Ep 54 Harm Reduction with guest Lara Okoloko, LCSW

Living With Your Child's Addiction Podcast
Living With Your Child's Addiction Podcast
Ep 54 Harm Reduction with guest Lara Okoloko, LCSW

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. It incorporates a spectrum of strategies that includes safer use, managed use, abstinence, meeting people who use drugs “where they’re at,” and addressing conditions of use along with the use itself. Harm reduction is critical to keeping people who use drugs alive and as healthy as possible.
Some of the topics discussed in this episode:
The 8 principles of harm reduction
Examples of harm reduction strategies for family members
How harm reduction helps with stigma
Links from this episode:
Lara Okolo’s Website
Article by Pat Denning about Harm Reduction in The Journal of Clinical Psychology
The National Harm Reduction Coalition
Episodes to listen to next:
Episode 35 Releasing Judgement
Episode 36 What to do about all the lies
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This transcript has not been formatted or edited.


I’m Heather after many wasted years, trying outdated, approaches to my daughter’s addiction, that felt wrong to me harmed.

Our relationship and didn’t help my daughter.

I finally found an effective evidence-based approach.


That repair my relationship with her helped me.

Create my own peace of mind and made me an ally in my daughter’s recovery.

I teach you a loving and compassionate approach to help you encourage change.

And create connection addiction impacts the entire family system.


Family recovery is the answer.

Today’s topic is harm reduction and I wanted to talk about harm reduction for a while because it’s a my dog, she does.


It’s like 8:45 at night and she gets really rambunctious when we work past 8:00 p.m., she is just in, this is past her working hours and she’s letting me know.

So I’m going to keep going, she’s running around and being rambunctious with a toy but Wanted to talk about harm reduction for a while because it’s a helpful concept, and because of my initial reaction to it, I reacted to it with judgment because I saw it as permissive.


I was looking at it from a place of fear and control because that’s where I was in my journey.

When I found out about harm reduction, My Lens had not changed yet.

I wasn’t in that compassionate and understanding.


Adding place and it was not easy for me to make that change.

There was always doubt they’re in different situations and I want to remove as much of that judgment and doubt from the situation for you as you listen to this, what we’re going through and what our kids are going through is hard enough without constant self-doubt, and we need tools that work.


So hopefully Episode helps you with that.

According to harm reduction, dot-org harm reduction incorporates.

A spectrum of strategies that include safer, use managed, use abstinence meeting.


People who use drugs, where they’re at, and addressing conditions of use along with the use itself, because harm reduction demands that interventions and policies designed to Have people who use drugs, reflects specific individual and Community needs.


There is no Universal definition or formula for implementing harm reduction.

However, National harm reduction Coalition, considers the following eight principles Central to the harm, reduction practice.

Number one, accepts For Better or Worse that illicit or licit.


And illicit.

Drug use is part of our world and chooses to work too.

A mais, its harmful effects rather than simply ignore or condemn them, number two understands drug use as a complex multifaceted phenomenon that encompasses a Continuum of behaviors from severe.


Use to Total abstinence and acknowledges, that some ways of using drugs are clearly safer than others.

Number three, establishes, quality of individual and community life and well-being, not Lee cessation of all drug use is the criteria for successful interventions and policies.


Number four, 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, in order to assist them in reducing attendant harm number 5, Ensures that people who use drugs and those with a history of drug, use routinely have a real voice in the creation of programs and policies designed to serve them.


Number six, a firm’s people who use drugs themselves as the primary agents of reducing the harms of their drug use, and seeks to empower people who use drugs to share information and support each other in strategies, which meet their actual conditions of use.


Number seven, 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.


Number 8 does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug.


If you noticed, as I was reading the harm reduction that it is not black and white, right?


It’s not one size, fits all.

And that’s what I like about it.

It’s realistic respectful and compassionate and it’s focused on safety.

And so that brings me to telling you about today’s guests.


I met her during a training that I took last month, it was the invitation to change workshop and invitation to changes similar to craft.

And I was drawn to Laura’s compassionate approach to helping families with their loved ones addiction.


So I reached out to ask her to be on the podcast to talk about harm reduction.

Today, Laura Oka, Loco is a licensed clinical social worker in Washington state.

She has a private practice where Is a family therapist.

She also teaches a master of Social Work, students and supervises, new clinical social workers in the field before working as a therapist, she worked, as a medical social worker and a social worker with people, experiencing homelessness and her therapy practice she focuses on working with families who want to help their Partners or children of any age.


Find Healing from substance use problems.

She uses an evidence-based Counseling Practice called community.

Reinforcement and family training, an alternative to confrontational.

Interventions are Al-Anon.

She is also a certified craft trainer.

She advocates for any approach that helps people stay safe, improve their quality of life and recover including harm reduction.


She has a real passion for improving the field of services for people with addictions like other medical and behavioral health issues.

She says that people with substance use disorder deserve access to high quality.

Dignified and respectful services for themselves and their families.


Her work is also shaped by her alliance with intersectional feminism, and her commitment to an anti-oppressive practice.

I hope you enjoy our conversation that you’re about to hear and more than that.

I hope that it removes.


Some of the doubt that comes up around safety and compassion.

When you’re done listening, make sure you check out the show notes for links to everything that we Ernst in the episode and also Lara’s website.

Hi everybody.


We have a new guest on that episode today, Laura Oka, Loco, agreed to come on and talk about harm reduction, which is something that’s been on my podcast wish list for a while.

Probably because my initial response to harm reduction when I heard about it was, I didn’t really understand it and it was a little bit – and so, I think the better understanding that we have something like harm reduction The easier it is for us to implement new processes like that with our kids.


So it helped me a lot with understanding my daughter and not expecting Perfection and not causing more painful feelings between us than we were already experiencing.

So Laura, thank you so much for spending this time talking with us today.


Yeah, I’m glad to be done with you.

So the first thing I want to talk about is how how you explain harm reduction to a family member when you introduce that concept to them.

When you I was thinking about that in preparation for talking to about it.


And realized, I don’t really do a formal introduction of harm reduction, the way that I would to a student or to a new therapist that I’m supervising or on a podcast like this.

That usually I’m saying something about harm reduction, to help a client of mine.


Understand, maybe why I’m answering a question the way that I am and my answer is usually, very simple.

So I might say something like, I believe in harm reduction, and that’s why we’re going to prioritize safety here over strategy.

So, I might say something, very simple like that or or whatever is relevant to what we’re talking about that.


I might talk about why we’re going to take a respectful approach and respect.

Someone’s boundaries are rights.

So it’s usually a pretty short explanation that really doesn’t get at like some academic answer about the depths of the philosophy of harm reduction.


Probably just probably what we might talk about a little bit more.

Yeah my introduction to it was there’s two things that I really remember.

One was my daughter was on kind of on probation and sure the person that she reported to I do Want to call my probation officer, because she was a minor and it was just, she was just refusing to followed directions.


So they started putting her on more and more restrictions but she had to do twice a week drug tests.

And he was the first one to really tell me about harm reduction and his explanation was just that they wanted them to use less.

They didn’t expect full compliance or totally clean drug tests every time.


But she said that to just me not in front of my daughter because They tell them the expectation is 100% so that was like the first time that opened the door to about it a little bit to me.

So that opened my mind to it.

And then the next time was hearing about a needle exchange which I didn’t have such an open mind about because to me it felt like initially, like it was saying that it was okay, right.


Instead of the safety aspect like you were just talking about, like, down the road when my daughter had more Or infections and she ended up in the hospital from injecting and reusing the same needle I started thinking about it a little differently.


Like okay, well maybe this is really important and then of course, after my daughter died there was a thought, well if she had been able to use safely somewhere with somebody around who had naloxone, she might still be alive and so that safety aspect now Have a totally different place in my heart with these realizations along the way.


So if we can help somebody realize sooner today, what would say that actually that issue?

My kind of description of harm reduction is usually just that piece is, I is just clients.

Hearing me, say, we’re going to prioritize safety first and that’s usually whenever the only, the only thing, initially that people might kind of hear me say that, they think maybe there’s something behind that other than just, Just prioritizing the person safety, but I think you you’re talking about some of the common resistance to some of those ideas that to provide for someone safety means that we’re improving or encouraging, a certain behavior.


And so I found it helpful in my own learning about harm reduction is to think about the parallels and other areas of Public Health or safety, because it’s much more intuitive sometimes And some of those Realms.

So for example, wearing a helmet is a thing we do when we’re doing risky activity and what?


It’d be safer to never write on a skateboard or motorcycle or bike?

Yes, but if someone’s going to choose to do that risky activity, then we want them to wear a helmet and that doesn’t mean that we think that they it’s good to be Reckless seat.


Belts are another example of that condoms are.

Another example of that, there’s lots of examples Bowls of things that we promote old to engage and safer, engagement of a potentially risky activity.

And so, I think sometimes broadening our concept of harm reduction helps it to make sense a little more.


Yeah, I really like that concept of thinking about it, relating it, to other things, that aren’t so.

We don’t have such an emotional attachment to and maybe there’s not the stigma related to it.

I think that helps and also Again, the thinking about the safety aspect of it, makes it simpler for me.


So, is that really the hardest part about introducing harm reduction to family members?

Is it the stigma and the beliefs about addiction?

I guess?

Or maybe like I just hear this over and over again.

From parents is just everything is the fear of my gosh?


Am I enabling by doing this?

Yeah and that’s such a big question that people have About being really scared that they’re enabling, which kind of underneath that I think is ways that people get blamed for the addiction that a loved one has and it’s kind of like a backdoor way of blaming people.


And so, even bigger than harm reduction is this like bigger idea of what does that mean?

What does enabling mean?

And how does one know that they’re doing it to visited?

Good or bad thing is, it always bad.

And the way that I addressed that issue with my clients is to really ask them to finish the question of enabling.



Because the important part of that question is the behavior that you’re enabling?

Is it a behavior?

You want more of our Behavior if you want less of?

So if you’re giving your kid a ride to their outpatient sessions, are you enabling?


Yes, you are enabling making a bowl.

For them to go to those meetings.

Is that a behavior?

You like?


Okay, then you can keep doing that if you want, you you’re not obliged to do it.

You could say no I’m not going to give you a ride but you’re enabling your behavior, you are wanting them to engage in.


So then on the other hand, if you’re enabling helping to make able a behavior, you don’t want them to do.

You might consider not doing that one.

You might consider picking other helpful behaviors, rather than that one, and helping your loved one in a different way.



Yeah, I agree.

When you think of it more like, okay, what do I want to positively reinforce versus fear of what, I’m enabling?

Because every time you think of enabling, I feel like people convince themselves that anything could be enabling.


So when you think about like, okay, what do I want them to do?

More of than it, makes it a lot easier to decide it’s just so so condemning.


And I think it can get in the way.

Family is being loving and kind and present and in relationship when we have these kind of broad ideas of things to avoid and we don’t get into some of that Nuance of some of those terms.


And as a family therapist for people with substance use problems, I don’t want families to stop being helpful or kind, or present or in relationship with one another because family relationships are protective.

It’s an important protective factor for vulnerable people.


Yeah, absolutely.

And I love the kindness aspect of it as well.

Let’s go back to like, can we talk about a couple other examples of harm reductions when it comes to abusing substances?

So I think there’s, there’s Kind of two Realms of harm reduction.


There’s really where most of harm reduction lives which is in Services provided directly to people with substance use disorders and which is are not the services I’m providing.

Because I’m working with the family members of people with substance use disorders and harm reduction for families is a much lesser written about topic, covered topic, it’s kind of on the sidelines of it.


And so I don’t want to ignore a kind of In parts of harm reduction, which is those Services directly to people.

But for the family side of it to me, harm reduction for families looks like if your loved one has an opioid use disorder than learning about overdose and how to recognize signs of Overdose having Narcan at your house.


If the person lives with you or spends time at your house, providing stable housing is a harm reduction tool.

Anything that makes people safer Or even if they’re not yet ready to be in treatment, even if they’re not yet ready to change their substance use patterns, even if they’re not yet ready to quit.


So other things family members can do that are to me.

Harm reduction is to be willing to continue to pay for health insurance or help your loved one.

Get signed up with Medicaid or pay for co-pays or anything that removes barriers for your loved one to engage in healthy activity or Treatment activity.


Those are the, some of the examples of things that are harm reduction activities because they’re saying the message is, you may not be ready for what I wish you were ready for, but I’m wanting to connect with you.

I want to be helpful to you.

I want to be kind to you.

I want to help you to take steps towards your own safety and well-being.


Even if it doesn’t include abstinence from substances right now, yeah, I really like the, you said, removing barriers, I Think that that’s a really great way to look at it because a lot of times we hear the tough love kind of approach.


Like if they wanted, they’ll figure it out.

And me going through my own health issues.

Last year, I had breast cancer, I needed, family, support, you know, I can’t even imagine anything else.

Somebody saying to me?

Well, Heather, if you wanted it, you’d figure it out.

Like, I needed help navigating the health system just with that and I had a clear mind.


And so it’s a much less predatory Healthcare System than what people with mental illness and substance use disorders are trying to navigate.

So I love that normalization that you’re providing, which is you needed, help you needed support.


And there’s a lot of drawing.

Those parallels are really helpful to understand the approach for harm reduction.

That no one would say that you don’t really want it or that or something – about you.


If you wanted a loved one in one of those meetings to help you take notes because you’re going to forget what your what was said or no one’s going to think something negative about you if you want to get a second opinion.

So there are things in healthcare that are totally okay for almost everybody.

But when a person with a substance use disorder has its we have a negative spin on it.


We don’t allow for the same type of help or support or encouragement and Healthcare navigation.

So that’s another thing that families And do that.

I really encourage most of my family’s that work with me, is to be willing to be a Healthcare Advocate for their loved.

One dies, a great role for families to increase the protective nature of their family relationship.



And I was just thinking about how I could have easily been judged as saying like treatment-resistant.

I wanted to do things my way.

I went to see multiple people.

I didn’t want to do exactly what my doctors were telling me to do, it was my quality of life that.


Mattered to me.

So if we can look at it from that perspective like you said like any other situation where we’re navigating the healthcare system and how it’s different for each person.



Well and you just raised two issues that are relevant in harm reduction.

And one of them is your right to self-determine as the patient and self-determination is one.

I think it’s an important part of harm reduction, the philosophy of harm reduction.

Just respecting the self-determination of the client and as a social worker, that’s part of my code of ethics.


So that’s important to me as well.

And then you also talked about quality of life and that’s also an important harm reduction concept as well, which is we can support people and increasing quality of life.

Even if they’re not ready for total abstinence.


Yeah, absolutely.

I can see that bike on the path with my daughter before she was willing to become.

Totally abstinent.

She had to try one point.

She wanted to try just smoking pot, which was a huge harm reduction from injecting heroin.


And I did not feel that that was what was best, but I had to allow her, the Dignity of figuring that out for herself.

I can’t imagine what it’s like to face the thought of I can never do this again.


I’m never going to be able to use Any substance without some resistance to it or some desire for trial and error.

So I had to give her the Dignity of figuring out that that didn’t work for her and that she had to.


But she had to take it one step at a time on her own path.

Yes, you’re doing such a good job of covering all the harm reduction topics which is respecting the Dignity of each person of starting with a person’s at.

So Which is an important concept here, which is rather than saying, here’s the bar, you have to jump over, it’s really high up here and if you don’t jump over and then I know that you’re not, you don’t mean there, you don’t want our, you’re not willing, but instead to say, let me come meet you where you are and then, let’s see where we can go from there.


And so, to me, it’s really immoral.

Unethical wrong to meet someone who says I would like to, for, like your example, I To reduce or eliminate my opioid use.


But I’m going to continue my cannabis use and to say, I’m not willing to help you until you’re willing to do all the things I want you to do.

I’m going to provide, you know, assistance whatsoever with the life-threatening issue that you have because I have a junction to your cannabis use.


I mean I just can’t understand that approach to being to helping people rather than to say that is a great goal and that goal really reduces a lot of harm and potential.

Risking your life.

So I would love to help you with that and support you in that and maybe that person will decide later that their cannabis use causes problems in their life.


And they would like to look at that or maybe their cannabis use doesn’t cause problems in their life or maybe it causes problems in their life and they don’t want to look at it.

They have a right to all those things.

Yeah absolutely.

And I can’t imagine any other condition that somebody would be dealing with that.


We had.

They would be told there’s only one way that will help you.

All you have to do it.

This one way, I had a friend from the safe home podcast.

She wrote post one day about her son experienced that where he was told, unless he totally quit, everything they wouldn’t help him and she was like, can you imagine if somebody was diabetic?


And we said, you know, unless you quit eating sugar, we won’t give you insulin or we won’t do anything to help you like it’s unimaginable.

Yes, yes.

Those are great parallels.

Similarly, with just about anything if Take depression, for example, that a lot of people experience, we know that medication can be very helpful to some people with depression.


And also, if you don’t want medication, I can’t imagine being told you’re not allowed to try therapy, talk therapy if you’re not willing to do the medication.

So there’s lots of other places where we have Choice as the patient about what Carrie want to engage in, what our goals are.


And so these are important parts of harm reduction, which is to start with a person’s ad to do.

Works to prioritize safety to understand the clients goals and to work for the clients goals rather than your own.

To as you said earlier, about one being able to take one step at a time, as you start where someone’s at, who walk with them, whatever steps.


They’re willing to take will do those ones and often change begets change and momentum often causes more movement and so that’s great.

That’s often the path that people take two.

To some people, may start in kind of more traditional harm reduction reduction, approaches and up deciding the abstinence is best for them or not.


And that’s fine too.

So, can you give some examples of some harm reductions for the person with substance use disorder that because I know, as a parent without specific examples are brains going to go to is this right?


Is this okay?

So, can you give some Like examples of that.

So for the person with the substance use disorder, harm reduction services are really anything.

That one has the embodies the philosophy of a respectful compassionate, pragmatic approach.


And so that can include things, like the examples you gave, like needle of clean needle program or needle exchange program or it could include if we think really broadly.

They could include someone engaging in healthcare that doesn’t include Direct Services for the substance use disorder for example, you know, having a wound or abscess looked at by a doctor or psychiatric meds for other things.


At the persons experiencing there also is a whole world of harm reduction Psychotherapy, which is in the harm reduction umbrella.

But Is you know what?

We would think of.

It’s like talk therapy with the harm reduction philosophy and so there’s a few authors who have written about harm reduction, Psychotherapy and have good books on that.


If there are people listening who are therapists or counselors themselves, that want to learn about it.

But essentially, if you were looking for harm reduction therapist for a loved one, you would be looking for someone who is knowledgeable about substance use disorders as a warm curiosity about where the person’s at and how they experience their relationship with substances.


And wants to work with someone wherever they are on the change Spectrum in a respectful way.

I didn’t even know about that because from what I have heard in some ways, I know that therapist will not see somebody if they’re using bright.


Yes, that’s true.

A lot of people I think we’ve had a long history of abstinence-only services, really being the standard of care and I think that’s that has begun to change, but I think it’s made us feel that it’s A to tell people that are not willing to work with them unless they’re willing to work on our goals instead of their own goals.


And I think that’s been accepted for a long time so I don’t think that’s okay.

But I think that’s been the standard for a long time.

Yeah, I agree because you need tools in order to quit or reduce you substance use and how are you supposed to do that if nobody will work with you to give you the tools that you need?


Yeah, I mean this substance use sorta is one of the few things that to engage in therapeutic services.

People often have to promise to not do the symptoms in order to get the help to reduce the symptoms.

We don’t really do that anywhere else.


And so I think there’s still that really comes from kind of the moralistic beginnings of what passed for therapeutic services for substance use disorders, and still is like embedded in our Treatment World in a lot of ways.


So how does the harm reduction approach, help with stigma in the broad sense?

I think it helps with stigma because we are doing the opposite of what stigma tells us to do, which is to judge to stereotype and to reject people.


And instead says, we’re going to be curious about people, we’re going to be non-judgmental, we’re going to respect people, which is not only about out treating people respectfully but about respecting their civil, right?

And their human rights about not being coercive about not trying to control people to be respectful of people’s boundaries.


I think at its Essence, it fights stigma to say.

We’re not going to treat people.

Like second-class citizens are not going to treat people.

Like unworthy beings, we’re not going to treat people like they are unworthy now and it is only through abstinence They are going to be redeemed of become worthy people.


There were the people now they’re deserving of respect and dignity.

Now, regardless of what their relationship has with substances.

Yeah, I love that.

That’s, and I’ve heard you say, compassion and respect several times, and I think that that’s so important because it’s really often left out of the equation and it wouldn’t be acceptable.


Well, under any other circumstances to not have a compassionate and respectful approach for some reason?

That’s what’s happened over time.

And I think that this conversation can go a long way to help make it more comfortable.


That’s the hard part for me when I look back and I think how uncomfortable it was for me for so long and even after years of doing the work that I’ve done the things that I was still in the And when my daughter relapse for the last time I was still struggling with fears of enabling and what’s the right thing to do and the fear of doing too much.


And I mean with hindsight, I wish I had done more but there’s still like it’s to me, the hardest thing that family members or any other loved ones have to fight.

Is that fear like that?


It’s wrong to be respectful and compassionate that you’re harming them.

The person that you love more than helping them if you show up that way, right?

Well and I think what you’re saying is really important because I do think this approach does require whether you’re their parent or family member a loved one or whether you’re the therapist, it does require managing your discomfort and so I can understand why I although I don’t think it’s right, I can understand that.


Draw to work with the philosophy that says, when your behavior makes me uncomfortable, I’m going to tell you, I’m not going to see you anymore until you stop that behavior.

I think it is harder to be with people in relationship with them when they are suffering and when they’re really challenged and to be their compassion, by definition is painful.


It is to share in people’s Pain and to have to feel for people.

And I think we use judgment and rejection and termination from Services.

We use all those things in a lot of ways to manage our discomfort.


And there’s a one of the kind of Founders leaders important people.

In the harm reduction world are two people in San Francisco, Pat Denning and Jeannie little.

And I can’t remember who it was.

One of them was on a podcast.

I listened to years.

Ago and the interviewer had asked them a question about.


Well, how do you something on the lines of?

How do you manage when the people that you’re trying to help or doing scary dangerous things?

And her answer was something like, it’s exactly that.

I have to manage.

I have to manage myself.

First, I have to manage my own feelings and reactions first.


And so I, when I think about my work with family members, and how does this apply to like the parents of someone with a substance use disorder, a lot of my work with the Family member is about learning the difference between having boundaries which is about me versus controlling somebody else’s Behavior.


Because if people can learn to know that difference and to understand what your own boundaries are, then you can still care for yourself, which is about boundaries to me is about knowing where your limits are and you can know, it’s okay to have limits as a family member to say this.


This is too much.

For me or I can do this for you but I can’t do this for me.

It’s too distressing to me and that’s not the same thing as saying you have to if you don’t, I’m going to punish you in some way or over to try to control the other person.

But to say, I can respect your decisions to do certain things do.


Or don’t do certain things, you’re deciding, but I get to decide for myself, what I can tolerate, and where my limits are in this relationship.


And I love what you said about discomfort.

I think that that’s like the number one skill that I had to develop as a parent was just the tolerating my discomfort without reacting to it with being able to take my time and have a measured response instead of a reaction that I regretted and really not expecting her to fix my discomfort.



And I mean, and that’s something that’s similar.

I like to see our similarities that we have with our loved one, is they have struggled with their discomfort in the substance.

Abuse is what relieves that for them.

And, you know, we’re just doing different things to try to relieve our discomfort and it’s both of unless we’re able to tolerate our discomfort.


What we’re doing is not helping And that’s the human condition for all of us.

We don’t want to be in pain, we don’t want to be uncomfortable and we develop all kinds of methods of coping with that.

Avoiding it soothing it like we all do that.


There’s a lot of things about addiction that we can all relate to.


Yeah, absolutely.

But when we can see that instead of focusing on how bad and wrong different, it is that we can see those similarities.

It helps bring down some of the emotions so that we can think and reason through it.


So what do you think?

The hardest part is for parents or loved ones when it comes to opening up to the idea of harm reduction?

I think there are some like pragmatic difficulties.

I think it can be hard to find support when you’re trying to use a practice or philosophy or approach, that doesn’t feel like the mainstream thing.


And so I think that’s a difficulty for people.

So some places where people can find support are in looking for, for example, a smart recovery, family and friends meeting or craft, based support groups for families from the website, helping families.


Help, I think those are some alternative places that people can go to try to find Community, which are not not explicitly harm, reduction spaces, but they are kind of respectful.

Pragmatic compassionate approaches that don’t have kind of better not built around attachment or hard lines and so finding support so that you don’t feel like you’re doing something that feels like it doesn’t have that there aren’t plenty of people out there that are using these approaches.


And and so I think that’s I think Community is important and I think it can also maybe be helpful to just read about some of these approaches and how they are effective.

And so Even if you are not in, don’t live in the academic world and you’re not a researcher and you don’t have all these paid Journal subscriptions, to read those articles.


You can go on Google Scholar and you can access millions of Journal articles and at least read the abstracts.

And so, I think that’s a way that people can also, kind of fact, chat for themselves.

So, say these might seem like radical ideas because they’re different than the mainstream but they’re really not that radical, especially if you’re in the The kind of healthcare research world where it’s a pretty accepted that these are helpful practices and effective practices.


So I think those things are helpful getting support for yourself so that you can work through some of the things that we’ve talked about what are the questions that come up for you as you’re trying to help in this different way and especially this piece about boundaries or limits for yourself because I really believe that good boundaries which again is not about telling other Do what they have to do, but about knowing ourselves and our own limits that good boundaries help us to avoid burnout.


And when we burn out of relationships, we cut people off to feel better good, boundaries help us to act in our own integrity and the relationships were in and good boundaries help us to avoid resentful being resentful and resentments awful for relationships.

So that feels like a really important part.


If you’re going to stay present in relationship in one way or Or another with someone who might be suffering might have a lot of Chaos in their life might have a lot of their own pain.

It’s hard to be around other people’s pain.

Yeah and there’s so much there’s even stigma and misunderstanding about boundaries there so often misused and like you said they’re used to control or punished yes.


Yeah and so then people are trying to do it and they’ve got these thoughts about that.

It’s mean or wrong or But it’s so hard to for me boundaries are loved and they really helped create a more loving relationship with my daughter was like the beginning of healing for us but there’s just so much understood.


It’s hard sometimes to come up with good boundaries but I really like the way you explained it and what I would say to the idea of coming up with good boundaries is to even set that side that idea side and instead to think how do I Look inward to discover the boundaries, I don’t have to think them up or which I think is often how people especially because what you’re saying about people kind of misunderstand or misuse boundaries is if somebody else is telling you, where your boundary should be, it’s not your boundary but that’s a process of feeling out, kind of within yourself either.


And people can’t see this video.

But if they did, they would see my hands.

Like, hovering around my chest like this feeling.

Out process of, how do I know when I’ve reached a limit?

What does that feel like in my body?

What thoughts?

Our emotions come up for me.


How do I know?

So I first have to figure that out so that when I’m approaching a limit for myself, a boundary that I can say, okay, I recognize this this feeling I’m having is a sign for me that I have a limit here and I’m feeling pushed past my limit, so that’s a discovery process.


Yeah, I love that.

It’s a discovery process and And really, just the things that we feel resentful about as a good place to start.

Like what are we doing that?

We don’t want to do but we’re afraid to say no yes resentment is a great place that if you feel resentment you are past your limit even if you have cruised past a boundary and you’re out there and this is what resentment does, is it distracts us from finding our own limits because we’re focused on what’s wrong with the other person.


And so we’re focused outward and we Need to move our view.

I’ve inward to say, okay clearly I’ve passed the limit here.

So let me back up, let me find where that limit is.

There is this thing that I’m doing actually something I’m willing to do if it wasn’t then?


Where would where did I need to say no?

Instead of saying yes and that’s for me.

Not about the other person.


The problem isn’t that they asked you to do that.

The problem is that you didn’t want to and you said, yes, yeah, it certainly annoying.

When people ask us, Us over and over again till then we’ve said, no lots of times that’s annoying but ultimately it’s our responsibility to decide when I say, yes, I say was yes willingly and when I say no, I say no because I have a limit, I’m not willing to do it.


And that ultimately, I have to be responsible for those things for myself which is hard, but is empowering because the power is with me to decide where my guess is.

And where am I knows there’s a great therapist in Oregon Cordelia.


Across and she talks about we get all the Ws right?

Want willing won’t is and I think that’s a nice kind of frame for thinking about boundaries about my willingness that I want to do something, I’m willing to do something.

I won’t do something.


And so all these things are kind of this reorientation around boundaries to look Inward and to feel something out for yourself rather than Someone telling you where they should be or looking at what the other person needs to do, they need to stop asking me instead of I need to feel stronger about when I say no when I say yes.


So that’s a lot of the that is a lot of the sessions that I have with families are on issues around boundaries.

Yeah, it’s so important.

So is there anything that we haven’t covered about harm reduction?

That’s important for families to know?


I would say I don’t know if this is is literally like Central to the tent of harm reduction but an idea that I think is really helpful is ideas of radical acceptance and I think this helps families answer some of these questions around.


They may not approve of things.

But you know what does it mean?

Just to accept that what is today is just what’s today?

And actually also Pat Denning and Jeannie little have an article I think?

Is that maybe ten years ago about harm reduction for families and there’s very few of these articles.


So I will send it to you so so that you have it as well.

And one of the things that they write about is not helping which is not the same as being hopeless and so which is really in line with this idea of radical acceptance which is we’re really prone as people to kind of be on these roller coasters of like hope and despair, hope and despair.


And so to me, not hoping is about kind of just getting off the roller coaster.

But if I have a good day today with my loved one or I see them and they look I look at them I think oh they look good and that’s great they look good right now and I can then I felt connected to them right now and I had a good day with them right now.


Will tomorrow be good?

Who knows maybe tomorrow?

Be good.

Maybe tomorrow won’t be good, I don’t know.

But if I can get off that idea of something good happens and I ride up the Hope roller coaster and then something bad happens, and I feel Despair and I plunge to the other side.


I’d of like, it’s never going to be good.

They’re never going to get well there, there’s always going to be bad and so to try to get off that roller coaster and really kind of get your feet back on the ground.

And what’s in front of me, is what’s in front of me today?

Is what it is.

I can just accept things as they are.


My acceptance is not approval, my acceptance doesn’t mean that I’m saying.

This is what I want.

It’s just saying.

It is what it is.

I think that’s another idea or practice that can be grounding for people because that roller coaster is exhausting.


Yeah, for me it was just like being in the moment with my daughter, I wasn’t being in the moment with her.

If I was judging every single thing she did is this leading, does it look like this is leading towards sobriety or does it look like this is leading towards more use?


Like I’m not in the moment.

But with her, enjoying her presence.

If I am trying to figure out every single thing about every day like you were saying and then that’s what get would get me on that roller coaster was trying to figure out every little move.


And what does this mean?

And what is but instead I could just be present with her and love her in that moment and be really full of gratitude that it was a good day and I try to figure out what it meant like All of those other things you were talking about, really take us out of just being able to enjoy the moment and the person that were with, as they are, yeah, that’s real acceptance.



And if there are people listening that are not listening as therapists or counselors, but listening as family members that I really encourage them not to have so much judgment about themselves in this process to have compassion for themselves because a lot of what is written about harm reduction is written for Therapists counselors doctors helpers and those are not people.


The people who they’re working with are not their beloved partner or child and there is an amount of distance that we get to have as therapists as practitioners.

And that I do love the people that I work with.


I care for them, I love them.

They’re not my family members, I don’t live with them, they’re not my children.

So there is there’s an objectivity which we can’t really Have, but we can move towards it.

Hopefully, that we have with clients that we don’t have with our family members.


And so, these things are really, these ideas are hard to practice.

It’s really hard to not want to control when things feel out of control in our own homes.

It’s really hard to stay off that roller coaster, when we’re not just going to like write our note and put it down for the day and then go home.


So, I just really encourage people to have compassion for themselves in this.

Very hard process of staying isn’t and staying in loving relationship with compassion because compassion is sometimes about sharing that pain and that is so hard for families.


And so that’s my encouragement is to be compassionate with yourself.

Yeah, thank you for that.

That’s so important.

It is this is hard and it there’s no easy answers.

There’s no one-size-fits-all answers.

We’re trying to figure it out every step of the way as we go and we really do have to move through that with a lot of compassion for ourselves that what worked yesterday.


Today might not work tomorrow or we’re always thinking on our feet, it is not easy.

We have really have to give ourselves a lot of compassion for this situation that were in.

So thank you so much for your time.

I really, really appreciate everything that you shared.


I think that it will be really, really helpful for any parent that is struggling and not.

It’s hard to go against the grain and go against all of the things that people are telling you.

And All of the bad advice that we get is parents and even some of the advice that we get from the professionals that doesn’t feel right and we have to go against something like that.


So I really appreciate your respectful compassionate approach to helping parents and their family members and their loved ones that are struggling with addiction.

We are thank you for having me on to talk about it and I love what you’re doing with your journey to end.


Having this topic on your podcast, thanks.

Thank you for listening to this episode.

If you want to learn more about my work, go to Heather.

Ross coaching.com if you want to help other parents who are struggling with a child’s addiction, you can do it two different ways.


First, you can share the podcast with them directly or you can share it on your social media second.

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