What is Harm Reduction? Meet Dee-Dee Stout

Have you heard the term harm reduction but are unsure what it means?

Would you like more information on the approach?

I’m excited to share my interview with Dee-Dee-Stout today!

Dee-Dee has a Master’s in health counseling and has been a substance use counselor for nearly thirty-five years. In today’s interview, Dee-Dee discusses harm reduction and how the approach can help families. You can read some of the highlights from the video as well below.

Watch the video here:

Can you define harm reduction and what the term means for people who aren’t familiar with it?

• Harm reduction is anything that reduces or minimizes the harm, the negative consequences. In this case, it would be around substance use.
• We use harm reduction strategies in all the other areas of our lives. Think about cars. You know, more people die in car accidents than just about anything. Not right now because of COVID, but traditionally that’s been an area where, particularly, many young people get injured or die, unfortunately. And yet, we don’t outlaw cars. That would be insane. We work to make cars safer, while we appreciate that they are killing machines.
• With substance use, everything fits under the umbrella of harm reduction. Another thing that’s a big myth in harm reduction or substance use treatment is that somehow abstinence isn’t in there. Because obviously, abstinence cannot be, not for everyone, but for many people, that is the ultimate harm reduction. So, of course, it fits in there.
• It’s just that we are not saying you need to be abstinent. That’s not our job. It’s certainly my job as a harm reduction counselor to bring that option up.
• Harm reduction is one way you might change your relationship with substances and perhaps improve your life in some ways. And we can talk about steps you might use to get there, but I don’t know, this is your life. You tell me what you’d be interested in doing.
• So, many people come to me and say I don’t know that I’m ready to give it all up. Is there a way I can use it safely? And I always say, I don’t know, I don’t have some magic ball here that I can look at and prognosticate what will happen in the future. But what I can say is while many people do, however, it’s going to be up to you.
• How are you going to know that it’s working? How are you going to know it’s not working? That’s what’s important to me.

Parents want or are often told that sobriety is the only way to change, so what message do you have for parents who are coping with the negative behavior and how to help a son or daughter who is trying harm reduction?

• I appreciate that many people, parents, partners, want that. We could also throw the police in there because that’s a lot of the route that, unfortunately, people will take. They’ll wind up involved in the criminal justice system. The criminal justice system will only take abstinence as well.
• When it comes to people having boundaries around it, we like to say, how would you handle your child doing anything else that you’re not comfortable with?
• For us, it’s all about, again, the relationship that the person has to the substance. If I’m working with the individual and the rest of the family, how are you communicating with that person to start with?
• Often what I observe is that they’re not, that the rest of the family is sort of behind closed doors, trying to figure out what to do with the person who’s using. The substance user is kind of off here on the side. We talk about the individual using substances and the family as two separate entities. I realized I was doing that until recently and thought, how did we get there?
• Suppose I’m actively and chaotically using a substance. In that case, I may not have the wherewithal to be able to say to you, mom, I’m in a lot of pain right now, or dad, I was sexually assaulted recently, and that’s what’s happening. So,
• Unfortunately, where parents tend to go when we have those kinds of conversations is it must be our fault. We’ve done something to cause this. I mean, frankly, maybe you have, I don’t know. I mean, none of us know. I know that your child lives in a world beyond just the family. So, the idea that it could only happen within the family structure is pretty limited, right? It’s probably something that’s happened in their world that you are unaware of, and I hear many parents talk about that.
• That’s part of it, but it’s also about how we keep those lines of communication open? So even if you feel like you can’t be around that person that you love so much anymore because you can’t watch this, I’m still going to advocate for how do you keep those lines of communication open and at pretty much any cost you want to keep that line open.
• Because if you are not doing that, and your loved one feels alone and ashamed, I can guarantee they’re not going to stop. I can almost guarantee your loved one is going to use more because that’s part of the reason we’re using substances in the first place.
• Now I think too many people think, oh, people use substances for the euphoria. They want to get high. They’re irresponsible, and maybe at first, sure. But not if they’re stuck in that lifestyle. And if this is a behavior that has become entrenched, it has nothing to do with that anymore. I can guarantee that.
• And can I say something to that about kicking your kid out? I like to tell folks that is absolutely an option? Right? And you can only do it once. First of all, if you say that, you need to follow through because if you tell me you’re going to throw me out, and then you backtrack every time you say it, I’m not going to believe it anymore. That’s not helpful.
• And second of all, you can only do that one time, right. That is, it’s like, you know, in the old card games, that’s my trump card. I can only play that once. So save that for the last thing you do. Don’t let that be the first thing you do. There are lots of other options before you get to that point. That’s in your bag of tricks, but let’s see if we can try some other things first. They don’t want to do that. They don’t know any other strategy.
• I do the same thing around alcohol or other drugs. Start writing down all the times you’re using or use an app for that. And let’s see when you are drinking or using other drugs and how come. What are the effects? Simply doing that, believe it or not, can cut back people’s drug use.

Do you have a case study of someone who uses harm reduction and how it affected the family, what boundaries they set up, or how it worked?

• One of the things I love about harm reduction is that it’s not a one-size-fits-all. In doing harm reduction therapy, we’ll ask people to be abstinent for a period of time. We call it sobriety sampling.
• Look at this like a budget, a financial budget. If you’re going to look at a financial budget, how do you know how to budget if you don’t know what you’re spending? Right? So I want you to write everything down, but I want you to do that without judgment so that we can get a baseline of where you are.
• The conversation is always about the relationship, which confuses people. When I describe to them, “We’re going to look at your relationship to drugs,” they’ll always say, “I don’t have a relationship with drugs.” That’s part of what we want to look at and see. What does it cost you? What are those negative consequences, but also what are the positives? Because you must be getting something positive from that behavior.
• So we want to teach parents to say things like, you know, I love it when you’re not under the influence, you know, using meth, and we’re able to go out and have dinner together. Those are really special times that we all look forward to now.
• And if that’s your agreement that they’re not going to be under the influence when you get together, that’s a pretty typical one. Then you can say to your loved one, gosh, it’s too bad. We can tell you must’ve had a rough day today. Our agreement is that we only get together and go out when you’re not under the influence. It’s okay. Let’s give you a ride back.
• You may have heard of a research concept called contingency management. And essentially, what it means is rewarding positive behavior. We don’t use it in treatment in this country, even though it’s extremely effective.
• Watch the video to hear a beautiful piece by Gabor Maté. It sums up nicely how we can talk to people we love who are using substances problematically.
• Put on your oxygen mask. That’s so important to take that breath or several breaths. Nothing needs to happen right this moment. You have to believe that you can take that time, at least a few minutes, no matter what the crisis is.

Two additional resources for parents from Dee-Dee:

Dee-Dee Stout has worked in behavioral health for more than 30 years, and she relates her own personal story of addiction, other psychiatric diagnoses, and chronic pain to all conversations. Dee-Dee has been interviewed on television, radio, film, and print, discussing treatment issues, policy, and more. She has a private practice for individuals and families. She is an adjunct professor for the graduate department of Forensic and Counseling Psychology for Holy Names University in Oakland, CA. She is a frequent trainer across the country in evidence-based practices. Her book, “Coming to Harm Reduction Kicking and Screaming:  Looking for Harm Reduction in a 12-Step World,” is the basis for today’s conversation.