What is Harm Reduction?

By Andrew McNaughton, LCSW, CADC

Symmetry Counseling Chicago

Harm reduction is a behavior change approach through which an individual reduces their exposure to risk without a complete elimination of the problematic behavior, all while giving oneself the opportunity to learn important new life coping skills. This is for people who are contemplating significant behavior change, but are not ready to completely stop the behavior since they lack skills to cope with emotional discomfort they soothe with their addictive behaviors. 

Let’s say I drink alcohol to manage my anxiety and depression, but I have racked up a couple of DUI arrests. I also tend to get into arguments and even fist fights every time I go to the bar. It has become clear to me that my drinking is problematic. While it would probably suit me best to quit drinking completely, I am frankly not prepared to give up my primary coping method, so I may instead benefit greatly from taking a harm reduction approach.  

I could, for instance, sign up for a ride share app on my phone, load up my account with ample funds, and hail Ubers and Lyfts to provide me safe rides home from a night out drinking. While I am still drinking, I have reduced the risk of driving myself while intoxicated, eliminating the possibility of me causing accidents or getting arrested. To address the confrontations I am getting into at the bar, some of which have come to blows, I can instead drink in the safety and comfort of my own home, with the option to invite over people with whom I get along.

While taking this course of action, I can then begin to explore new ways of coping through attending individual therapy with a behavior change and substance abuse specialist, while also checking out SMART Recovery meetings in person and online. SMART Recovery is a harm reduction program that helps participants determine their own treatment goals rather than dictate to them that they must commit to lifelong and complete abstinence from day one. SMART Recovery is offered daily in person at Above and Beyond Family Recovery Center, a free, community-based, harm reduction focused outpatient recovery center in West Garfield Park in Chicago that teaches participants new coping skills. Signage at this facility promotes harm reduction:

Harm reduction values life, choice, respect, and compassion over judgment, stigma, discrimination, and punishment. Harm reduction does not try to remove a person’s primary coping mechanisms until others are in place. Instead, it allows them to learn new life skills and then move away from drugs, rather than attempting to force them to do the reverse. In many cases — particularly among the most traumatized and disenfranchised people — this may be the only path to a healthy balanced lifestyle.

Harm reduction could include alternating my drinks with something non-alcoholic, such as a “mocktail” or one of the palatable 0.0 ABV beers that have hit the market in recent years. This allows me to slow down consumption of alcohol and reduce my level of intoxication while still consuming something that tastes like alcohol. Harm reduction can include utilizing needle exchanges and providing Narcan training for intravenous opioid users to reduce risk for overdose or contracting disease through sharing equipment.  Harm reduction is not limited to substance use disorders. A person who is engaged in high-risk sexual activity can reduce their risk by taking HIV preventative medication such as PreP and using condoms. 

The benefit of harm reduction is twofold: it reduces the risk in inherently risky behaviors that someone could be engaging in while providing an opportunity to make slight adjustments as an individual might be still contemplating more significant changes. 

To learn more about harm reduction and options for building motivation to make lasting thought and behavior changes, contact one of Symmetry Counseling’s licensed behavioral change specialists in Chicago, IL, Phoenix, AZ, and Washington, D.C.