May 25, 2023 • 12 mins
Battling the disease of addiction is extremely complex. Treatment is not “one size fits all.” Harm reduction acknowledges where a person is in their unique battle and offers support to reduce risks. Dr. Julia D’Alo, Chief Medical Officer at Gateway Rehab, is joined by Jennifer Bloodworth, Administrator of Onala Recovery Center in Pittsburgh, to discuss types of harm reduction and the benefits recognized using harm reduction options. Not all participants in this podcast are medical or clinical professionals. Always consult with a qualified health care provider. Host: Jonny Hartwell.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Making a difference in the lives ofthe people that we love. Addiction is
a treatable disease, So I thinkit's more about bringing their guard down and
having them understand that, like weare trying to assist them in any way,
shape or form that we can.And I was like, oh,
I just oh my god, Inever want to feel this way again.
This is Gateway Rehabs Recovery Roll Call. This is Gateway Rehabs Recovery roll Call.
(00:32):
I'm Johnny Hartwell, I'm Julie Didello, I'm Jennifer Bloodworth. All Right,
today's topic is reduction in harm.All right, let's talk about harm
reductions. Let's define it. Whatexactly is that? So? Harm reduction
is an approach that's been around fora long time, and this is an
approach that looks at how can wehelp people stay safe at any point in
(00:56):
their recovery or their substance use.So I think, you know, we've
constantly looked at an abstinence based approach. Okay, let me maybe we should
start at the beginning and talk aboutharm. What are some things people do
when they're so if somebody's listening andthey have a family member or a friend
or a co worker who is facingaddiction. What are some of the outcomes,
(01:19):
what are some of the things?How do they harm themselves? What
is let's start there. Well,there's a lot of secondary health conditions that
can come from specific kinds of druguse, especially when you look at intravenous
drug use, the situations that peoplecan be placed in. I know,
before I entered recovery, I wasin a lot of questionable, maybe dangerous
(01:44):
situations because of you know, thehierarchy of my needs had been totally changed.
Were you aware of the self harmat times where there are times you
weren't aware of that you were harmingyourself? Yeah? I think both.
I think there were time times whereI was very cognizant of the situations I
was putting myself in, and therewere plenty of times where I wasn't right.
(02:07):
So if I was inebriated enough,or if I needed to go somewhere
to get something right, it didn'treally matter what was going on, and
my safety was not of the utmostconcern to me. And that came from
the emotional damage that's caused by substanceuse and addiction. And so what we
(02:31):
focus on in harm reduction is weunderstand that abstinence isn't for everyone, and
if it is not, everyone isthere right now. And so what we
can do is mediate the harm anddamage caused within active substance use or addiction.
(02:53):
And that can look like preventing infectionor diseases through a syringe service program,
RAMS, through free condom distribution,medical care access, a lot of
walk in services are extremely beneficial tothis community. There's so many different ways.
(03:13):
Narcan. Narcan is an example ofharm reduction, highly effective harm reduction.
In twenty seventeen, Narcan became widelyavailable to the public, and you
can see on any chart that youlook at a sharp decrease in overdose deaths
immediately following that. So we knowthat these things work and we know that
(03:38):
they help save lives and improve people'slives not only in their active addiction but
long afterward, especially if we preventinfection such as HEPSI and HIV. Do
you have do you assess harm?You know the harm people are doing and
(03:59):
see if there's harm that they're awareof. How does that work? Well,
I mean, you know, peoplewho are specifically using IV drugs,
they're all sort of at the samerisk level of getting an infection like hepatitis
or HIV, or injecting through dirtyskin or with a dirty needle, and
(04:19):
then they inject bacteria in their bloodstreamthat travels and plants and seeds like on
a bone somewhere in their body oron a heart valve when they get endocarditis
or next to their spinal cord,and they become permanently paralyzed. So the
idea of harm reduction is really meetingpeople where they're at in their disease cycle,
(04:40):
because not everybody is ready to doit exactly how maybe you and I
want them to do it, Butif we can keep them alive and we
can keep them healthy, we havea much better chance of helping that person
when they are ready. So reallythat's what it's all about. Give us
(05:00):
some examples of the levels of harmthat people do, and how do you
mediate that. How do you knowwhat level they're at? I don't know
that you necessarily do, so Ithink harm reduction is one of the best
all encompassing approaches to recovery and tosafety, and harm reduction really acknowledges the
(05:21):
humanity of everyone. When we talkabout saving the lives or serving the community
of people actively using drugs, specificallyintravenous drugs. This is one of the
few times that the public very casuallydiscusses whether or not people should be able
(05:43):
to live and what kind of qualityof life that they should have. So
the more services that are widely andpublicly and freely available allows for us to
meet more people where they are,so when people come in, a big
approach to harm reduction and the fieldin general right now is allowing people to
(06:05):
set their own goals and lead selfdirected lives and decide what recovery or quality
of life looks like for them.Opening the doors as wide as possible,
with as many services as possible isthe best way to reduce harm. Because
(06:26):
harm can look different to everyone.Needs look different to everyone. So some
people need food, Some people wanttreatment, but you need to look at
if they have a home to goto after that treatment. Some people want
to continue using drugs, but theydon't want to get a lifelong infection,
so we need to look at yousafe use supplies for them. And there's
(06:50):
a lot of debate around whether thoseare things that people deserve or should have
or money should find. But whatharm reduction does is take a very objective
look at drug use. People usedrugs and that does not mean they are
bad people or that they have amoral failing. We've used humans have used
(07:14):
drugs since we found them, right, and clearly there are a lot of
people using drugs currently. So isit frustrating that people have a cavalier attitude
to the harm level that people inflictthemselves. You know, there's a lot
of people who would say, hey, they chose to take to drugs,
they deserve whatever the outcome. Theydeserve the outcome, but at the same
(07:39):
time they may not be aware ofhow severe the damage is. Right,
So, if we look at substanceuse disorder as a disease as it's defined
by multiple medical associations, they don'tchoose any of that. And I think
to look at someone's behavioral or mentalhealth and think that you get to decide
(08:03):
what they get out of their lifeor how long they get to live it
is devastating. It's some of thehardest work that we do in the drug
and alcohol field is destigmatizing addiction andhumanizing the people who are afflicted by it.
You know the fact that a lotof my job is debating the humanity
(08:26):
of the people I work with everyday is it's gut wrenching to have to
try and convince someone that the peopleI work with their people, and that
I'm a person and that I deservedto be safe at all points in my
life, that I was enough atall points in my life, and my
(08:48):
value as a person didn't only comewhen I started practicing abstinence, or when
I got a degree, or whenI started working in this field. I
was always worthy and we're all alwaysworthy. And what harm reduction does is
acknowledge that every single person is worthyof care and safety, and then it
(09:13):
works to provide that to every singleperson, no matter where they are.
When somebody's facing addiction, you talkedabout the you know, people need to
be aware that you know, theyneed to be safe. That should be
That should be step one, shouldn'tit. We want them to be safe.
Absolutely. So, if somebody's listeningright now and they have a family
(09:33):
member, a friend, a relativewho is facing addiction, who is you
know that may be harming themselves orother people, what's your advice, what's
what's the call to action? Whatdo they need to do? Well?
I mean there are resources in Thereare places that you can go to become
more safe while you are using,such as Prevention Point Pittsburgh. What is
(09:58):
that. It's a syringe service programthat provides safe use supplies, so clean
chatterproof pipes, clean needles, theytake on exchanges. They have fentanyl test
strips, so they actually because theyexchange needles, also reduce harm to the
community because there's not as many needleslying around with possible contaminants on them or
(10:26):
for people to get stuck or hurt. Something I would really say to loved
ones of people actively using drugs isto meet them where they're at. That's
really the phrase you're going to heara lot in the recovery community, the
drug and alcohol community in general rightnow, because we've learned that there is
not one size that fits all.We've learned that everyone needs an individualized plan
(10:50):
and pathway. So talking to yourloved ones in a very clear and understanding
manner about what they need, wherethey are and how to support them there,
and that support can look a lotof different ways, because we also
need to acknowledge where we are inthat relationship and in our safety. But
(11:13):
just coming to someone and saying you'vegot to stop. Is not effective.
It wasn't effective when it was theonly option. Really, So when working
with someone that maybe has a frequentreoccurrences or is really struggling wants to achieve
abstinence but is really struggling with it, I talk to them about those plans,
(11:35):
how we can meet those goals.But then I also talk to them
about, hey, if you relapse, you're still enough. Here's please do
these things. You know, dependingon maybe they're the drug of choice,
Like, here are some things youcan do to stay safe during that,
(11:56):
and we really want you to staysafe and we want to support you in
that. So, I mean,it has been shown that people who are
who encounter these safer practices are alsomore likely to enter into treatment and recovery.
And so there's also an opportunity tomeet people in these places where this
(12:20):
harm reduction exists. You're already,You're always there and ready with open arms
to take them in when they're ready. But the differences, they're safer and
they're alive, and that's the ultimategoal. Right Absolutely, you're listening to
Gateway Rehabs Recovery roll Call
Making a difference in the lives ofthe people that we love. Addiction is
a treatable disease, So I thinkit's more about bringing their guard down and
having them understand that, like weare trying to assist them in any way,
shape or form that we can.And I was like, oh,
I just oh my god, Inever want to feel this way again.
This is Gateway Rehabs Recovery Roll Call. This is Gateway Rehabs Recovery roll Call.
(00:32):
I'm Johnny Hartwell, I'm Julie Didello, I'm Jennifer Bloodworth. All Right,
today's topic is reduction in harm.All right, let's talk about harm
reductions. Let's define it. Whatexactly is that? So? Harm reduction
is an approach that's been around fora long time, and this is an
approach that looks at how can wehelp people stay safe at any point in
(00:56):
their recovery or their substance use.So I think, you know, we've
constantly looked at an abstinence based approach. Okay, let me maybe we should
start at the beginning and talk aboutharm. What are some things people do
when they're so if somebody's listening andthey have a family member or a friend
or a co worker who is facingaddiction. What are some of the outcomes,
(01:19):
what are some of the things?How do they harm themselves? What
is let's start there. Well,there's a lot of secondary health conditions that
can come from specific kinds of druguse, especially when you look at intravenous
drug use, the situations that peoplecan be placed in. I know,
before I entered recovery, I wasin a lot of questionable, maybe dangerous
(01:44):
situations because of you know, thehierarchy of my needs had been totally changed.
Were you aware of the self harmat times where there are times you
weren't aware of that you were harmingyourself? Yeah? I think both.
I think there were time times whereI was very cognizant of the situations I
was putting myself in, and therewere plenty of times where I wasn't right.
(02:07):
So if I was inebriated enough,or if I needed to go somewhere
to get something right, it didn'treally matter what was going on, and
my safety was not of the utmostconcern to me. And that came from
the emotional damage that's caused by substanceuse and addiction. And so what we
(02:31):
focus on in harm reduction is weunderstand that abstinence isn't for everyone, and
if it is not, everyone isthere right now. And so what we
can do is mediate the harm anddamage caused within active substance use or addiction.
(02:53):
And that can look like preventing infectionor diseases through a syringe service program,
RAMS, through free condom distribution,medical care access, a lot of
walk in services are extremely beneficial tothis community. There's so many different ways.
(03:13):
Narcan. Narcan is an example ofharm reduction, highly effective harm reduction.
In twenty seventeen, Narcan became widelyavailable to the public, and you
can see on any chart that youlook at a sharp decrease in overdose deaths
immediately following that. So we knowthat these things work and we know that
(03:38):
they help save lives and improve people'slives not only in their active addiction but
long afterward, especially if we preventinfection such as HEPSI and HIV. Do
you have do you assess harm?You know the harm people are doing and
(03:59):
see if there's harm that they're awareof. How does that work? Well,
I mean, you know, peoplewho are specifically using IV drugs,
they're all sort of at the samerisk level of getting an infection like hepatitis
or HIV, or injecting through dirtyskin or with a dirty needle, and
(04:19):
then they inject bacteria in their bloodstreamthat travels and plants and seeds like on
a bone somewhere in their body oron a heart valve when they get endocarditis
or next to their spinal cord,and they become permanently paralyzed. So the
idea of harm reduction is really meetingpeople where they're at in their disease cycle,
(04:40):
because not everybody is ready to doit exactly how maybe you and I
want them to do it, Butif we can keep them alive and we
can keep them healthy, we havea much better chance of helping that person
when they are ready. So reallythat's what it's all about. Give us
(05:00):
some examples of the levels of harmthat people do, and how do you
mediate that. How do you knowwhat level they're at? I don't know
that you necessarily do, so Ithink harm reduction is one of the best
all encompassing approaches to recovery and tosafety, and harm reduction really acknowledges the
(05:21):
humanity of everyone. When we talkabout saving the lives or serving the community
of people actively using drugs, specificallyintravenous drugs. This is one of the
few times that the public very casuallydiscusses whether or not people should be able
(05:43):
to live and what kind of qualityof life that they should have. So
the more services that are widely andpublicly and freely available allows for us to
meet more people where they are,so when people come in, a big
approach to harm reduction and the fieldin general right now is allowing people to
(06:05):
set their own goals and lead selfdirected lives and decide what recovery or quality
of life looks like for them.Opening the doors as wide as possible,
with as many services as possible isthe best way to reduce harm. Because
(06:26):
harm can look different to everyone.Needs look different to everyone. So some
people need food, Some people wanttreatment, but you need to look at
if they have a home to goto after that treatment. Some people want
to continue using drugs, but theydon't want to get a lifelong infection,
so we need to look at yousafe use supplies for them. And there's
(06:50):
a lot of debate around whether thoseare things that people deserve or should have
or money should find. But whatharm reduction does is take a very objective
look at drug use. People usedrugs and that does not mean they are
bad people or that they have amoral failing. We've used humans have used
(07:14):
drugs since we found them, right, and clearly there are a lot of
people using drugs currently. So isit frustrating that people have a cavalier attitude
to the harm level that people inflictthemselves. You know, there's a lot
of people who would say, hey, they chose to take to drugs,
they deserve whatever the outcome. Theydeserve the outcome, but at the same
(07:39):
time they may not be aware ofhow severe the damage is. Right,
So, if we look at substanceuse disorder as a disease as it's defined
by multiple medical associations, they don'tchoose any of that. And I think
to look at someone's behavioral or mentalhealth and think that you get to decide
(08:03):
what they get out of their lifeor how long they get to live it
is devastating. It's some of thehardest work that we do in the drug
and alcohol field is destigmatizing addiction andhumanizing the people who are afflicted by it.
You know the fact that a lotof my job is debating the humanity
(08:26):
of the people I work with everyday is it's gut wrenching to have to
try and convince someone that the peopleI work with their people, and that
I'm a person and that I deservedto be safe at all points in my
life, that I was enough atall points in my life, and my
(08:48):
value as a person didn't only comewhen I started practicing abstinence, or when
I got a degree, or whenI started working in this field. I
was always worthy and we're all alwaysworthy. And what harm reduction does is
acknowledge that every single person is worthyof care and safety, and then it
(09:13):
works to provide that to every singleperson, no matter where they are.
When somebody's facing addiction, you talkedabout the you know, people need to
be aware that you know, theyneed to be safe. That should be
That should be step one, shouldn'tit. We want them to be safe.
Absolutely. So, if somebody's listeningright now and they have a family
(09:33):
member, a friend, a relativewho is facing addiction, who is you
know that may be harming themselves orother people, what's your advice, what's
what's the call to action? Whatdo they need to do? Well?
I mean there are resources in Thereare places that you can go to become
more safe while you are using,such as Prevention Point Pittsburgh. What is
(09:58):
that. It's a syringe service programthat provides safe use supplies, so clean
chatterproof pipes, clean needles, theytake on exchanges. They have fentanyl test
strips, so they actually because theyexchange needles, also reduce harm to the
community because there's not as many needleslying around with possible contaminants on them or
(10:26):
for people to get stuck or hurt. Something I would really say to loved
ones of people actively using drugs isto meet them where they're at. That's
really the phrase you're going to heara lot in the recovery community, the
drug and alcohol community in general rightnow, because we've learned that there is
not one size that fits all.We've learned that everyone needs an individualized plan
(10:50):
and pathway. So talking to yourloved ones in a very clear and understanding
manner about what they need, wherethey are and how to support them there,
and that support can look a lotof different ways, because we also
need to acknowledge where we are inthat relationship and in our safety. But
(11:13):
just coming to someone and saying you'vegot to stop. Is not effective.
It wasn't effective when it was theonly option. Really, So when working
with someone that maybe has a frequentreoccurrences or is really struggling wants to achieve
abstinence but is really struggling with it, I talk to them about those plans,
(11:35):
how we can meet those goals.But then I also talk to them
about, hey, if you relapse, you're still enough. Here's please do
these things. You know, dependingon maybe they're the drug of choice,
Like, here are some things youcan do to stay safe during that,
(11:56):
and we really want you to staysafe and we want to support you in
that. So, I mean,it has been shown that people who are
who encounter these safer practices are alsomore likely to enter into treatment and recovery.
And so there's also an opportunity tomeet people in these places where this
(12:20):
harm reduction exists. You're already,You're always there and ready with open arms
to take them in when they're ready. But the differences, they're safer and
they're alive, and that's the ultimategoal. Right Absolutely, you're listening to
Gateway Rehabs Recovery roll Call
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