Response supports a diverse range of people across our services, and some of the people we support may have experience of drug use. Our teams take a harm reduction approach, working alongside individuals to understand their circumstances, reduce the harms associated with drug use and support their health and wellbeing.
What is harm reduction?
We use harm reduction every day in many different areas of our lives. Examples include speed limits, designated drivers, seatbelts, face masks, needle exchange, nicotine patches, sunscreen, bicycle helmets, naloxone and methadone.
Harm reduction first became a widely used term in the UK in the 1980s in response to the increasing number of cases of HIV among drug injectors and the development of syringe exchange schemes. In 1987, Dr Russell Newcombe put forward the first academic article arguing for adopting it as a model of working with substance users across Merseyside.
As well as wanting to focus on preventing HIV and reducing deaths amongst IV drug users, Dr Newcombe argued that for people who already use drugs, primary prevention was ineffective and there needed to be a secondary approach to managing it.
The principles of harm reduction
The principles of harm reduction recognise that people’s experiences of drug use are different. They encourage us to understand the individual circumstances, experiences and challenges that can affect someone’s vulnerability to drug-related harm, and to involve people with lived experience in decisions about the support and services designed for them.
Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimise its harmful effects rather than simply ignore or condemn them.
Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviours from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.
Establishes quality of individual and community life and well-being, not necessarily cessation of all drug use, as the criteria for successful interventions and policies.
Calls for the non-judgemental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programmes and policies designed to serve them.
Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower people who use drugs to share information and support each other in strategies which meet their actual conditions of use.
Recognises that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.
Does not attempt to minimise or ignore the real and tragic harm and danger that can be associated with illicit drug use.
What do we need to think about?
When considering harm reduction, it is important to think about:
Reasons for using
This might include trauma, social factors, boredom or isolation.
Recreational, problematic or dependent
Drug use can range from recreational to problematic or dependent.
What areas of their life are being affected?
Consider what areas of someone’s life are being affected and how we can support to minimise that impact.
Details of use
This includes frequency, amount and method.
Motivation to make change
Understanding someone’s motivation to make change is also important.
Supporting change
Motivation to make and embed change is hugely helped by finding other activities that produce dopamine.
Dopamine is released when anticipating a reward. It boosts mood, attention and learning, and reinforces behaviours that lead to rewards. It is part of the brain’s reward system.
Dopamine cell firing encodes errors in reward prediction and guides future behaviour.
Finding other activities that produce dopamine can therefore help with motivation to make and embed change.
Things to consider
When thinking about harm reduction, consider:
- What are the areas of most concern?
- What can we address in the short term?
- What long-term support needs to be put in place?
- What can we do and what needs external support?
Things to remember
As you think about harm reduction and making changes, remember:
- Drug use is a complex, multi-faceted phenomenon.
- Some ways of using drugs are clearly safer than others.
- Quality of individual and community life and well-being are important.
- Harm reduction is non-judgemental and non-coercive.
- People who use drugs are the primary agents of reducing the harms of their drug use.
- The realities of poverty, social isolation, past trauma and other social inequalities can affect vulnerability to drug-related harm.
- Harm reduction does not minimise or ignore the real and tragic harm and danger that can be associated with illicit drug use.