Harm Reduction and/or The Stages of Change (Transtheoretical Model TTM)
I have a love for theories. They are my highest page views so I’m happy that other people get it. They HELP! especially with the substance abuse population. I do have practical methods that have helped me but it all goes in the same boat, -get people to make BETTER decisions. I’ll go over the 2 most common ones I try to consider with patients.
Harm Reduction
People always find ways to do harm reduction or to cut back. It occurs more often than people realize such as seatbelts, sunscreen, speed limits, partying and drinking only on the weekends, etc. It can honestly be the difference between life and death. So harm reduction includes many different factors and forms so I like this explanation of using it as an umbrella term:
Harm reduction refers to policies, programs, and practices that aim to minimize negative health, social and legal impacts associated with drug use, drug policies, and drug laws. Harm reduction is grounded in injustice and human rights. It focuses on positive change and on working with people without judgment, coercion, discrimination, or requiring that they stop using drugs as a precondition of support.
Harm reduction encompasses a range of health and social services and practices that apply to illicit and licit drugs. These include, but are not limited to, drug consumption rooms, needle and syringe programs, non-abstinence-based housing and employment initiatives, drug checking, overdose prevention and reversal, psychosocial support, and the provision of information on safer drug use. Approaches such as these are cost-effective, evidence-based, and have a positive impact on individual and community health. I also want to quickly note that harm reduction is defined by multiple ways and practices:
There is no universally accepted definition of harm reduction. The definition above lays out Harm Reduction International’s position on this issue based on our years of work on drug use, public health, and human rights, and incorporates views shared by partner organizations. –harm reduction international
Currently, the most important reason for harm reduction is due to the opioid epidemic. However, can you see if we tackled these bad behaviors/habits in the first place, we can hopefully avoid this problem down the line? Heroin and partying activities can lead to STDs/HIV, heart attack, strokes, kidnappings, mental instabilities, death…etc. So I don’t only target the substance abuse populations but everyone including kids to stop bad habits and make them aware of the consequences. I just don’t trust society, public officials, schools, etc. anymore to help people go in the right direction. If anything, the world promotes and rewards bad behavior and we see it plastered everywhere.
Harm Reduction Principles:
- Accept that there are benefits and consequences of alcohol and other drug use, and that use has been around for thousands of years.
- Focus on decreasing more immediate harms vs. striving for a drug-free society.
- The focus is on harm, not the substance.
- Giving people choice and access to a broad range of options that helps to keep people safe and alive and healthy.
- Making an individual’s goals a priority and focusing on what they see is their most immediate need.
- Small gains add up over time.
- Recognizing that people know what is best for them and are doing the best they can with what they have.
The Cons: the biggest issue with harm reduction is that it may not be good enough and it’s not how society operates. You can’t just do “a little bit” of heroin or cocaine, so many activities need to completely stop or you’re risking death. “Micro” dosing heroin, can still easily have fatal consequences. It’s no standard on an appropriate amount of “drugs” and if it’s mixed/contaminated with fentanyl it’s NO JOKE. Some people say they need drugs to function, then why are so many people dying, in rehab, or seeking help?? Try to tell the families of those who have died how it helped… Therefore, I somewhat avoid harm reduction with hard drugs. I personally don’t agree with giving people clean needles or crack pipes, but harm reduction also includes Suboxone, which is what I prefer, and/or sending them back to rehab.
TTM
TTM also helps meet patients where they’re at. If I’m struggling with someone, I frequently refer to what stage of change the person is in because things (e.g. relapses) can get frustrating. As I suggested before, don’t take them personally but continue to tailor the harm reduction strategies and target the anxiety. The stages of change also help you not waste extra time or energy, focusing on the wrong areas. (Read more about TTM)
The Cons: I’ll tell you what gets frustrating. If someone is in rehab, the counselor, or the situation/patient suggests how they’re in a different stage than what’s being observed. Almost nothing happens in a linear fashion in psych and most theories recognize that but the “stages” are not presented in that cute way. People may think they “terminated” the behavior when it’s actually or secretly still occurring. So look at the stages of change as something fluid, overlapping, or simply wrong (and need to go to another phase). It’s many other theories that act like this; The Stages of Grief, Maslow’s Hierarchy of Needs, etc. that don’t reflect the order that it’s given. So I usually don’t put “the stages” of anything in my notes, though the clinician/therapists sometimes do or a person doesn’t agree. I’m simply using these theories as a personal reference…
Additional References and Information
- Motivational Interviewing for School Nurses (How To Talk To Kids With Suicidal Ideation/Self-Harm): a nice MI handout –Hi Angela
- Stage of Change Model; a fun PDF booklet about implementing change and interventions
