Abstinence/Harm Reduction

Abstinence vs Harm ReductionHelping patients is not always about getting them to STOP what they are doing.

Sometimes it is just as important to help our patients take smaller steps that reduce the harm they may be causing.

That is, although in certain circumstances we may want the patient to stop using a substance, including alcohol, altogether, this may not be a reasonable goal. In fact, sometimes attempting to get a patient to become abstinent can drive them away from getting the help they need. Starting with harm reduction and moving toward abstinence can be a great way to  help your patient. Remember, if you can get them to say yes to some small behavior, you are well on your way to larger changes.

Your Patient and The Boiling Frog

frogIn a way, your patient is exactly like the opposite of the old story of the frog in boiling water. If you toss the frog into already boiling water, he’ll jump out. If you put him in water and slowly warm him up, he will stay right there. Our patients are often already in boiling water and they don’t even know it. We want to pull them out but they may jump right back in. However, if we slowly help them turn the water down, by taking small steps to reduce the harm they may be doing to themselves and others, then they may hop right on out of that boiling water on their own and with your help.

Generate Options: The First Step Need Not Be Abstinence

In generating a menu of options to the patient, recall that not all change goals in the brief intervention process end in abstinence from substance use.  In fact, there are a variety of different types of goals related to harm reduction, including, but certainly not limited to:

  • Cut back on frequency of use;
  • Cut back on quantity of use at each instance of use;
  • Talk to friends/family about options raised by the brief intervention process;
  • Make the decision to avoid driving or other risk behaviors on days when you choose to drink;
  • Drink a full glass of water between each alcoholic drink that you consume.