Mental Health Matters - The Beauty of Harm Reduction

What's up, folks? Welcome back to another episode of Mental Health Matters. I'm Evan, your resident mental health and addiction therapist. Here we are, another live it is. What day is it today? Wednesday. So today I brought a topic, and that is harm reduction. All right. I got the notice. The beacon went out, so now I could put it on do not disturb, because now I know I'm actually live. So today I brought a topic, and that is harm reduction. And this is something anyone could apply to their lives that is relevant to everybody.

And you'll hear it most in the context of addiction, substance use, alcohol use. What up, Steve or Steph? So, yeah, harm reduction, we apply that to substance use, but it's applied in many different ways. So I'm gonna go ahead. I'm gonna talk about it. What up, recovery cafe? I'm gonna break down what harm reduction is, how we could apply it, how anyone could apply it, and to have a better understanding of what that is. So. But anyone coming in, let me hear. How you doing? What's the update with you?

And again, if you have any questions about addiction, mental health, feel free to ask it. What up, Jules? We got the regulars in the. So, yep, feel free to ask anything about mental health, addiction. I want it to be an interactive conversation. Happy Wednesday to you too, sir. And, yep. So it'll be an interactive conversation, as we always do. But I thought we'd bring this topic. So if you have questions about harm reduction or comments, I would love to hear that as well. So let's do a breakdown.

What is harm reduction? Now, if you're anywhere near the addiction world, you often hear about it, often as an opposition to abstinence. So an abstinence based approach to addiction would be not partaking in the activity, meaning not using drugs. So something like a twelve step program, which would promote abstinence. Meaning if I'm a heroin addict, I don't use heroin at all. I don't try to manage it or control it or alcohol. I don't use it at all. However, maybe I choose to abstain from everything.

It's often recommended. If I'm addicted to alcohol, I don't just start picking up another drug. How to educate the public about harm reduction and the benefits? Okay, yeah, that's a good question. How do we get this out to the public? Well, I'm trying to do that right now. This is a slice of the public, but I think it should be done in schools. I think that's the most important. And first place it should be done is schools, because this is really teaching folks from a young age. And it's more honest, too.

I've always thought about doing some, like, use education for adolescents and that kind of thing. Because a lot of times they come to me as adults after getting a DUI or even struggling with an addiction. Whereas if they would have known certain things before, they wouldn't have gotten to this point. So right now I'm creating. This is on top of my mind. Cause I'm creating an education program. I did one at one point and I'm trying to update the info and create some videos to do a harm reduction program.

I'm like having ideas like, pop into my mind. So, yes, so that's how I would do it. I would do it from a young age. And so as I talk a little bit more about harm reduction, I will explain what we should teach. So anyway, harm reduction comes down to three different things. One, it is a philosophy. Number two, it is a public policy. Number three, it is an intervention in and of itself. Let me explain a philosophy, essentially, harm reduction. The philosophy around it states that life is full of inherent risks.

There are risky activities and things we partake in as a natural part of life. We cannot fully avoid risk. In fact, if we did, life probably wouldn't be all that fun. We would not drive a car. We wouldn't get in the water and swim. There are just all sorts of acting and we wouldn't drink at all, right? We would live this cleansed, sterile life. I wouldn't leave the house and I know I would be safe, but that would be boring that, you know, sometimes it's some of those riskier things. It'd be like, you know, even eating like a donut.

Okay, that could be risky over time. So it's not about not doing those things. It's about taking steps to reduce the risk of inherently risky activities. So for everybody it's different. However, there are some universal principles. So that's the overall philosophy. So number two is public policy. So we have a lot of harm reduction in our public policy for many different things. For example, we don't say don't drive. We say we're going to put up some speed limits and there will be consequences. If you break the speed limit, there will be a ticket if you don't wear a seatbelt, there's blood alcohol levels for drinking and driving.

There's rules paced opposed to all of it. The swimming pool, don't dive, don't this. So it's not saying don't come to the pool, don't dive. Yeah. So you said, I'd like to connect you with. I'd like to connect with you in that program and help share. Okay, yeah, for sure. I'll let you know once I get that going. But through my counseling program, we have, you know, a harm reduction education program for a lot of people. Get Dwis combining that with counseling and such. So teaching some of these principles.

So other examples of public policy, right. Is we tax unhealthier foods, fatty, salty, sugary ones that lead to more health consequences, sometimes at a higher level or like sugary drinks or cigarettes. Like one of the reasons cigarette smoking has gone down so much, not just because of now the vapes, it was already going down before and all that other stuff, but, you know, was that there was a huge campaign to educate people about the harms of you. So that's a part of harm reduction policy, but also increasing the price of cigarettes, disincentivize people to go down.

So providing. So the policy is kind of providing disincentives so that doesn't happen. Now, harm reduction is about lowering risk, therefore saving lives. However, it doesn't just benefit the individual, it's a benefit to society as a whole. Why? Because it saves us money, money that could be better spent elsewhere. Something like alcohol is extremely expensive. The more people binge drink, the more costly that is for society, as alcohol is one of the most damaging. Also, the most commonly used substance causes taxpayers billions of dollars a year.

Health care costs. Alcohol is horrible for your health when consumed in too high of amounts for too long of a period of time. Not just treatment costs, but cancers, diabetes, weight gain. I mean, there's just everything. Any health condition you can imagine, alcohol is associated with making worse. That costs a lot of money, raises our total health care costs, loss of job productivity, wages, higher legal costs, divorces. So there's all these reasons. It's super costly. So if we can get people to decrease their amount of alcohol use, it's going to be less costly for the rest of us.

Even if I don't drink, it still has an impact on me. So it's good for the goose, is good for the gander. And that's why the public policy is important. Third element, intervention. Now, an intervention can break down in a few different ways. One, let's say I was educating you all right now, which I'm kind of doing, but let's say there was like a specific reason for it. Y'all got duis when you're my program or something? This would be an intervention. I'm teaching people different harm reduction skills.

For example, when it comes to alcohol, if someone gets a DUI, it's like, okay, how do we find different skills? How do we educate you about how alcohol impacts the body so you don't overdo it? That's one thing we do. But also having a harm reduction plan of maybe decreasing the amount you drink, the type of what you drink, how many days you drink, having a plan for a ride to not drink and drive, to have all these different things already in place, to have a plan. Harm reduction is mindfulness. Harm reduction interventions are mindfulness, whereas not doing that is impulsivity.

That's where people usually get in trouble. They don't have a plan for how they're going to get home. They don't have a plan for how many drinks, approximately they're going to have. They don't have a limit for themselves. They just go willy nilly in the moment. The problem is when you do that with something like alcohol, your decision making gets more and more impaired as you go, therefore increasing the likelihood that you're going to make a bad decision. Right. So harm reduction is a mindful, mindfulness is you're going to have a plan going in.

So you could apply this to any area of your life, but the intervention is the actual actions you take to reduce harm, but also, you know, an intervention that I'm doing, like with you all right now, as I'm teaching you about this, as I'm having someone create a harm reduction plan. Now, another big one is great examples when it comes to opioids. Luke would have a very good understanding about this as he created an extremely innovative program here in Minnesota, Northstar Behavioral health, which was, I believe, the first one treatment to focus solely on opioids as the epidemic was going on.

So he had some good foresight there. And part of that program and part of a healthy, balanced, necessary approach to dealing with opioids is harm reduction. So a lot of people do get sober from opioids, heroin, they don't take withdrawal meds, whatever, and they're like in a twelve step program and their life is amazing. However, that sometimes takes a long time for people to get there. It may not be realistic for everyone's situation. So instead of saying, hey, just don't do opioids, and no, we're not going to allow these other methods, you have to hit the gold standard, saying, hey, there's other options out there, even if you're not sober and living the most grand life, it's better to be alive until you get to that point, right?

So having drugs like naloxone, that reverse overdoses, that save a ton of lives, medications like methadone, suboxone, ones that clog the opioid receptors so that you don't get that intoxicating effect. In the same way, that keeps you a little more level that reduces cravings for some of the more harmful drugs like heroin, fentanyl, all that, those kind of things. And people actually with those can lead a higher quality of life and have, because they don't have that same level of intoxication, they could be more productive and navigate life better.

So that is an intervention in and of itself. Right? Or having a treatment program where you have people set their own boundaries. Abstinence is actually a form of harm reduction, because if you don't, if you choose not to use drugs or alcohol, whatever, that's going to reduce harm greatly. In fact, you probably will never have harm related to drugs or alcohol if you don't use them unless it's somebody else's use. Right? So that is a form of harm reduction. However, taking a different approach beyond abstinence just expands the boundaries of the individual.

Now, that doesn't mean that it's right for everyone in that, like, someone's coming in with a severe alcohol addiction, we're like, okay, we're going to learn some ways to moderate your use. Well, it's worth a try early on, but for some people, it's not realistic for them. It's just they have too strong of an addiction, they have too little of self control anymore. And to just try to do this harm reduction intervention specifically is not super, going to be super helpful. And maybe abstinence, and that's why abstinence exists.

And it was kind of the dominant form for a while because so many people with severe addictions struggle. But there's a lot of people that fell through the cracks. So pain management, medical cannabis, ketamine, holistic modalities of care as a form. Yeah, those are all very good examples. Now, look, I'll admit I'm not the biggest medical cannabis fan. Maybe it's because I manage sober houses and deal people with severe addictions who abuse it. So I have a jaded person perspective on it. However, if I had someone, even if myself, let's say I had chronic pain and my only option was to take opioids, it was the only thing that helped.

However, medical cannabis helped to actually helped to the same degree or similar to the point where I could not be on opioids, I'll take that any day. Or let's say if it's a medication for seizures or something where it's actually better than another medication or even if you don't have, like, an addiction or potential of addiction for medical cannabis, then. Okay. Right. So it's just balancing the risks and benefits of it. I'm gonna move back to the other room. I was avoiding the lawnmower, so now it'll be back, quieter in my office.

But, yeah, so, I mean, these are all really good examples. Harm reduction is really important. It saves lives. I always kind of joke that, like, at work I'm a harm reductionist, but at home I'm an abstinence kind of guy because, like, I choose abstinence for myself for various reasons. It's my own form of harm reduction. But, you know, that's, you know, that's my personal choice. When people come to me, I either will. Most people come to me. That's what I'm saying. At work, I do more harm reduction because they're coming to me at earlier stages.

So we do that. But then a lot of times we try over time. So that's what I advocate for. Maybe more harm reduction interventions in the earlier stages. This is why I think it's important to educate people too, at a young age, because all these people get DWI's like, they don't even understand how alcohol impacts their body. That's why I'd love to teach them this s*** at schools. But, yeah, so, yeah, but, yeah. Recovery cafe, frog town. Let's see you either. Okay, so you kind of have a similar view, but helped you get to where you are through your surgeries, not to go.

Yeah, exactly. So again, levels of harm opioids are much more harmful than cannabis in general. Now, if you're getting out of a really significant surgery, probably cannabis ain't gonna cut it. And, you know, like, for someone like me who was addicted to both, that would have been interesting if they're like, hey, maybe you should do cannabis instead of opioids, because I was really addicted to opioids. Would I have done that? Well, I know it wouldn't have been sufficient for the surgery I had. I don't know.

I don't know what that would be like. But you're abstinent now. Yeah. So, like, that was the thing too, is like, I'd been abstinent off opioids for God knows, you know. Let's see. I don't have to say God knows how long. I know how long. So 2001, right? So about 14 years. 1415 years. Like, 13. Okay. Let's just say 1314 years hadn't touched opiates. Well, another surgery I did. So a couple times I did it, and opiates were my drug of choice. But it didn't have the same impact on me because I'm in a different place in life, but I still had to have really strong boundaries.

I used it within a short window of time, and then I stopped, and that was okay. Was it a little difficult? Sure, but it's not the same as it was before. So all these things, you gotta wait for the individual. But anyway, I hope that's helpful. I'll let you know. What. I have this new program out. I've been working on it all day, and I thought, you know, and actually, like, a lot of it I have in videos on Cadre, because as I'm going through and, like, rewriting this, I'm like, a lot of this content I have just in different videos, like, in my addiction masterclass.

And then I have the series on making changes. And if you really, like, combine those two things together, that probably be. That would essentially be all. All of it. So. Yeah, that'd be cool. Anyway, folks, it's been real. We'll check in with you next week. I'll be around. Make sure to check out some of the new videos coming down the pipe. And have a good rest of your week. Bye.