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Wednesday, September 22, 2010

Toward a Harm Reduction Approach in Survivor Advocacy (2001)


Reprinted from the Spring 2001 newsletter of Survivor Project. Jump to principles of harm reduction in survivor advocacy.
There is no question that everyone who takes part in the movement against domestic and sexual violence is working to reduce and eliminate harms of violence in our society, but not all of us come from the specific perspective known as the harm reduction approach. How, then, is the harm reduction approach different from other approaches, and why is it important?
Harm reduction is a philosophy first developed by people organizing against HIV/AIDS crisis and other health issues among injection drug users. Harm Reduction Coalition states: "Harm reduction is a set of practical strategies that reduce negative consequences of drug use, incorporating a spectrum of strategies from safer use, to managed use to abstinence. Harm reduction strategies meet drug users where they are at, addressing conditions of use along with the use itself." HRC further states the following principles: Harm reduction:
  • Accepts, for better and for worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.
  • Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.
  • Establishes quality of individual and community life and well-being--not necessarily cessation of all drug use--as the criteria for successful interventions and policies.
  • Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
  • Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.
  • Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.
  • Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people's vulnerability to and capacity for effectively dealing with drug-related harm.
  • Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use. Harm reduction approach stands in stark contrast to the law enforcement efforts to criminalize and prosecute drug use as well as to the medical community's efforts to pathologize it. Although there are different sets of implications arising from these competing frameworks, they both threaten to take away drug users' self-definition and to reduce the impact of serious social problems such as poverty and racism to individuals' moral or biological flaws.
Simply put, harm reduction is the opposite of these paternalistic approaches exemplified by law enforcement and medical communities. By "meeting drug users where they are at," providing clean needles, gears, and accurate information about safe usage, harm reduction approach aims to save lives without relying on coercion.
Sadly, paternalism also exists in the movement against domestic violence, often in the form of official shelter (hotline, etc.) policies as well as unofficial pressures compelling survivors to act in certain ways.
An example--an old one in fact--would be how advocates frequently pressure victims of domestic violence to leave their abusers through scare tactics and guilt trips. Of course, this tendency has began to shift as we learned the fact that leaving the abuser is the single most dangerous act a victim could take and therefore we should be weary of pressuring someone to leave when s/he is not ready to do so. However, as long as we pretend to know better than the survivor does what is in her or his best interest, we are bound to make the same mistake over and over. Instead of waiting for new researches to tell us which direction we need to push survivors to, we should adopt as a fundamental principle that survivors can decide for themselves what should be done in order to be safe, and stop pressuring them in any direction--that is the harm reduction approach to survivor advocacy.
Redefined in terms of domestic violence, harm reduction is a set of practical strategies that reduce negative consequences of certain survival and coping mechanisms survivors use. It believes in creating a larger pool of options survivors can choose from, rather than narrowing them down through paternalistic guidance. In simpler terms, I am referring to many coping mechanisms that others call "maladaptive" or "unhealthy": alcohol and drug use, self-hurting, survival sex, irregular eating and sleeping patterns, as well as being in contact with the abuser.
Of course, harm reduction would not deserve its name if it merely stepped back and sat by idly as survivors engage in these behaviors; on the contrary, harm reduction, if executed correctly, requires us as advocates to do much more work than if we were working from the paternalistic approach. Under the paternalistic approach, we simply ban those behaviors we deem harmful, label survivors who use such coping mechanisms pathological or uncooperative, sending them to "treatments" or kicking them out of our programs. In a shelter working from the harm reduction approach, we need to get over our presumptions and judgments, realistically assess actual dangers, provide accurate rather than exaggerated information, and assist survivors develop strategies to do whatever it takes for them to cope while staying relatively safe from extreme dangers. No coping mechanism is "maladaptive" or "unhealthy" in itself unless and until the survivor herself or himself decides it is--at which point we offer resources that can help them develop alternative coping mechanisms. The guiding principle here is to create more options rather than less.
Harm reduction does not mean that "anything goes" either: when one survivor's coping method directly threatens the safety of others, including that of her or his children, an intervention is warranted. This includes situations where the survivor is high from using drugs and acting reckless, for example. But even then, we can address negative impacts of the particular coping mechanism and how to keep it from harming other people without labeling and banning such coping mechanisms as maladaptive or pathological. In such a situation, the role of the advocate is to assist the survivor and everyone else affected come up with a way to remove the harm rather than instructing her or him what coping method can be deployed. Survivors' their own voices must play a prominent role in determining the parameters of any interventions that affect them.
Another situation where an advocate need to intervene is when the survivor's behavior is causing an imminent life-threatening danger to herself or himself, such as when she or he is unconscious from overdosing on drugs, bleeding heavily from cutting up the vein, or refusing to eat for an extended period of time. Because the purpose of harm reduction is to reduce harm as survivors engage in whatever behavior they need to in order to feel safe and in control, overlooking any behaviors that lead up to death defeats the purpose.
Harm reduction approach in survivor advocacy is fundamentally feminist, and is true to the roots of our movement of survivors creating resources for other survivors. It demands that advocates accept survivors as the source of authority and expertise in issues that concern them, rather than relying on so-called experts to determine what they need. It seeks to empower survivors to reduce the harms of their coping mechanisms rather than to modify their behaviors.
It is an alternative to the paternalistic ways survivors are treated within abusive relationships and then by legal and medical establishments. It is a natural progression of our movement whose purpose is to empower survivors in their own unique ways rather than merely secluding them from the rest of the mean world.
And it is possible, if we as the advocates stand up to our funders, boards, and legal and medical experts and state clearly that we will not be part of a system that routinely deny survivors' right to self-determination. A true advocacy is about creating more options rather than less, and we owe it to the survivors who come to our programs.

Harm Reduction Principles in Survivor Advocacy

based on the model by Harm Reduction Coalition; adoptation by Emi Koyama
  • Accepts, for better and for worse, that survivors learn to cope in whatever ways that reduce their pain and increase their sense of control, including those traditionally viewed as "unhealthy" (e.g. staying or maintaining contacts with the abuser, alcohol and drug use, wrist cutting and other self-harm, survival sex and sex work, irregular eating and sleeping patterns), and chooses to work to minimize their harmful effects rather than simply ignore or condemn them.
  • Understands each method of coping as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from recklessly extreme to no action, and acknowledges that some ways of doing it are clearly safer than others.
  • Establishes quality of individual and community life and well-being--not necessarily cessation of all activities deemed unhealthy or unsafe--as the criteria for successful interventions and policies.
  • Calls for the non-judgmental, non-coercive provision of services and resources to people who are coping with the effects and aftermath of abuse and the communities in which they live in order to assist them in reducing attendant harm.
  • Ensures that survivors themselves--both those receiving services currently and those who have in the past--routinely have a real voice in the creation of programs and policies designed to serve them.
  • Affirms survivors themselves as the primary agents of reducing the harms of their various coping methods as well as the authorities on their own experiences, and seeks to empower them to share information and support each other in strategies which meet their actual conditions of survival and coping.
  • Recognizes that the realities of poverty, class, racism, social isolation, past trauma, discrimination and other social inequalities affect both survivors' vulnerability to and capacity for effectively dealing with the effects and aftermath of the abuse.
  • Does not attempt to minimize or ignore the real and tragic harm and danger associated with certain coping methods survivors may employ.

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