1. Harm Reduction Implementing Harm Reduction Strategies in Your Health Center

2. Heartland Alliance for Human Needs & Human Rights Ed Stellon, M.S., M.A., CADC Director of Resource and Community Development, Mental Health & Addiction Services, Heartland Health Outreach estellon@heartlandalliance.org www.heartlandalliance.org

3. Heartland Alliance for Human Needs & Human Rights Harm Reduction People marginalized by high-risk behaviors have the right to access a continuum of service options and strategies that include outcomes such as reduced harm, abstinence, and enhanced quality of life. The philosophy of harm reduction recognizes the resilience of people who engage in these behaviors and aims to reduce stigma associated with them. Harm reduction does not promote or enable harmful behaviors, or protect individual participants from experiencing the consequences of the choices they make.

4. Heartland Alliance for Human Needs & Human Rights Harm Reduction and Substance Use Harm reduction is a set of practical strategies that reduce negative consequences of drug use, incorporating a spectrum of strategies from safer use, to managed use to abstinence. Harm reduction strategies meet drug users “where they’re at,” addressing conditions of use along with the use itself. – Harm Reduction Coalition

5. Heartland Alliance for Human Needs & Human Rights Harm Reduction and other High- risk Behavior Many of the same strategies can be applied to other high-risk behaviors Harm reduction is consumer-centered, taking into account the needs articulated by the consumer and avoiding labeling

6. Heartland Alliance for Human Needs & Human Rights Harm Reduction as a Continuum Safer Sex – condom use, avoidance of risky sexual practices, abstinence…… Safer Driving – speed limits, seat belts, intoxication limits, air bags, emission controls, alternatives to driving…… Safer Drug Use – reduced use, avoidance of risky routes of administration, drug substitution, safe using partners (designated driver), abstinence…..

7. Heartland Alliance for Human Needs & Human Rights Harm Reduction and Drug Use – Why the discomfort? Cultural and social factors – America has an uneasy history of acceptance of drug use; politics, not science, is the basis for drug policy Mythology – our perception of why some drugs are bad, some are not so bad, and others are o.k. is often based on biased information

8. Heartland Alliance for Human Needs & Human Rights Harm Reduction and Abstinence Harm reduction and abstinence are highly congruent goals. Harm reduction expands the therapeutic conversation, allowing providers to intervene with active users who are not yet contemplating abstinence. Harm reduction strategies can be used at any phase in the change process.

9. Heartland Alliance for Human Needs & Human Rights Principles of Harm Reduction User’s decision to use is accepted (pragmatism) User is treated with dignity User expected to take responsibility for his/her own behavior Users have a voice Reducing harm not consumption No pre-defined outcomes

10. Heartland Alliance for Human Needs & Human Rights What Harm Reduction Is Not… Neither for or against drug use Tacit consent to use drugs “Don’t ask, don’t tell” “Trojan horse” for drug legalization “Anything goes” Anti-abstinence

11. Heartland Alliance for Human Needs & Human Rights We Practice Harm Reduction by: Offering a range of options and choices to facilitate positive change Exploring the benefits of changing, reducing or eliminating high-risk behaviors Establishing and maintaining a relationship with participants who continue to engage in high-risk behaviors Defining and re-defining success with participants

12. Heartland Alliance for Human Needs & Human Rights We Practice Harm Reduction by: Helping participants build motivation Working with participants to develop adaptive coping strategies Being non-judgmental and providing balanced, factual information Recognizing decision-making power rests with the participant

13. Heartland Alliance for Human Needs & Human Rights Best Practices Balance the practice of harm reduction between the needs of individual, family, community and organization. Offer objective, factual information, both positive and negative, in the context of educating regarding choices and decision-making. Clarify consequences of choices, both positive and negative.

14. Heartland Alliance for Human Needs & Human Rights Best Practices Build policies and practices around safety issues and participant functioning – focus on expectations and responsibilities rather than rules. Acknowledge change is hard, ambivalence is normal, and look for opportunities to build motivation to change. Celebrate collaboratively defined successes and identify lessons learned from setbacks.

15. Heartland Alliance for Human Needs & Human Rights Helpful Websites Harm Reduction Coalition: www.harmreduction.org www.harmreduction.org International Harm Reduction Association: www.ihra.net www.ihra.net Harm Reduction Therapy Center: www.harmreductiontherapy.org www.harmreductiontherapy.org Harm Reduction Journal: www.harmreductionjournal.com www.harmreductionjournal.com