“I’m not going to stop smoking marijuana.”
“It isn’t a big deal anymore.”
“It is even legal in some states and everyone smokes now.”
These words can be frustrating and upsetting for loved ones bringing a teen or young adult to care after a crisis, when it has been identified that drugs or alcohol may be playing a part in creating worsening mental health symptoms or difficulty in school or relationships. It can feel like each party is getting ready for battle and a path forward seems impossible.
Situations like this are ideal for a treatment approach called “harm reduction”. This treatment moves away from focusing on substance abstinence as the only way to improve wellbeing. The goal of treatment instead becomes supporting steps towards health, even if the patient is not ready or able to make a dramatic change. In addition to helping patients who are not willing to stop their substance use all together, it can be helpful for individuals who want to stop the use of some substances but not others. A harm reduction philosophy acknowledges that abstinence from substances is the only way to prevent all negative outcomes or consequences, but that each movement toward making safer choices or changing attitudes for the better is a success.
Using harm reduction in the above example of a teenager who is using marijuana and does not want to stop, the clinician would work with the patient to identify the negative consequences of their current amount of use and encourage the patient to cut down the amount and frequency of their smoking. They would counsel the patient on making safety choices while smoking such as not driving or riding in a car with someone who is under the influence. There would be continued discussion about the benefits and drawbacks of abstinence from marijuana and education about how marijuana impacts the brain and behavior would be discussed.
In this type of treatment, small changes in behavior or attitudes would be viewed as a success because the patient would be at less risk of physical harm, legal consequences, and the psychological and developmental impacts of regular substance use. Many consider harm reduction to be patient centered, meaning it provides a patient with validation for where they are in their journey toward health and recovery from behaviors that have caused them distress.
This approach can be especially helpful with older adolescents and young adults because a central developmental task at this time is identity formation and development of autonomy. It is a normal for young people to question and at times pull away from authority (parents, doctors) as they attempt to determine who they are, what is important to them, and how their values and beliefs may be the same or different from their family. Treatment which focuses on telling someone they have a problem and dictating how they should fix it can feel especially bad or controlling at this time in life. One of barriers to providing treatment for substance use to young people is that they are more likely than adults to drop-out of care. Applying a harm reduction approach can help a young person feel more motivated and connected with their treatment because they are in charge of creating their goals for care and are validated for steps in the right direction.
A common misconception about harm reduction is that the clinician is supporting or enabling the patient to continue to use drugs. This is actually not the case and research on harm reduction has shown that this treatment approach is associated with less substance use over time, improved quality of life, and an increased likelihood that the patient remains in care. While harm reduction clinicians respect a patient’s attitudes and beliefs, they are not passive observers and continue to provide education and recommendations for treatment.
A type of therapy that is aligned closely with harm reduction principles and can be especially effective when working with young people is called Motivational Enhancement Therapy or Motivational Interviewing. For more information about this type of therapy, which is utilized by clinicians in the Dual Diagnosis Clinic, stay tuned for our next blog post!
Logan DE, Marlatt GA. Harm Reduction Therapy: A Practice-Friendly Review of Research. Journal of clinical psychology. 2010;66(2):201-214. doi:10.1002/jclp.20669.