Dr. Jessica Katzman
  • Home
  • Specialties
    • Outdoor Therapy
  • About Me
  • Contact
  • Fees and Insurance
  • Resources
    • Blog
    • Recommended Reading

Harm Reduction, Part Seven: The Menu of Change Options

5/19/2016

2 Comments

 

Ready to make a change in your alcohol or drug use, but quitting isn't on the table for you?

Check out the menu of options for strategies that meet YOUR needs.

Picture

​If you've been taking a closer look at your use of substances, and have decided to make some changes, ​you may be wondering where to start.

You may not be interested in quitting, but are curious about other positive choices you could make.

One of the most wonderfully liberating aspects of a harm reduction
* approach is the ability to choose from an incredibly varied menu of potential change options.
​
Here's what could be on the menu for you...
​
Picture
​You can reduce the AMOUNT you use each time. For example: ​

  • Having five drinks a night instead of six
  • Taking one less pill during each weekend binge
  • Switching from spirits to beer (lower proof)
  • Smoking fifteen cigarettes instead of a pack a day
  • Snorting two lines with friends instead of three
  • Ordering a single rather than a double latte​
​
Sometimes this is a better option for longer-acting drugs (such as heroin or alcohol), but your experience may vary. In order to go this route, you'll need to measure how much you are actually using in order to track your progress. (Additionally, please make sure you reduce slowly; if you are physically dependent on alcohol, benzodiazepines, or barbiturates, medical detox might be the safest option). 

Picture
You can alter the FREQUENCY of your use, which you might do by:
  • Skipping the office happy hour every other week
  • ​Using Ecstasy only at monthly dance parties or special events, rather than each weekend
  • Deciding that you will use speed only in social situations, not to go to work every day
  • Cutting out your afternoon coffee run
​
This might be a good option if you find it difficult to stop using once you've started, and for substances that are shorter-acting or harder to reduce in amount (crack cocaine or speed, for example).


Picture
You can change the number or types of substances you MIX together.

Much of the harm from our use comes from the way substances combine, and you can reduce negative outcomes by using just one at a time. This might initially involve paying closer attention to the reasons why you want to mix them in the first place. (You can use a decisional balance to look closer at your potential motivations and barriers.)

Picture

You can change HOW you take your substance, such as:
  • Using pills instead of shooting up
  • Trying marijuana edibles instead of smoking
  • Drinking on a full stomach to slow down absorption
  • Experimenting with an e-cigarette 

Routes of administration range from safer (ingesting) to less safe (smoking) to most risky (shooting), which also affects how quickly or intensely you feel the effects. You may also find that part of the complex relationship
 you have with a substance is an attachment to the particular ritual of using, which may require further exploration.


Picture
You can change the SITUATION that you use in. For example

  • Finding a clean, safe, well-lit place to shoot up
  • Choosing to drink only socially if you get depressed when drinking alone
  • Choosing to only drink at home if drama happens every time you drink in public
  • Getting high with your best friend instead of your abusive ex-partner​​

​​This tactic is all about paying careful attention to setting, and choosing safer options.
​

Picture
You can put more effort into PLANNING your use, such as:​
  • Going to needle exchange to get clean equipment
  • Choosing a designated driver
  • Drinking plenty of water and making sure you've eaten recently
  • Thinking about what music or media to have on while high
  • Paying attention to set and setting; being around people you like in an environment that feels safe while attending to your mood state
​

Picture
You can try SUBSTITUTING a less harmful drug for a more harmful one:
​
     
  • Buprenorphine (for opiates)
  •  Methadone (for opiates)
  • Naltrexone (blocks effects of opiates and alcohol)
  • Marijuana (for more harmful drugs, if that works for you)
  • Nicotine replacement patches or gum (for cigarettes)
  • Antidepressants or anti-anxiety medications (if you are self-             ​                   medicating anxiety or depression with your use)
​

Picture
You can focus on OVERDOSE PREVENTION:
  • Educate yourself about and obtain Narcan if you use opiates
  • Don't try to sleep off alcohol poisoning--learn about the Bacchus position and seek medical attention if necessary
  • Be wary of mixing more than one sedating drug
  • Know your dose and your dealer

This may be one of the most important harm reduction techniques of all--since survival is essential for making any future positive change!


Picture
If you decide that you are going to keep using just as you are now, you can still engage in SELF-CARE while using

  • Compassionately accept yourself as drug user, and accept that ambivalence is very human
  • Engage in other healthy behaviors: eat regularly, drink water, exercise, stay warm, get enough sleep
  • Build relationships with people who accept your use without shaming or belittling you, and support your overall wellness
  • Pay attention to yourself while using; build awareness of why you use substances
  • Avoid legal consequences and use within your financial means
  • Take good care of your emotions: address your feelings, notice dysfunctional thinking, stimulate your mind, soothe yourself when upset, have fun, be spiritual​


Picture
Finally, if you've decided that your goal is ABSTINENCE ​(which qualifies as a harm reduction goal!) there is a variety of ways to get there.
  • You can quit everything all at once (most traditional substance abuse programs can assist you with this)
  • The "warm turkey" route, such as the following:
  1. Tapering your use (see above about changing amount or frequency) towards zero
  2. Sobriety sampling--trying abstinence for a brief period to see what your challenges and strategies might be
  3. Trial moderation--attempting to use moderately for a brief period


​There are many more safety strategies tailored to specific substances (such as only using nitrous or ketamine from a stationary position, or supplements that might be helpful following Ecstasy use). The variations are endless, and this means that you can really design a strategy that works for you!

From here, you could pick out some potential options that feel feasible, and begin preparation for that particular change.

This can be a complex undertaking, and you might find it helpful to have coaching or support. If you'd like more assistance, I encourage you to contact me for a consultation, and we can discuss the kinds of strategies that might work for your life.
​

If you are just now joining me, and are curious about the harm reduction model, I invite you to check out the other posts in this series, and feel free to ask questions if you're curious. Next time, I plan to discuss some more specific tips around risk reduction and benefit maximization for psychedelic substances. Have a great week!
​

* Some of the information in this post was gleaned from the excellent book Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol. For those seeking further education about this topic, I can not recommend this book highly enough.
2 Comments

Harm Reduction, Part Six: To Change or Not to Change? The Decisional Balance

5/10/2016

0 Comments

 
Picture
​Want to make a change, but feeling stuck?
​

Here's how to 
to turn awareness of both your motivations and roadblocks into a solid action plan.
​

The DECISIONAL BALANCE is one of my favorite therapeutic tools to help folks initially explore their ambivalence about making chang​es.

We tend to criticize ourselves for failing to take action in our lives. However, this “stuck” feeling may be a signal that we harbor some fears and doubts about the process: if you felt 100% certain that change was necessary and completely beneficial, you would have already taken action!

Often our uncertainty serves as a reminder that there are important and unacknowledged factors involved; in my experience, it is usually these factors that secretly stand in our way. (This is particularly helpful in addressing substance issues, as the helpful and positive aspects of our use are often shamefully ejected from consciousness, or publicly denied.) The decisional balance is a way to honor and explore ALL
your potential feelings and doubts about making change.


This format goes beyond a simple pros/cons list, with power to pull out some additional information. We'll also see how there is a balance that must be tipped before any movement will occur.

​Here's how to begin: think about something in your life that you've been contemplating changing. You might even feel a little guilty or bad that you haven't worked on this part of your life yet.

​Grab a piece of paper (or create a 2x2 table in your program of choice), and divide it up like this:

  
Benefits/Pros
Costs/Cons
Making a Change

​
  
Not Changing

​

​
​In the first cell, please list all the benefits, pros, and positive outcomes you can think of that might result from making a change. (You can note both short-term and long-term outcomes.)

In the cell below that, try to think of all the benefits, pros, and positive outcomes from NOT making a change--having things stay exactly as they are.

In the top right cell, you can now list all the costs, cons, and negative outcomes that you think might occur if you made a change.

​Finally, in the bottom right cell, contemplate all the costs, cons, and negative outcomes you predict might happen if you do NOT change.


I'll show you how this might go with someone who is considering a change in drinking behaviors:
  
Benefits/Pros
Costs/Cons
Making a Change
-I'd be proud of myself!
-I'd spend less money

-​Have more energy at work
-Sleep will improve (in the longer term)
-My health might improve, stop getting stomachaches 
-I might feel awkward when I go to parties--what do I do with my hands?
-I might have to stop going to the bar, which is where I meet people, so I might feel really lonely
-Sleeping will be harder (in the short term)
Not Changing
-Inertia is easier, wouldn't have to do anything hard or be uncomfortable
​-Maybe that stomach irritation is unrelated and will go away on its own
​-Get to still have fun 
-I'd feel like a failure
-Health might deteriorate (probably not actually good for my stomach lining)
-Continue to be tired at work​
-Might have an impact on my relationship at some point

-This behavior might get old pretty soon
Next, take a look back over the results. It’s important to consider not just the number of items listed in each cell, but each item’s weight, or how personally significant you rate that item. Circle or highlight the item that stands out as the most significant factor to you at this moment.

(The real key here is to focus on YOUR motivations, fears, and concerns. Your doctor would immediately target the health issues, and your partner might be concerned about the quality of your relationship, but our goal here is to get to the very heart of YOUR dilemma, and where you feel most stuck.)


In the example above, if the person selected the items related to work as the most significant points (because they recently were written up for poor performance and are concerned about losing their job), our focus will be very different than if they were terrified of feeling loneliness (because they have a history of depression and self-injury, and know isolation can easily trigger an episode).


Let’s now look at the item you find most compelling. Does it show us what motivates you, displaying the core value that will drive your change process? Does it point towards the barrier that we most need to address, and can we use this information as a jumping-off point to explore potential solutions or other ways to get your needs met?

Brainstorm about your most significant items, and use this set of ideas to begin building your plan of action:
  • Do you need to address other life problems first before any change can happen?
  • Do you need to reach out to professional helpers or a support network?
  • Would it be helpful to embed reminders of your core values and motivations into your daily life? (e.g. the smoker who tapes a photo of their family to their pack)
  • Can you be patient with this process, or is there anything that needs urgent action?

Before committing to change, the balance must shift towards the reasons for changing having greater weight than the reasons for maintaining the status quo. Addressing the roadblocks and narrowing in on our motivations helps us begin to tip that balance. 


I hope that this exercise helped you discover some new and helpful information, and I thank you for your participation! If you are just now joining me, and are curious about the Harm Reduction model, I invite you to check out the other posts in this series.

Next time, I intend on laying out a potential menu of change options, which allows us to see the infinite variety of positive steps we can take towards our goals. Have a wonderful week!


0 Comments

    Jessica Katzman, Psy.D.

    I'm a psychologist with a private practice in San Francisco's Castro District. I'm interested in harm reduction, LGBTQQIAAP issues, psychedelic integration, social justice conversations, size acceptance, and any intersections of the above. I welcome your comments!

    Picture
    Photo credit: Tristan Crane Photography.

    Categories

    All
    Events
    Harm Reduction
    Job Postings
    Networking
    Practice News
    Resource Mondays
    Reviews
    Tarot

    RSS Feed

    Archives

    June 2020
    May 2020
    April 2020
    March 2020
    December 2017
    March 2017
    February 2017
    November 2016
    July 2016
    May 2016
    April 2016
    March 2016
    February 2016
    December 2015
    October 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014

    Disclaimer: The information and resources contained on this website are for informational purposes only and are not intended to assess, diagnose, or treat any medical and/or mental health disease or condition. The use of this website does not imply nor establish any type of therapist-client relationship. Furthermore, the information obtained from this site should not be considered a substitute for a thorough medical and/or mental health evaluation by an appropriately credentialed and licensed professional. ​This website includes links to other websites for informational and reference purposes only. This website does not endorse, warrant or guarantee the products, services or information described or offered at these other websites.  Examine the content carefully.
  • Home
  • Specialties
    • Outdoor Therapy
  • About Me
  • Contact
  • Fees and Insurance
  • Resources
    • Blog
    • Recommended Reading