Harm Reduction
“Harm reduction values life, choice, respect and compassion over judgement, stigma, discrimination and punishment.”
— Harm Reduction International.
Although harm reduction was initially developed as a public health strategy for people who use drugs and for those with substance use disorders, over time it has been expanded into a strategy directed towards reducing the harms associated with a range of behaviours, largely enacted through policy change and public health programming (BC Harm Reduction Strategies and Services, 2011).
Harm reduction can be described as any program, policy, or intervention that seeks to reduce or minimize the adverse health and social consequences associated with certain behaviours such as substance use.
Given the breadth of interventions that harm reduction may encompass, it is better viewed as an attitude and framework rather than a fixed set of rules and regulations. Utilizing a harm reduction approach means encouraging, supporting, and acknowledging any steps that are moving an individual away from harm in a non-judgemental, acceptance-oriented, and compassionate curiosity manner. Through this approach, it is possible for clients to also start to hold themselves with less judgement and more acceptance, compassion, and care which is particularly important when the behaviours they are engaging in are ones that are frequently judged and shamed in our society.
Substance Use
When considering the prevalence of substance use in our population, it is important to understand that people use substances for many different reasons and that substance use exists on a spectrum with beneficial and non-problematic use on one end and potentially harmful use and substance use disorders on the other (Aggarwal et al., 2012). According to the Health Canada Tobacco, Alcohol, and Drugs Survey (2017), of the general Canadian population
have been tobacco smokers.
have used alcohol.
have used cannabis.
have used at least one of 5 illicit drugs (cocaine, methamphetamine, ecstasy, hallucinogens, and heroin) in their lifetime.
have had at least one psychedelic experience in their lifetime.
have used ecstasy in their lifetime (Health Canada, 2017).
Harm reduction is useful in this regard as it seeks to disentangle the notion that drug use equals harm and instead identifies the negative consequences of drug use as the target for intervention rather than drug use itself (Des Jarlais, 1995; Hawk et al., 2017). This is an important divergence from the moral and disease models of addiction and abstinence-based approaches that have historically been prominent.
What are the harms associated with psychedelics?
A landmark study published in the Lancet in 2010 examined the individual, societal, and global harms associated with 20 commonly used substances.
Adapted from Lancet, 2010.
Psychedelics such as ecstasy, LSD, and mushrooms were amongst the least harmful (Nutt et al., 2010). Both animal and human studies have shown that psilocybin in particular has low abuse and no physical dependence potential (Johnson et al., 2008; Johnson et al., 2018) along with centuries of traditional use by Mazatec Peoples in cultural practices. Similar studies have shown that MDMA possesses addictive potential, but much less than structurally related compounds such as amphetamine (MAPS, 2021). Ketamine, on the other hand, has a higher addictive potential and so consideration must be given to this when screening and preparing participants for ketamine-assisted psychotherapy (American Society of Health-System Pharmacists, 2020). With that said, recent research on MDMA and ketamine-assisted psychotherapy has not observed increased use of these substances by study participants outside of clinical settings (Dore et al., 2019; Mitchell et al., 2021).
When these substances are being used outside of clinical settings, proper education, preparation, and support can mitigate potential harms and increase the likelihood of clients having productive experiences (Gorman et al., 2021).
Learn More
Harm Reduction Psychotherapy (Tatarsky, 2007; Tatarsky & Marlatt, 2010), Integrative Harm Reduction Psychotherapy (Tatarsky & Kellogg, 2010), and Psychedelic Harm Reduction and Integration (Gorman et al., 2021; Pilecki et al., 2021) are recently developed psychotherapeutic frameworks that apply harm reduction principles to psychotherapy. Motivational interviewing (Miller & Rollnick, 2013) may also be useful which uses non-judgemental but directive techniques to allow participants to explore their intrinsic motivation for.
Justice, Equity, Dignity, and Inclusion
At Numinus, the dignity of all clients is respected, and an individual’s behaviour is secondary to the potential harms that may result from their behaviour. Practitioners are expected to maintain a non-judgemental, accepting, compassionate, curious, and positive anti-racism stance when exploring a client’s substance use, as well as other risky or harmful behaviours. It is also appropriate and necessary for therapists to talk to their clients about the dangers of certain substances, substance use practices, and other risky or harmful behaviours in an open and effective dialogue in mutual decision-making.
References
Aggarwal, S. K., Carter, G. T., Zumbrunnen, C., Morrill, R., Sullivan, M., & Mayer, J. D. (2012). Psychoactive substances and the political ecology of mental distress. Harm reduction journal, 9, 4-4.
American Society of Health-System Pharmacists. (2020). Ketamine. Drugs.com.
BC Harm Reduction Strategies and Services. (2011). Harm Reduction Training Manual.
Des Jarlais, D. (1995). Harm reduction—a framework for incorporating science into drug policy. Am J Public Health., 85(10), 2.
Dore, J., Turnipseed, B., Dwyer, S., Turnipseed, A., Andries, J., Ascani, G., . . . Wolfson, P. (2019). Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy. J Psychoactive Drugs, 51(2), 189-198.
Gorman, I., Nielson, E. M., Molinar, A., Cassidy, K., & Sabbagh, J. (2021). Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice [Hypothesis and Theory]. Frontiers in psychology, 12(710).
Hawk, M., Coulter, R. W. S., Egan, J. E., Fisk, S., Reuel Friedman, M., Tula, M., & Kinsky, S. (2017). Harm reduction principles for healthcare settings. Harm reduction journal, 14(1), 70.
Health Canada. (2017). Canadian Tobacco, Alcohol and Drugs (CTADS) Survey: 2017 detailed tables. Government of Canada.
Johnson, M., Richards, W., & Griffiths, R. (2008). Human hallucinogen research: guidelines for safety. J Psychopharmacol, 22(6), 603-620.
Johnson, M. W., Griffiths, R. R., Hendricks, P. S., & Henningfield, J. E. (2018). The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act. Neuropharmacology, 142, 143-166.
MAPS. (2021). MDMA Investigator Brochure.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change, 3rd edition. Guilford Press.
Mitchell, J. M., Bogenschutz, M., Lilienstein, A., Harrison, C., Kleiman, S., Parker-Guilbert, K., . . . Doblin, R. (2021). MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nat Med, 27(6), 1025-1033.
Nutt, D., King, L., & Phillips, L. (2010). Nutt DJ, King LA, Phillips LD. Drug harms in the UK: a multicriteria decision analysis. Lancet 376: 1558-1565. Lancet, 376, 1558-1565.
Pilecki, B., Luoma, J. B., Bathje, G. J., Rhea, J., & Narloch, V. F. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm reduction journal, 18(1), 40.
Tatarsky, A. (2007). Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems. Jason Aronson.
Tatarsky, A., & Kellogg, S. (2010). Integrative harm reduction psychotherapy: a case of substance use, multiple trauma, and suicidality. J Clin Psychol, 66(2), 123-135.
Tatarsky, A., & Marlatt, G. A. (2010). State of the art in harm reduction psychotherapy: an emerging treatment for substance misuse. J Clin Psychol, 66(2), 117-122.