Harm Reduction Practice: Substance Use Conversations

Part 3 of 3

Challenges, strategies, and resources

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

• Dominant ideologies

• Broaching the subject of drug or alcohol use

Transferable Skills

• Non-judgmental

• Unconditional positive regard

• Belief that she is deserving of safety and support

• Safety planning

• Coping skills

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?

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)

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

Counselling Themes

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

Goals

• User, self-identified goals

• Teasing out abstinence based goals

• Plan A and Plan B

• Strengths based

“Triggers”

Differences between trauma triggers and using triggers

Triggers and Strategies

• Awareness and practical planning

“Things I Need” An exercise to shift internalized shame1)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 possible4)When she is done, write the actual title of the exercise at the top of the page5)Debrief her reactions and feelings6)Use this exercise as a roadmap for goal setting

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/