, cellulitis, vein care, lung health -Advocacy within medical systems and services

8. Counselling Themes Advocacy –Medical and health services –Child welfare services –Housing –Income support –Criminal justice system –Internal policies that stigmatize drug users

9. Goals User, self-identified goals Teasing out abstinence based goals Plan A and Plan B Strengths based

10. “Triggers” Differences between trauma triggers and using triggers

11. Triggers and Strategies Awareness and practical planning

12. “Things I Need” An exercise to shift internalized shame 1)Ask her to make a list of positives connected using her drug of choice (I usually write) 2)Be curious and reflect back your understanding of each positive 3)Keep probing to make the list as long as possible 4)When she is done, write the actual title of the exercise at the top of the page 5)Debrief her reactions and feelings 6)Use this exercise as a roadmap for goal setting

13. Resources Mella and Bo Yih email contact: harmreductionconsultants@gmail.com Canadian Harm Reduction Network: canadianharmreduction.com Ontario Harm Reduction Distribution Program: http://www.ohrdp.ca/