Here at ATC, we hear a lot of misconceptions about harm reduction—both what it is and what it is not and how exactly harm reduction plays a role in the work we do. We sat down with our program staff to talk about four of the most common myths they hear about harm reduction and to have an in-depth discussion about what is actually happening on the street.
Myth #1: Harm reduction was “invented” recently.
People often think that the concept of harm reduction was created recently, and in a way this is true. The term ‘harm reduction,’ as it is used today, came about in the early 1990s through the work of activists and healthcare workers who provided clean syringes, HIV testing, and counseling to drug users. However, the practice of reducing harm in one’s life and one’s community is something that has been around in many different contexts for generations. One early example of a community harm reduction approach came out of Oakland in the 1960s where the Black Panthers launched many community social programs including the Free Breakfast for Children Programs, community health clinics, and after-school programs.
Even though harm reduction has been practiced by diverse communities around the world for a long time, with the creation of an official term there can be a sense of alienation experienced by people who are not included in the discussion. For Outreach Counselor, Bri, reflecting on this dynamic is important, “As a service provider, the relationship that people of color have with harm reduction is always at the forefront of my mind. There are a lot of buzz words and movements that can unintentionally isolate folks who may not have the time or resources to stay up to date on the latest terms.”
Bri talked about how when counselors are on the streets offering supplies to our clients, it’s important to be aware that clients may not be comfortable talking about harm reduction or may not know what we mean when we offer certain supplies. It’s ATC’s job to make sure that our services are as accessible as possible, and part of removing any possible barriers to our services is not using words that make our clients confused or uncomfortable.
Our program staff is well aware that just because people don’t always have the particular jargon used by service providers doesn’t mean they are not practicing harm reduction in small and large ways every day. Program Manager, Demaree, describes, “I have learned that many of the communities we work with already practice harm reduction, despite the fact they may not have the particular phrase in their lexicon. Cutting toxic people out of their lives, not drinking as much the night before a job interview, seeking therapy, changing their diet based on current health needs; all of these things are harm reduction.”
Myth #2: Harm reduction is only about substance use.
While harm reduction is a very important strategic approach to reducing the harm of substance use in our communities, it is not the only way that it comes up in our clients’ lives. Each counselor at ATC can point to different examples of harm reduction in their client work.
One of our Outreach Counselors is working with a client who has the long-term dream of owning their own company. But the path to this dream is not a straight line. The counselor describes why: “Their housing and financial situation mean most of their time is spent trying to make money and/or finding a place to stay for the night.” Because this client can’t spend a lot of their daily life focused on their long-term goals, their counseling meetings are a space where they like to come up with steps they can take towards making this dream a reality. “We spend a lot of our meetings discussing this business, what it would look like, who works there, and why it would be different and successful.” ATC is there to help address immediate material needs for day-to-day survival and to make space for this client to dream beyond their current reality.
Another common way that harm reduction comes up in our work is through conversations about safer sex. A different counselor describes working with a client who has done sex work for over a decade. It wasn’t until this client had been meeting with their counselor for about a year that they opened up about their work. The counselor describes the conversation, “We talked about the ways their work benefits them and the ways they wished it could be better. They identified safety as being their number one priority so we brainstormed ways they could improve their safety while working.” Together, they came up with a few initial steps the client could take like getting a phone, having a friend on standby while they worked, and different ways of practicing safer sex methods.
In all of these conversations, ATC’s counselors center the client and listen to what the client identifies as their most important wants and needs. Each of our clients has knowledge of what they need to increase their safety and reduce harm in their lives.
Myth #3: Harm reduction “enables” people.
Try thinking about it this way: if you were diagnosed with a condition that required a certain diet and prescription medicine and you showed up to a doctor’s appointment and had not followed your dietary guidelines, nor taken your medicine properly, would you be refused care? While this depends on the kind of healthcare you have access to, your location, your race, gender, body type, and any number of compounding factors, the answer is, probably not. You would most likely continue to receive the care you needed and your doctor would encourage you to make choices that were healthier for your condition.
Substance use is one of the only medical conditions where if you exhibit symptoms (i.e. use the substance) your healthcare is taken away. It is common for healthcare providers to offer care to patients who use under the condition that they stop using altogether. A lot of the funding that goes towards providing services to the most disconnected populations, to people on the streets, to substance users, to people who have both of those identities, is poured into treatment facilities and approaches that tend to work for a small percentage of that population and is not reaching the majority. This is one reason that many people are not accessing care at all. According to the 2017 National Survey on Drug Use and Health, 87.8 percent of people who self-identified as needing substance use treatment at a specialty facility did not receive treatment of any kind.
Demaree sees harm reduction not as “enabling” but as a more effective way to reach people who are not accessing services and empower them to make decisions about their lives. “Harm reduction is acknowledging that a person has autonomy over their own self. It’s an anti-colonial way of thinking. So much of imperialism is going to other cultures and telling people what to do. Harm reduction is a different way of doing things.” Our clients are the experts on what they need to stay safe in their daily lives, so Demaree’s approach is to encourage clients to actively participate in creating their own harm reduction practices. When people have the opportunity to make choices for themselves, any positive change is more sustainable.
Sometimes our clients pursue sobriety. Sometimes, the way that a client practices harm reduction is by using. For example, it might be having a drink after work to de-stress, or using a drug that helps them stay awake all night so that they can be alert and minimize the likelihood of getting harmed or robbed on the streets. Day-to-day survival looks different for each young person who is homeless or unstably housed and this means that the decisions that individuals make in order to stay safe vary widely. No matter what choices our clients make, ATC will provide them with the same care and support.
Myth #4: Harm reduction is something that we teach to our clients.
It might be easy to assume that our counselors are “teaching” our clients how to practice harm reduction, but that’s not the whole truth. As Bri describes it, her clients are the ones that take the lead on their harm reduction practice in partnership with their counselor, “Our organization is harm reduction focused because we provide low threshold access to services. ATC approaches client work with the understanding that the people we serve are experts in their own lives and any goals that we have as service providers should always come second.”
Conversations about harm reduction can take many different shapes: it’s about working with a client to identify what their goals are and coming up with a harm reduction strategy that works for that individual. For Outreach Counselor, Anna, it’s like being a sounding board for her clients, “Clients share their ideas with me and I reflect these ideas back to them. Often, I might ask them why they have a specific goal, how motivated they are to achieve that goal, and what are the potential risks or pitfalls.” Then if a client’s goals change over time, Anna checks back in with them, “I might remind them of the goal that they told me they wanted to achieve and ask them if their goal has changed. If it has changed, I would help support them in their new goal. If it hasn’t changed, I would ask how I can support them.”
One counselor brought up a meeting in which a client wanted to talk about an experience they’d had recently when they drank too much at an event. “I have a client who was unhappy with their drinking but did not want to abstain completely. They don’t drink every day or even every week. But when they do, usually for celebratory occasions, they will drink an amount that they feel is too much and regret the decisions they make.” This had happened recently in the client’s life and they were experiencing a lot of shame. In talking together, the client identified this pattern and was able to describe to their counselor what they felt a healthy relationship to alcohol would look like.
Together, this client and their counselor came up with a concrete set of strategies to shift this pattern while still allowing for them to be a part of celebratory occasions with friends. According to their counselor, “It’s been six months and they haven’t had one of these nights! And they know if they do, ATC will not judge and is here to talk about it.” When we can provide a non-judgemental space for our clients to identify their priorities and create strategies to implement them, clients are empowered to try new things, make different choices, and know that they will continue to receive support no matter what transpires.