Your child’s drinking or getting high is worrisome and often a challenge to figure out what steps to take. Flexibility and being open to different approaches to prevention, counseling and treatment for substance use is crucial. Harm reduction approaches can offer you an approach allowing you to get back into the ‘driver’s seat’ of family control if you find yourself in the passenger seat—or even worse, the back seat.
The philosophy of harm reduction is based on our knowledge that human beings will always be engaged in behaviors that carry risks, like alcohol and other drug use and unsafe sex. Harm reduction embraces the value of each person’s dignity and the respect of a person’s right to make choices. This shifts the focus from attempting to restrict or prohibit risky behaviors to reducing the negative consequences associated with them.
Examples of harm reduction approaches in our society today include designated driving programs, safe sex education programs, naloxone distribution for heroin overdose prevention and needle exchange programs to reduce transmission of HIV and Hepatitis C.
At the society level, these programs have in common an important element of harm reduction: improving public health by focusing on exploring alternatives to policies of prohibition of high-risk lifestyle choices. Harm reduction approaches are important because they treat drug abuse and addiction as a complex interaction of biological, psychological, social, and spiritual issues rather than a crime. Criminalizing drug use is associated with failed prohibition approaches.
Treating drug use as a health issue rather than a crime may offer more effective and sustainable alternatives for those with addiction problems by increasing accessibility to treatment options. We also know that stigma is reduced when making drug use a health issue rather than a behavior that is punished.
What follows are some examples of how principles of harm reduction are incorporated in my work with adolescents and young adults and their families as they struggle with managing drug and alcohol use and abuse.
Meeting People 'Where They're At'
Most kids aren’t willing to discuss their substance abuse or other personal issues often because of the shame and stigma associated with admitting problems and going to a therapist.
Teens I see are often mired in distrust and defensiveness and long ago tuned out lectures and warnings by parents. However, despite denying the extent of the their problems, there is usually an admission of some disappointment and embarrassment about failing to live up to parents expectations that can be a ‘hook’ to motivate teens to make changes.
Harm reduction approaches look to meet people “where they're at”, starting with where they’re willing to discuss the current understanding of their problems and any willingness to accept or change certain aspects of them. Kids use drugs and alcohol for reasons and acknowledging the reasons with them allows them to be more open to explore both the positive and negative effects of substance use in their life. The counseling goals initially are the child’s goals, focusing on where she sees the problem and the effects of any consequences from her perspective.
Obviously, a child’s safety trumps treatment goals and every counselor must incorporate safety as part of any treatment plan. I look to educate them about the research and the risks involved with risky behaviors like getting high or drinking in order to help them make decisions if they are interested in reducing any consequences connected with their use.
Some people's substance use reaches a point where abstinence is necessary. Others who aren’t that far down the continuum of consequences, or for teenagers, who’s normal developmental tasks include the behaviors of challenging authority, seeking novelty, and risk-taking, starting where they're currently at in the process and collaborating with them to set goals to begin reducing harm where they see it at the moment is an approach more likely to engage them in the process of change.
Discussing Risky Behaviors
My job is to create a safe atmosphere where we can openly discuss the circumstances of drug use along with the use itself. We talk about the continuum of use and when safe use, managed use, or abstinence is appropriate. I often use a tool that I call “The Three C’s” to explore the spectrum of use and abuse with clients.
A good place to start is to explore the teen’s friends’ drinking and drug use. This is much less threatening than discussing their own use and gives us a context to place their use in. Examining the consequences of friends’ use enables kids to begin making some judgments about their own use drug use and drinking behavior and often leads to discussion about what are safe boundaries of his behavior.
A consequence most kids worry about is the disappointment and disapproval by parents as well as the fractured trust. Admitting that lying to parents usually makes things worse. With this admission, the problem focus shifts a bit from her “mean” parents to her own behavior that contributed to the problem—enough to give us something to work on.
Enabling and Harm Reduction
As an addictions counselor, it’s always a pleasure to work with parents who have the instincts and skills to maintain good communication with their teenager as well as the courage (and energy!) to set appropriate and consistent limits.
Sometimes, however, these skills can be a double-edged sword and work against us, especially when the emotional and behavioral instability of a child keeps pushing us out of that ‘driver’s seat’ mentioned above. Being in the back seat of your family contributes to the fear that develops when we start losing control of a child’s behavior. This fear often motivates us to become even firmer in our resolve to ensure our child’s safety while keeping ourselves sane along with the rest of our family.
Parents learn about the ‘evils’ of enabling when support groups and counselors, in the interest in creating healthier boundaries, encourage us to directly confront our kids and not back down to the often self-destructive manipulating that at-risk teens will engage in. Enabling unfortunately can become a badge of failure and shame that many parents wear when they repeatedly fail in their attempts to affect the course of their child’s addiction or mental health problems.
Education and Harm Reduction
Another important element of harm reduction in our culture focuses on what and how to provide information and support to those practicing risky behaviors in our community. Adolescents want honesty and information and the faith that they can make their own minds up. I provide information on alcohol and other drugs that is based on science and established research, encouraging discussion of this information. Interactive online educational resources on drug abuse are available to engage teens in learning on their own if they wish.
Many of our current drug and alcohol education and prevention programs are not effective because they ignore the fact that most young people greatly exaggerate in their own minds the extent of their peers' drinking behaviors. As a result, they will choose to drink--or drink more--than they normally would in their attempt 'fit in. Prevention programs also fail to acknowledge that many of teens’ authority-challenging and risk-taking behaviors that drive us crazy are a part of the normal developmental road that teens travel and must learn to navigate.
Parents look to me for strategies to more effectively parent their children through these choppy waters, so helping them understand their teenager in the context of normal adolescent development—which includes risk-taking and challenging limits and authority--is a crucial component of the counseling process.
Exploring Parents’ Role
Zero-tolerance is an instinctive parental response to danger associated with a child’s risky behaviors because the human brain is hard-wired to sense and respond to danger automatically. This instinctive “fight/flight” reaction—to run away, freeze, or attack—is an adaptive response essential to species survival we all experience when we sense danger.
The part of our brain that allows us to think rationally and makes us distinctly human--the prefrontal cortex—balances the “flight/flight” reaction and helps us calm down and infuse some reasoning and alternatives for the perceived dangers. Harm reduction approaches offer training in some of these alternatives in thinking.
Parents will frequently move to “lockdown” mode in an attempt to eliminate all risk, triggered by fear of their child’s risk-taking and part of her normal parental protective response to focus on trying to eliminate the behaviors completely.
I also encourage parents to look in the mirror at their own substance use behavior, both currently and in their childhood. As parents, we often forget that we were teenagers once and struggled with similar developmental challenges. Our teens are already looking into that same mirror, so honesty with our own behavior and childhood experiences will help you be more open to intervening appropriately with your children. Reflecting on our own experiences as teens often helps us better understand some of the unintended consequences of rigid prohibition approaches.
Teenagers prefer to learn from their friends, but whether they admit it or not, the wisdom we share resonates with them because at some level they can appreciate that their parents once faced similar problems--and at some point down the road that wisdom may come in handy.
Harm Reduction Approaches and Effective Parenting
Overall, harm reduction approaches conform to research that shows that when parents connect with their teens and lead them with a light but stable hand, staying engaged but allowing independence, their kids generally do better throughout life. Human beings respond more favorably to harm reduction’s compassion and flexibility--characteristics essential to effective parenting.
Parenting a child with a substance abuse problem can be nightmare. Harm reduction offers a way to regain control of your family’s dreams and improve the chances of creating more peaceful outcomes.