Harm Reduction is social worker/health professional speak for practices and programs designed for compassionate damage control in working with at-risk populations. Harm reduction seeks to minimize the avalanche of unfortunate economic, health, and social consequences inherent in substance abuse and other risky behaviors. Needle exchange programs & no-judgment condom distribution are two examples of this approach.
Will a clean needle stop an addict from shooting up heroin? Of course not. But it might mean that he is only a heroin addict, not a heroin addict with AIDS. Likewise, condoms won’t prevent participation in dangerous sexual behaviors. But, condoms can decrease the chances of those behaviors spawning long-term consequences.
Baby steps, baby.
When we were learning to walk, baby steps were all we could take.
Baby steps.
When we were learning to read, it was Dr. Seuss not Shakespeare.
Baby steps.
When my patient is dehydrated and sick from a night of hard drinking and a morning of sleeping in this hot southern sun and he is not ready for rehab but he is ready to want to feel better, we think about baby steps. Maybe we agree that he will drink 2 bottles of water today and 1 less 40 ounce beer tonight. And maybe he’ll come see me tomorrow and we’ll talk about how he feels.
Baby steps.
I’m not looking for a cure for his alcoholism or seeking to convince him he needs treatment. Instead, together, we are looking at small, incremental steps that will keep him from hurting himself quite so badly.
That’s one part of harm reduction. The other part, and the one I like the best, is that with a harm reduction approach, we treat everyone we work with (note I say with not for) dignity and accept them for who they are and where they are in their lives.
If a person is coming to me in one of my homeless clinics, I can pretty much assume without fault that she has experienced some sort of trauma. It could be a big trauma like having been on the streets for fifteen years or a relatively moderated one of being thrown out of her mother’s house the night before. It’s all trauma and it all hurts. It’s not my job to rate it and provide services based on a 1-10 scale.
It is my job to accompany my patients in the moment we are sharing. When I can avoid being judgmental (and I confess, I don’t always), I avoid the marginalization that stereotyping inevitably generates. That doesn’t mean, however, that I don’t see them clearly, nor does it mean that I can’t envision them in a moment better than this one. It is my job to be caring in my care.
Accepted professional verbiage would say that I attempt to bring compassion to my patient encounters. I’m not the rebel I used to be, but I am not fond of the word compassion as it is applied to the work I do. Compassion has a slight whiff of I am somehow better than my patient because I have a home and I’m not suffering from a debilitating mental illness and I’ve had the luxury of running water every morning. That whiff could all too easily grow into the noxious stink of self- righteousness.
I’m not better. Today, I am just more fortunate.
I prefer, instead, to seek to be kind, always.
You can’t fault kind. Kindness is the ultimate harm reduction vaccine.
We should practice it with our patients and our partners, with our children and our parents, with those we love and those who challenge our tolerance. And yes, we should strive to practice it most of all with those whose circumstance, religion, or politics places them squarely as “other” in our perception.
I’m still working on that one.
The last wild woman
