|The steps of identifying and reducing
specific drug-related harms (harm reduction strategies) in clinical drug management should
be undertaken by both:
1. exploring the possibility of reducing or stopping drug use, as well as
2. identifying and reducing drug-related harm to self and others.
The best clinical outcome will be gained by weighing up the costs and benefits of these strategies along with careful review of the impact on the presenting problem.
The overall aim is to ensure that the key harms, particularly those that are related to your agency (eg lack of accommodation, child neglect, etc) are reduced regardless of choice of intervention.
Clinical Steps Which Incorporate Both Moving
to Cessation and
|Some high priority drug-related harms:
Overdose Suicide Domestic Violence
|Two examples of harm reduction approaches:
A parent is bingeing on alcohol on a weekly basis. A young child is at risk of neglect or abuse during the period of intoxication and hangover. The parent does not want to give up the binge drinking. In other respects assessment has shown the parenting to be adequate.
Possible Harm Reduction Options:
Have a sober partner or other care-giver look after the child while parent is bingeing and recovering.
Help the parent develop skills and strategies to avoid child violence or neglect in the context of stress such as during a hangover.
Teach parent the value of drinking lots of water after a drinking session to reduce hangover.
Work with the child/ren regarding protective behaviours in relation to physical, sexual or emotional harm.
Consider referral to the Child Protection Team.
A heroin user (single father) was neglecting his child. He had agreed to stop using heroin and was going into a detoxification unit in two weeks.
Possible Treatment Support Options:
Follow-up on changes to parenting practices before, during and after detoxification.
Ensure strategies are in place for safe care of the child prior to the detoxification program.
To minimise the impact of separation during the detoxification period, provide direct support to the child, organise visits, and help the parent prepare the child for a period of separation.
Possible Harm Reduction Options:
Make sure the parent has a management strategy in case of relapse which not only reduces risks to the parent, but also to the safe care of the child, which is age appropriate.
A problem solving approach can clearly identify drug-related harm, develop concrete steps to reduce this harm and use feedback methods to review changes.
Problem solving steps:
do no harm
Harm maximisation can result from both stopping drug use as well as strategies which may seem like harm reduction.
Examples of therapy induced harm and risk of harm:
|Problem||Possible Result of Intervention|
|Worker fear of drug-induced neglect, led to parent being asked to stop her Valium.||Parent had been using to reduce aggressive feelings towards child. Risk of increased child violence...|
|Heroin use in pregnancy. Advised to stop for fear of damage to foetus.||Miscarriage from unsupervised heroin withdrawal.|
|Offender with little supports using heroin. Court ordered Naltrexone therapy.||Overdose death when relapsed because reduced drug tolerance.|
|Limited student knowledge of solvent sniffing dangers - solvent sniffing education introduced into schools.||Increased curiosity led to greater use, accidents while intoxicated, and subsequent harms.|
How to minimise the possibility of unintentional harm:
These examples point out the need to answer the following questions prior to any drug-related intervention:
What is the exact relationship between drug use and the presenting behaviour? What functions does the drug use have? What are the possible range of consequences should drug use be reduced or stopped?
The above examples do not mean that drug use issues should be ignored. A range of clinical interventions should be considered to minimise potential risk (such as providing alternative child care while a mother is detoxifying; consulting with the chemical dependency unit for pregnant women; providing strong social supports for clients on naltrexone; limit solvent education to known users & teach others about avoiding intoxication, etc).