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Harm Reduction in the Real World · Talking FACS

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  Welcome to Talking Facts.
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  What you need to know about family food finance and fitness.
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  This nationally recognized award winning podcast is hosted by the University of Kentucky Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals,
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  families and communities to improve quality of life.
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  Hello and welcome to Talking Facts.
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  What you need to know about family food finance and fitness.
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  I am your host,
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  Mindy mccully Extension Specialist for instructional support at the University of Kentucky.
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  Today,
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  Doctor Alex Elswick Extension specialist for substance use prevention and recovery is joining me again.
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  So welcome Alex.
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  Good morning,
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  Mindy.
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  And our topic today is harm reduction in the real world.
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  And we're gonna talk about how harm reduction which we talked about on our last show,
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  the implications for that in life.
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  So let's just dive right in.
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  It's a great idea to do this follow up podcast because I think you did a tremendous job with our last podcast as you always do Mindy.
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  Uh but I also think harm reduction is,
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  it's a little nuanced and a little complicated and it's helpful to have it applied in kind of the real world in a way that makes sense.
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  And so I think it makes a lot of sense to,
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  to apply harm reduction in this context.
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  So one way that I thought we could think about harm reduction is how we apply harm reduction and prevention.
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  Because our traditional approach as we kind of alluded to in our last podcast,
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  that prohibition approach has been to tell kids drugs are bad,
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  just say no.
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  Um And what that does is if you,
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  if you just take a hard line stance that says drugs are bad,
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  just say no,
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  it precludes any discussion about what actually is harmful about drugs for whom they're harmful under what conditions.
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  So I'll give you just one example as drugs go,
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  cannabis is largely considered one of the safer drugs.
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  But there's a a robust body of research that shows for people who have a history of schizophrenia in their family.
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  Cannabis use can be particularly harmful because it can actually trigger the onset of schizophrenia and schizophrenic symptoms.
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  So it would be something really valuable to teach young people that if you have this in your family,
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  you should wholly avoid cannabis.
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  And that's not,
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  you know,
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  we,
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  we can't get to that granular level of really telling kids what their individual risk is because the way that we're having the conversation,
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  conversation is,
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  hey,
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  all these drugs are bad and stay away from them,
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  right?
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  When in reality,
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  since they were born,
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  we've been giving them drugs,
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  whether it was a baby aspirin or recife or whatever drug it is that,
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  that we've needed to keep them healthy.
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  We've been doing that since birth.
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  And I love that you brought up that point because I think for young people it's dissonant.
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  It's confusing.
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  It doesn't,
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  it's,
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  it's a contradiction for us to say constantly the same refrain,
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  just say no drugs are bad.
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  But every time I get home from school and dad gets off work,
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  he pops the top on a Coors light silver bullet AAA beer or whatever.
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  Right?
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  And that's not bad.
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  And we're not trying to pathologize that or say that dad's a bad person for doing that.
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  Dad's using alcohol and using it responsibly and that's fine.
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  We should teach kids that we should teach them that that's what dad's doing rather than act like,
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  um,
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  they're just gonna ignore the fact that moms smoke cigarettes,
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  but we're telling them drugs are bad.
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  Drugs are bad.
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  It's,
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  I think very confusing for young people and it requires us to have a more nuanced conversation.
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  Yeah.
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  And that's sometimes tricky for us as human beings.
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  Right?
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  It definitely is because we like to see things in black and white and one thing I can appreciate,
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  um,
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  my partner's daughter is,
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  um,
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  six years old as I learn more and more is why you want things to be black and white as a parent because everything's in the gray,
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  isn't it?
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  You know,
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  it's just,
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  I get it,
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  especially with Children to a certain point that they don't understand the gray,
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  the black and white is what makes sense.
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  And so we have to kind of go where they are.
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  That's right.
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  One example is sometimes after I've spoken at like a,
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  a middle school,
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  for instance,
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  I'll have young people come up to me afterwards who are really concerned that they,
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  for instance,
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  that their mom smokes a Vape and that she's gonna end up going to jail.
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  And they think that,
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  you know,
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  that what's happened to me because of heroin is gonna happen to their parents because of nicotine.
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  And what I realize is no one has explained to them anything.
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  There's so much that they don't know because again,
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  we've been having that one dimensional conversation about drugs.
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  Yeah.
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  Ok.
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  So we've talked about absence about,
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  just say no.
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  And you and I both grew,
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  have grown up in a world where probably those things that were forbidden were the things that had the most interest for us.
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  Exactly.
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  And so maybe we need to talk about that a little bit more.
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  That's exactly right.
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  This is a good segue from prevention because the way that the sort of the failures of abstinence based sex education I think can teach us a lot about the failures of abstinence based drug education.
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  So,
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  for,
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  for decades,
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  we,
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  we practiced abstinence based sex education,
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  which means we taught kids to abstain from sex until marriage.
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  We used,
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  um,
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  scare tactics,
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  you know,
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  the scary pictures of S T I S and that sort of thing.
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  And that was really it,
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  that was the limited extent.
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  We didn't talk to kids about actual practical strategies to reduce their harm if they choose to have sex.
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  We wanted to sort of ignore that kids might have sex and sort of pull the curtain over our eyes and say,
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  well,
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  they,
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  we just hope that they aren't.
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  But again,
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  harm reduction lives in the uncomfortable reality,
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  the uncomfortable fact that kids,
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  some young people are going to choose to have sex.
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  And if that's true,
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  then it's pretty critical that we arm them with the facts so that they can reduce their harm,
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  the likelihood of,
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  uh,
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  unwanted pregnancy or an S T I.
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  And the same thing is true of,
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  of abstinence based drug education.
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  When,
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  when we have that one dimensional conversation as we've established,
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  you can't get down and,
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  and really talk about harm.
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  But when you,
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  when you practice a harm reduction approach to doing prevention,
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  you can tell kids the truth about drugs and that doesn't mean you're telling them some graphic awful story.
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  Of course,
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  we're gonna make it age and stage appropriate.
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  We're gonna,
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  we're gonna meet kids where they are.
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  But,
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  but insofar as we're able,
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  we're also gonna arm them with the reality of that,
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  that,
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  that some drugs are safer than others and some ways of using drugs are safer than others so that they know what really is harmful and what actually might be a threat to their life or to the lives of their friends.
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  Abstinence based education might work for the rule followers.
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  But there are awful lot of non rule followers in the world.
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  So we need to recognize that.
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  Right.
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  Mindy,
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  you have like an intuitive sense of how to do this.
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  I'm telling you.
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  But you're exactly right.
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  That's exactly what the research shows in prevention.
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  It basically shows you can divide a gymnasium full of middle schoolers into three groups.
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  There's a group who because of their genetics,
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  their protective factors assort assortment of reasons.
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  They're just never gonna use drugs.
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  They're just not,
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  it doesn't matter if they're put in certain social situations,
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  it doesn't,
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  they're just not on the other side of the spectrum.
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  There's a third who doesn't really matter what interventions you implement,
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  they're probably going to use drugs or they're gonna experiment with drugs.
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  I mean,
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  they're gonna try some drugs.
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  They just have all of the risk factors.
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  Your,
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  your one time school program is gonna be ineffective against that.
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  But then in the middle,
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  you have a middle third that we call like the persuadable middle,
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  which are the kids that you're really trying to target a lot with a lot of your prevention activities because you're trying to say,
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  hey,
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  you need to know what the reality of your situation is that,
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  that sounds perfectly logical to me.
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  So what are some implications for family members as we talk about harm reduction as opposed to simply just say,
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  no harm reduction gives family members a different way forward,
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  I guess is a way a way to say this.
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  So the traditional prohibition approach has said to family members,
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  if your loved ones addicted,
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  you need to cut them off,
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  you need to give them an ultimatum,
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  you need to kick them out the door um until they hit rock bottom so that they can go and be well.
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  And we had 100,000 people this past year whose rock bottom was dying.
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  And so,
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  you know that,
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  that rock bottom concept was developed in a a and about alcohol and you know,
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  most people aren't gonna overdose on alcohol,
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  not nearly the risk of overdosing on opioids.
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  So I say all that to say,
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  um rock bottom has a different meaning today than it did back then.
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  And so the harm reduction approach instead says,
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  rather than trying to force our family members to hit bottom,
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  we're sort of gonna try to do the opposite.
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  We're gonna try to prevent the harm as much as possible.
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  And so the best way to,
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  to tell you kind of the value that I want to tell you a story about my friend Jessie B.
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  Jessie B.
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  I'm sharing this with permission.
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  Jess B um is a,
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  a mom in a southern state whose daughter became addicted to heroin.
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  And she started,
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  do you know,
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  she sought advice from everyone she could,
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  her primary care provider,
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  she went to some alon meetings,
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  she talked to other affected parents and she sort of heard different versions of she needs to cut her daughter off,
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  she needs to kick her out.
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  And so she tried that and she watched as her daughter got worse and worse and worse and she ultimately realized had her own sort of epiphany that her daughter is using drugs.
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  That was her epiphany.
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  She said,
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  I just,
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  I didn't want it to be true.
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  I wanted so to believe that she was gonna quit the next day,
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  it was always gonna be the next day.
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  And she said,
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  finally,
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  I accepted the reality.
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  My daughter is using drugs and those drugs are harmful and I want to keep my daughter alive.
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  And so she talked about how she started learning about harm reduction.
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  She bought naloxone,
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  started getting that for her daughter.
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  She started um,
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  getting access to sterile syringes for her daughter asking her daughter to use drugs in the house as opposed to using drugs out of the house so that if she were to experience an overdose,
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  then her mom could revive her.
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  And so she's talking about all of these little hr kind of practical strategies she implemented.
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  She said,
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  but you know,
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  Alex,
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  the thing that,
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  that sold me on harm reduction,
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  the most is.
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  It's enabled me to have a relationship with my daughter all along the way.
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  It's not the relationship that I would choose because I wish my daughter were completely happy and completely healthy and we could have that relationship,
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  she said,
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  but it's better than nothing.
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  It's better than my daughter suffering out there in the street.
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  And me wondering every day where she is that,
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  that for me was a powerful instruction in what harm reduction is.
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  If you do harm reduction as a family member,
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  you're able to be connected to your loved one no matter what.
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  And I think that,
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  that we've just wrapped up a book club,
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  beautiful boy by David Chef that you.
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  But as I read that book,
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  I was struck by,
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  I think I saw the father move through this continuum.
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  You know,
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  at first he turned and,
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  you know,
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  said go,
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  go do your thing and,
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  and when you're well come back basically,
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  and then realized that if he wanted a relationship with his child,
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  that he was gonna have to be involved in that.
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  And,
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  you know,
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  that's probably a great place to kind of wrap this off because harm reduction has been a journey for everyone I've ever met.
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  Uh most people who come to,
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  to really embrace harm reduction.
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  They started on that other end and they,
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  they started with that prohibition.
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  We got to get everybody to stop using drugs.
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  That certainly was my crusade when I first got sober because I wanted everyone else to be sober.
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  I was happy and it was working for me.
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  And so I wanted it to be working for everyone.
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  And over time I came to understand everyone isn't me.
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  They don't have the resources that I have at my disposal.
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  They might have different barriers.
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  We're all having different experiences.
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  And so we really have to find a way to meet people right Where they are and harm reduction does that.
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  And I think you're right.
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  That's a perfect way to wrap this up.
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  Thank you,
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  Alex for joining me today.
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  I know that this discussion has been so important for our listeners and for our future listeners.
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  I hope as well.
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  Yeah.
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  Thank you for the opportunity to have it with me.
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