Harm Reduction is a method of concurrently reducing the harm that medical, mental health and addiction problems create for individuals, for communities, and for society.   On the individual level, the Harm Reduction approach begins with a realistic assessment of the client and then utilizes the relationship between the provider and the client to improve the client’s situation.  This approach allows the provider to work with an individual regardless of his/her readiness to change.  The provider builds a relationship with a client and uses that to motivate the client toward recovery and health.

People existing in impoverished environments tend to be isolated and stigmatized, often having difficulty trusting and building relationships.  A support network is a critical element of any recovery process; often, clients must be engaged and supported long before any expectation of significant change or abstinence can be made.  When working with clients in poverty, the clinical relationship between the provider and the client becomes most important.  It is within the context of this relationship that the provider works with the client toward treatment goals that are, more often than not, incremental.

What is learned when the relationship is the priority, is that abstinence or adherence comes more easily to some than to others.  A provider will be working with a range of clients – some fully adherent to treatment plans, some in varying stages of readiness to change.  As a result, the provider who practices with a commitment to improving individual and community outcomes develops an interest in harm reduction strategies.  Because the relationship is clinically valued by providers, they recognize the importance of assisting the client to reduce the harm caused by maladaptive behaviors.  The clinical relationship is maintained whether or not the client is ready to change or enter treatment. 

Harm Reduction incorporates creative strategies that can both maintain the provider-client relationship and reduce the harm that clients pose to themselves and to the community.  For example, needle exchange both reduces rates of HIV and hepatitis transmission and presents opportunities to engage clients regarding health education and addiction services.

Harm Reduction:

• Creates a supportive milieu that helps clients regardless of their readiness to change with the understanding that motivation to change frequently stems from the experience of being valued and respected as an individual and therefore deserving of such support.

• Utilizes the provider/client relationship in the process of encouraging incremental behavior change.

• Partners with the client in a process to improve adherence to the individualized plan of care, working toward realistic long-term health outcomes.

• Measures success in smaller steps – not only in the traditional definition of treatment adherence.

• Understands that poverty complicates rehabilitation and often prolongs the process of recovery.

• Applies to any compliance issue with any disorder – it is not restricted to substance abuse but is relevant to mental health and medical treatments as well.

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