“The curious paradox is that when I accept myself just as I am, then I can change.”
– Carl Rogers
I will here be addressing alcohol harm reduction but I think what I say is easily generalizable to other forms of harm reduction.
One overly simplistic way to attempt to measure success or failure in harm reduction for an individual would be to set daily and weekly drink numbers (e.g. the NIAAA no-risk drinking limits–men: 4 daily and 14 weekly; women: 3 daily and 7 weekly) and say that individuals stayed within the limits were successful and that those who exceeded the limits were failures.
Such a definition is problematic on many accounts:
1) It fails to “meet people where they are at” Harm reduction needs to support every positive change. A person who goes from 80 drinks per week to 60 drinks per week has made a positive change and is successful at harm reduction. Likewise any reduction in risky behavior is a positive change. If the person continues to drink 80 drinks a week but sells their car and buys a bus pass instead because they swore off drunk driving then they still have made a positive change and are a success.
2) “Meeting people where they are at” also includes recognizing the validity of their choice to engage in recreational intoxication instead of always sticking to limits sanctioned by some outside agency. This is an essential part of respecting the dignity of the individual–we must recognize the right of the individual to make choices in order to build self-efficacy in the individual.
My experiences as a harm reduction support group leader lead me to the following conclusions
1) Some people find it relatively easy to make a plan and stick to it
2) Some people are very much creatures of habit and can fall as easily into a good habit (or rut) as a bad one
3) Some people have a high degree of spontaneity and find it very difficult to stick to a plan for that reason
4) Many people beat themselves up for failing to stick to a plan or failing to change quickly enough
5) The more that people beat themselves up for failure the harder it is to change, and the more likely they are to drink to drown out a sense of failure (the well known Abstinence Violation Effect)
6) It is very important to increase people’s self belief and self efficacy
7) It is essential to teach people self praise for every positive change
8 ) It is also very important–especially for some people–to help them to increase their self-esteem–affirmations are one thing to help with this
9) Self-acceptance is an essential feature of positive change–which brings us back to the Rogers quote we opened with
THE MEASURES WE CAN USE TO RATE THE SUCCESS OF HARM REDUCTION INCLUDE THE FOLLOWING:
- Charting drink numbers
- Charting drinking risks
- Charting plan adherence
- Charting increases in self-esteem
- Charting increases in feelings of self-efficacy
- Charting personal satisfaction with progress
- Charting increases in self-acceptance
- Charting increases in positive non-drinking activities
Many clients must be repeatedly reminded of improvements which they have made in their behaviors to help them build self efficacy–because when left on their own these clients do nothing but dwell on failure and imperfection.
The client him/herself will know when he/she is happy with the changes in drinking and non-drinking activities and the balance between them. Some clients may choose alcohol abstinence as their goal. Some may choose moderate drinking. And some may choose to engage in safe recreational intoxication.
So long as we choose not to live in padded cells and eat gruel three times a day there will be some risks attached to all of our behaviors. Reducing risk to zero is as impossible as living to be a thousand. In the final analysis the goal is quality of life.
Note–Risk ranking worksheets and risk tracking charts can be found on the HAMS website:
Copyright © 2011, The HAMS Harm Reduction Network