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...  You can reduce the AMOUNT you use each time. For example:
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).  You can alter the FREQUENCY of your use, which you might do by:
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).  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.)  You can change HOW you take your substance, such as:
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.  You can change the SITUATION that you use in. For example
This tactic is all about paying careful attention to setting, and choosing safer options.  You can put more effort into PLANNING your use, such as:
 You can try SUBSTITUTING a less harmful drug for a more harmful one:
 You can focus on OVERDOSE PREVENTION:
This may be one of the most important harm reduction techniques of all--since survival is essential for making any future positive change!  If you decide that you are going to keep using just as you are now, you can still engage in SELF-CARE while using
 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.
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.
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 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 changes. 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.
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:
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:
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! |
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! 
Photo credit: Tristan Crane Photography.
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