Harm reduction can be broadly defined as a range of strategies and policies aimed at lessening the negative social and/or physical consequences associated with various human behaviors. I did not come to learn about harm reduction until a decade after using substances for the first time and I cannot imagine how much safer I could have been had I been exposed to this way of thinking earlier in life.
As a young child I did not know that my father, and primary caregiver, struggled with opioid dependency, but I knew that he was sick and that it impacted his ability to work, care for himself, and care for me. While my parents never spoke to me about illegal drug use, starting in elementary school I began receiving an education on the subject at school. The education was fairly standard for American health curriculum, with common messages such as: “Drugs are harmful,” “People who use drugs are harmful,” and that “People who make the choice to distribute drugs are bad people that must be removed from society.” As I got older I understood my father’s sickness to be substance use related and I began using substances to cope with ongoing trauma in my life, this foundational knowledge my public school provided me with started to break down and not fit into my new reality. The tricky thing about stigma though, is that even though the messages didn’t make sense to me anymore, I found myself pre-judging people that used drugs as worthless, even myself.
I developed conflicting viewpoints me throughout my teenage years. Substance use was both the scapegoat on which I pinned all my father’s shortcomings and the best option I had to cope with my life in the face of inadequate resources. These narratives did not exist separately but instead created an ongoing internal conflict that degraded my self-worth and relationships over time. When my drug use made me feel like I didn’t matter, I no longer avoided people and situations that could knowingly cause me harm. I no longer saw the value in my own well-being. I made allowances for my father’s abusive and harmful behavior and to compensate I adopted a parental role that further allowed me to view my father as helpless. I overlooked my father’s ability to follow up with his own healthcare professionals, while neglecting to assist me in following through with the care recommended by my doctors and social service providers. With these inverted parent-child roles, I found that when I used illegal substances I blamed my substance use solely on a perceived weakness in my character. Being a child without access to my own income, I often resorted to selling drugs to classmates in order to pay for my basic needs that included drugs, food, and transportation. I know now that I was doing my best to survive, but back then it only furthered my emotional downward spiral. I resented what I had to do to survive and in this confusion, I internalized endless harmful narratives for both myself and my peers. I saw my father as a victim of drug addiction and myself as a villain within the war on drugs, this would later be challenged when I got older and began seeking out my own path for recovery.
I cannot recall hearing of any option other than 12-step programs and abstinence but I remember being told it was The Only Successful Option. I understand that many people find strength and comfort in this method, and while I do not mean to discredit it, I am saying that it does not work for everyone. As a woman, I faced the all-too-common problem of pursuing meetings for support only to be met with inappropriate stares and propositions from male attendees. Meetings were overwhelmingly male dominated and it was a barrier for me to be able to connect with other women who could have potentially assisted me in understanding what my needs were in recovery. Being told that this was the only solution to substance use disorders felt more like a punishment than rehabilitation only strengthened my growing worldview that bad people who use drugs deserve bad consequences. That the harms that I experienced at the start of my recovery were my own fault and the fault of those around me, this internalized shame kept me at an arm's distance from other people in recovery as I did not trust them and could not see them clearly for the whole person they were. This feeling of being unsafe and isolated resulted in my eventual departure from meetings.
I then tried to work the steps on my own but the focus on seeking forgiveness furthering a cycle of shame for the things I did to survive. This is not to say that I never harmed anyone in my youth, but rather to point out that I did the best I could as a child raising both myself and my father. What I understood from the 12 steps was that anything negative that occurred during my years of substance use was directly linked to my choice to use substances. This was an incredibly dangerous and damaging narrative to hold as a young woman who experienced sexual assault on multiple occasions during this difficult period. Victim blaming plagues survivors of sexual assault even without drugs present, the added stigma only serves to further harm those trying to heal. However, I found that I could not blame my close female friends for having similar experiences while intoxicated. I knew that they could not be responsible for the violence they faced or the actions they took to exist in cruel circumstances. The cognitive dissonance that arose from these clashing truths began my search for alternatives.
Later, I was introduced to a harm reduction organization that was created by and for women engaged in street economies (e.g. the informal drug trade and sex trade). As I was nearing the end of my extended journey to graduate college, I decided to reach out to them about a potential summer internship. I had experience in community organizing primarily at the intersection of LGBTQ+ community and sex work that proved vital in my securing the internship but I was unaware of how heavy on substance use this internship would truly be. That internship evolved into years of shifting roles within a community where I was finally able to see myself clearly. I became immersed in a community and philosophy that allowed me to rebuild myself and understand my own path to recovery that I do not think I would be alive today without. I learned that substance use did not strip me of my value as a person, I was able to recognize the vast strengths and positive attributes I possessed. I saw clearly that if I drugs didn’t kill me, the reckless choices I made due to my internalized stigma would.
I met two women in this organization who would change everything I thought I knew about substance use and parenting. In the face of decades of trauma, housing instability, and opioid dependence they never stopped helping others. They are mothers not only in the traditional sense but they are mothers of this community, pushing back against the social isolation and violence that plague vulnerable populations. Spending time with people who refused to rely on substance use as an excuse to be cruel, who instead sought to put whatever energy they could gather to making sure other people were safe and comfortable forced me to reevaluate what substance use really means about who a person is. These women have looked out for my safety and well being far more than my father was ever capable of, even though they often were dealing with personal struggles that he could never have imagined. They taught me that compassion and empathy do not have limits, but are endless pools to draw from for the people you care about. Mostly they taught me to have strength in my convictions and in my ability to not only survive but thrive as a caring and thoughtful person. They also taught me to stop making allowances for my father and to demand that I be treated with love and respect from my family members. When my father could not step up to these new expectations, I felt confident in the understanding that he chose to exit my life because of his own learned cruelty and not the false belief that opioids had robbed him of kindness. Having these women care for and support me in every aspect of my life undid years of damaging self hate. I respected and trusted them when they told me they loved me, and in time it has taught me to love myself.
Before I finish I want to summarize some of the most important life lessons harm reduction has given me. These are not in any particular order and do not fluctuate in their value.
Practicing harm reduction made me kinder and more forgiving. By focusing on keeping people safe instead of changing their behavior I learned to value the people they were instead of the people I thought they could be. This made my relationships deeper, more empathetic, and allowed for connections I previously felt were unattainable. A study into the experiences of people utilizing harm reduction found that “the majority of reasons participants discussed for employing harm reduction strategies in their life centered on their relationships to others and themselves”. It is much easier to value taking care of yourself when you have relationships with people who value you.
Community care is a vital tool for recovery that is often overlooked and undervalued. Isolation is a valuable weapon of stigma, not only in separating us from talking to each other about shared experiences but also in convincing ourselves that we are helpless and incapable of aiding in each others recovery. We are told frequently that we need to seek professional help or practice self care, but harm reduction taught me the importance of community care built on our innate human abilities to care for each other. Judi Chamberlin, a long time patients rights advocate within behavioral health, advocated for similar alternatives focused on mental well-being but can be easily understood as beneficial to both behavioral health and substance use. In her book “On Our Own” she writes about the importance of programs that “see every person having a combination of strengths and weaknesses, and the need for help in one area does not negate the ability to help others also.” By implementing recovery in a community setting we can empower the previously disenfranchised and begin to rebuild the self-worth that stigma has robbed for years.
Recovery is not linear and there is no one size fits all recovery model. Harm reduction gave me the language to expand and explore these ideas more fully. I find this to be a hallmark of a great education, not just the ability to understand a new concept but also to find the words for you to express it fully and contribute to the growth of that knowledge. Rachel, a harm reduction specialist for the Philadelphia Department of Health and dear friend, notes that “Harm reduction provides a framework that allows for recovery in many forms. People are able to define for themselves what recovery might look like, whether that is completely abstaining from just one substance or using in a managed way or ways that pose less risk. This framework empowers people and trusts them to make an informed choice that best meets their particular health needs.”
Connecting with other women with histories of trauma allowed me to fully understand the link with substance use. That emotional dependency can often outweigh physical dependence for many people. I learned that I do not have an addictive personality, I have just had periods of inadequate mental health support and resources. Rachel from Philadelphia weighs in again to point out that “For many folks struggling with addiction, it is important to think about what their substance use is doing for them. Many individuals in chaotic use have a history of trauma and drugs can provide a reprieve from feelings and situations that seem unmanageable. It becomes a part of someone’s coping mechanisms. When we try to understand drug use from this perspective, we can understand it as a valid response to horrible situations and as a tool that often enables people to keep on going.”
I thought that my lived experiences shielded me from stigmatizing others, allowing me to turn a blind eye to my own harmful behavior. Harm reduction helped me understand my own internalized stigma and to better understand how widespread stigma is throughout our society. It taught me to recognize when I was stigmatizing others in my thoughts in order to address them before they infected my actions. I am thoughtful in the relationships I maintain, I now have supportive and loving parents in my mother and step-father, relationships I was able to repair and reconnect with as I created distance with my biological father. I am dedicated in my personal and professional life in pushing back against the stigma I encounter and try to encourage others to do the same. I hope reading this can help others join me.
Nina Ovian
(Dedicated to Mel, one of the women mentioned in this article who passed away in 2018.)
Boucher, L. M., Marshall, Z., Martin, A., Larose-Hébert, K., Flynn, J. V., Lalonde, C., … Kendall, C. (2017). Expanding conceptualizations of harm reduction: results from a qualitative community-based participatory research study with people who inject drugs. Harm Reduction Journal, 14(1), 10. doi: 10.1186/s12954-017-0145-2
Chamberlin, J. (1988). On our own: patient-controlled alternatives to the mental health system. MIND.