Harm reduction strategies aim to reduce the harm associated with drug use. The emphasis is on reducing harm or preventing problems. It does not necessarily mean stopping drug use. Stopping use is one option for reducing harm. It is not the only option.
Harm reduction is a common sense approach that recognises that people do use drugs and may continue to do so, no matter what the risks are. Telling people not to use drugs may influence some people to stop or reduce their drug use, but not everybody. Expecting a young person to stop can set them (and you) up to fail. The ‘war on drugs’ approach has not been effective in preventing many drug-related problems.
People respond more positively to messages and strategies that recognise and respect their ability to make decisions about their drug use. Harm reduction avoids judging a person for using drugs. It provides practical information and strategies to help individuals and communities reduce health and social problems related to drug use.
There are three levels of prevention, which include a broad range of intervention options. Intervention can include simply giving information, or it can involve supporting someone who is withdrawing. The type of prevention strategy used for an individual depends on the type of drug use and the problems experienced.
Primary prevention aims to prevent drug use from occurring at all or to delay the onset of use. Strategies include education, information, community education through media campaigns and sponsorships, community development initiatives, and legislation.
Secondary prevention aims to prevent drug problems by identifying and modifying potentially harmful drug use. Information and campaigns promoting safer levels of alcohol consumption are examples of secondary prevention strategies. Intervention may involve working with individuals, families, schools, youth groups, or peer networks. Brief intervention is a secondary prevention strategy.
Tertiary prevention aims to prevent problems caused by drug use from getting any worse and causing further harm. These strategies usually target people with an identifiable drug dependency.
Tertiary prevention is often called drug treatment and rehabilitation. Intervention options include detoxification, counselling, substitute therapy (methadone, nicotine patches), rehabilitation, family therapy and self help groups. Goals of treatment are likely to be the reduction or termination of drug use.
There is general community concern that young people who use drugs will become dependent. No drug leads to immediate dependence. However, frequent use of a drug can lead to dependence.
There are degrees of dependency from mild to severe. It is impossible to say how long or how often a person has to use a drug before dependency develops, as there are many contributing factors.
Dependence can be psychological, physical, or both. Young people may become dependent on aspects of drug use as well as the actual drug. Examples include the rituals associated with injecting and the conventions for smoking marijuana in groups.
Psychological dependence. Psychological dependence on a drug has developed when drug use becomes far more important than other things in a person’s life. They crave the drug and feel compelled to keep using it. They feel that they can’t cope without it.
Psychological dependence is usually much stronger and more difficult to overcome than physical dependence. Do not underestimate the power of psychological dependence. The body can eliminate a drug and return to normal within days or weeks. The mind and the emotions can take a lot longer.
Physical dependence. This occurs when a person’s body adapts to a drug. The body gets used to the drug and needs it to function ‘normally’. High tolerance to the drug will have developed.
If a physically dependent person stops taking the drug, they will go into withdrawal. This is the body reacting and attempting to readjust without the drug. Withdrawal symptoms differ according to the drug and how long the person has been dependent. Symptoms can include nausea, vomiting, anxiety, sleeplessness, diarrhoea, stomach cramps, mood swings, sweating and fever, chills, aching joints, delirium and tremors.
Withdrawal symptoms are the effects felt when regular drug use stops. The range of symptoms a person experiences is called a withdrawal syndrome. The length and severity of withdrawal depends on:
- the drug
- how long the person has used the drug
- the amount used
- the method of administration
- individual physical and psychological factors.
Physical withdrawal, or detoxification, from most drugs takes from four to ten days. Many people find psychological withdrawal much harder to cope with than physical withdrawal. Going through physical withdrawal is often just the beginning of the process. Psychological and emotional issues will often surface and need to be addressed. The person is highly likely to start drinking or using again if they don’t face these issues.
A young person often becomes attached to the social aspects of their drug use. Drug use can provide meaning for young people who believe that life is otherwise meaningless. Giving up or stopping can leave a perceived void that takes time, and requires alternatives, to fill.
The terms detoxification and withdrawal are often used interchangeably. Detoxification (‘detox’) is part of physical withdrawal. It literally means ‘un-poisoning’ and refers to the process of eliminating the drug from the body.
There are a range of options to help detoxification. Drinking plenty of water helps ‘flush’ toxins from the body. Therapies such as massage, accupressure, acupuncture, drug substitution and counselling may assist a person cope with detox. Exercise and good food are also helpful, as is a supportive environment. Medical assistance may be required if the person detoxing has a high level of dependence.
TYPES OF DRUG USE
The spectrum of drug use goes from ‘no-use’ to dependent use of one or more drugs. A person can move along the spectrum or ‘rest’ at any point or move backwards. One stage does not necessarily lead to the next. The ‘one hit and you’re hooked’ belief is a myth.
Although not always clear cut, there are four main types of drug use. It is useful to know these, as the harms and problems associated with drug use differ along the spectrum. So too do the strategies needed to help the user.
Non drug use. A person does not use a particular drug.
Experimental use. A person ‘tries out’ a particular drug. Experimental use refers to ‘once off’ or very short-term drug use. Young people may experiment with a number of drugs and then discontinue use of some while continuing to use others. The low tolerance level of experimental drug users places them at high risk of overdose or poisoning.
Recreational use. A person uses one or more drugs in a deliberate or controlled way to enjoy their leisure more. Sometimes called social drug use, this type of drug use often takes place in a group. Other people use drugs alone recreationally to relax and get ‘away from it all’.
Recreational use can occur very occasionally or every weekend or several times a week. It may be quite habitual (for example every Friday and Saturday), or it may be for a particular purpose or circumstance. The person might have small amounts, or they might ‘binge’.
Harms related to recreational use include the risks taken when intoxicated. Recreational use of most psychoactive drugs can be hazardous as they affect a person’s judgment. Also, many drugs cause a ‘hangover’ effect. Recreational users are unlikely to experience a withdrawal syndrome. If they do, it is possible that they have developed a dependency.
The important aspect of this type of drug use is that the person generally makes a conscious choice as to when, where and how much they will use. They are unlikely to suffer physically or psychologically if they have to go without the drug.
Dependent use. With dependent use the person has little or no control over their drug use. They feel compelled to use to feel normal or to cope. Often called addiction or alcoholism, dependency is the result of prolonged, regular use of increasing amounts of the drug. As discussed earlier, a person can become physically dependent, psychologically dependent, or both.
The drug is likely to be the person’s major preoccupation and play a key role in their life. Choice of friends and social life may revolve around their drug use. They may see less and less of non-using friends. Depending on the drug, its legal status and how much it costs, the person can experience a range of problems.
Misuse Drug misuse is a term, which like abuse, dependency and addiction, has often been associated with consumption levels, patterns, length of use, problems with use, legality etc. Factors determining misuse are varied and are dependent on such things as laws relevant to different countries or regions. Therefore, varying definitions of misuse may not be helpful in determining whether the use of a drug is harmful or not. For example, given a situation where a person is drinking alcohol, the drug use may only start to be considered misuse if that person decides to drive a vehicle.
Peer Education. Peer education programs involve training young people to educate other young people about issues relating to alcohol and other drug use.
Abstinence. Being drug free; not using a drug.
Antagonist. A substance that specifically blocks the effects of another drug.
Opioids. A class of drug that has morphine-like activity, includes heroin, methadone, pethidine, codeine.
Receptors. Cells in the brain that are sensitive to particular drugs. For example, the effects of heroin are experienced once the drug attaches itself to the opioid receptor in the brain.
Tolerance. When a person requires increasing amounts of a drug to get the same effect as they did when they originally used.