Harm reduction is a way of managing behaviour that is potentially risky, damaging, or unhealthy by putting in place plans and techniques to reduce the harm of those behaviours.
It is often discussed in terms of substance addiction, but many people have found the framework really useful for other kinds of behaviour.
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Harm reduction is an alternative approach from suddenly stopping a behaviour ('cold turkey' or abstinence). Suddenly stopping a habit can be really hard, and some people find that it just sets them up for failure, which makes them feel powerless.
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Person: Every time I self harm I say 'never again, that was the last time', and then I feel like such a fuck-up when it happens again. It's a vicious cycle.
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Harmful behaviours are often coping mechanisms - things that help you process difficult emotions, or stressful events. Suddenly removing a coping mechanism, even a harmful one, can deprive someone of the very thing they need to survive a rough period.
Harm reduction is a way to gain some control over something you feel you don't really have a grip on. Successfully controlling a bit of what happens around 'uncontrollable' feelings can help it feel more manageable, instead of a big scary thing you can't do anything about.
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An example harm reduction system could look like this:
Can you put in place something that provides alternatives to the unwanted behaviour?
Are there ways to make that behaviour less damaging if you do end up doing it?
Is there a plan for safety for if things escalate, such as a way to call an ambulance or someone who can check on you?
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Let's look at an example!*
*examples taken and modified from real people
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I'm Rashaad, and I sometimes have manic episodes. I've had problems with money when I'm manic - I impulse-buy things online that I can't really afford. Once I gave away hundreds of dollars to charities online, and then I didn't have enough money for rent.
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What I do now, if I feel like things might be slipping into a manic episode, is to make sure I have enough food and necessities for a few days, and freeze my credit and debit cards in a block of water. That way I can't just impulsively buy something, and if I do feel like I really really need something I have to wait for my cards to melt out. That extra time often gives me a second to consider what I'm doing and decide whether it's really necessary.
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Awesome, Rashaad!
Who else?
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I'm Dex. I get really wrapped up in these black, angry moods sometimes. I can feel it coming on like a storm. Sometimes when my brain starts spinning around like this I end up so mad at myself I hit my head against walls or punch things, and I end up hurt.
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I've noticed that if I have something to distract myself, like a bunch of episodes of a new tv show, or an immersive video game, I'm less likely to end up escalating to hurting myself.
So I make sure I always have an 'emergency' supply of distracting material; a few hours of tv to watch, or a game I know I can play for an entire evening. It doesn't always work, but it helps to have something to try.
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Good job, Dex!
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I'm Phillip, I have a history of having compulsive, unsafe sex with people when my headspace goes south. I'm really trying to get a hang on it, but until I do I make sure I always have condoms and safer sex supplies with me, so at least I can physically protect myself and others. It's really hard, but every little step I take to look after myself makes me feel a bit more in control.
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Thanks Phillip!
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Harm Reduction is not a treatment in itself; it's a management tool and a stepping stone while you try to sort things out, by yourself, with the help of your support network, and/or with the help of a mental health professional.
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My model of harm reduction celebrates small victories and makes room to forgive lapses. Planning ahead keeps me safer and makes it more likely that I'll be able to reduce, avoid, or mitigate unhealthy behaviour in the future.
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Don’t worry, future-me! I’ve got your back!
