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As harm reductionists, we don’t ask our clients (or family or friends) to change their use in any way they don’t want to because our research has shown that not everyone is ready, willing, or able to stop using. But substance-related harm happens, and even hardcore harm reductionists worry about their clients (or family or friends). How do we manage our own anxiety and bring the healing? Here are some ideas…

Make your office a safe space

Offer harm reduction information in the waiting room as well as condoms, naloxone, and/or safer-use supplies. This signals acceptance to clients. If you are working in a harm reduction practice, be sure to let the client know that you are not going to ask them to change their use in any way they do not want to and that you will work with them to understand their use and work together on devising relevant safer-use strategies. Avoid mandatory urine toxicology testing and be sure to be very transparent about any relationships your practice has with other entities like the court or criminal justice systems.

Let’s talk about drugs!

Instead of starting with a formal, rapid-fire assessment or SBIRT outline, try initiating a friends-over-coffee conversation about drugs. You can start that conversation by asking open-ended questions. Simply state warmly and with curiosity, “A lot of us use substances to celebrate the good times or feel better in the bad times. How about you?” Or “What has your experience with alcohol and other drugs been like?”

From week to week, you can continue the conversation with, “What’s your substance use been like this past week?”

Listen and reinforce clients’ own steps towards harm reduction

While they share their narrative, mirror clients’ expressions (except anger), make gentle eye contact, and keep your body language open. Affirm clients’ stories by thanking them for sharing their experiences with you. Keep it simple: “Thank you for sharing your experiences with me.” Offer strengths-based reflections on what they say, sharing how that fits into their own efforts towards harm reduction. For example, “It sounds like you are trying to cut down on your drinking a little on the weekends. That’s great because cutting back can help you avoid the blackouts you’ve been experiencing.”

And remember, no matter how incremental the change, be sure to compliment clients (or family or friends) on what they are doing right versus focusing on what they are doing wrong. Research shows that affirmations are more helpful in shaping substance use behavior than criticism.


We hope these harm reduction fundamentals help you engage with your clients, family, and friends in a way that feels positive for everyone.

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