What is harm reductioConsider the following scenarios:
⦁ Street social workers distribute literature on safe sex and drug treatment in a notoriously crime-ridden neighborhood.
⦁ A social worker receives training in drug screening to volunteer his or her services at a first-aid station at a secretly located rave; the drug screening is to protect youth from taking Ecstasy pills laced with life-threatening adulterants.
⦁ A worker at a women’s shelter helps clients develop a personal safety plan for themselves and their children even if they are not ready to leave violent partners.
⦁ A college program to prevent binge drinking targets youth with problems and works with them to reduce their alcohol consumption and decrease the risks associated with intoxication.
⦁ A school social worker conducts an after school group to help kids with gender identity issues talk through problems of internalized homophobia that might otherwise lead them to seek self-destructive channels of expression.
All of these situations are high risk for the substance misuse; yet, except for volunteering at the rave, they are typical of the ones social workers encounter regularly. Common to all these interventions is the theme of pragmatism, or helping people choose from options they are willing to take, rather than trying to push on them changes that they are unprepared to make. Harm reduction is not about doing what is best; it is about doing whatever works at whatever level n? According to the Dictionary of Social Work, harm reduction strategy is
A pragmatic, public health approach to reducing the negative consequences of some harmful behaviors rather than eliminating or curing the problem. For example, in alcohol or substance abuse problems, the strategy is less concerned with achieving total abstinence and more concerned with helping clients take whatever steps they are willing to take to reduce their risks (e.g., substituting methadone for heroin, beer for vodka, and nicotine gum for cigarettes, or using clean needles rather than those that others have previously used). (Barker, 2014, p. 189)
In the United States as well as in Ireland, harm reduction for prevention of heroin overdose or for contraction of HIV/AIDS through the use of dirty needles has achieved greater acceptance by policymakers and treatment providers than in treatment of clients with serious alcohol problems (Woods & Butler, 2011). In the latter situation, a total abstinence approach has predominated.
“Meet the client where the client is” is a popular slogan of social work practice that sums up the harm reduction philosophy. Harm reduction joins client and therapist in the realistic pursuit of survival. Typical strategies include
⦁ Helping clients substitute a less harmful drug for a life-threatening drug; a controversial example is that of Brazil, where researchers help clients overcome crack cocaine addiction by providing marijuana.
⦁ Recruiting heroin addicts into methadone-maintenance and needle exchange programs.
⦁ Providing women returning to their battering partners a plan for self-protection
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