The idea of harm reduction is nothing new. It is very common for people to make sure that family and friends who are going out drinking have a way to get home that won’t result in a drunk driving accident. They may use a ride-sharing service like Uber or Lyft, take public transportation or have a designated driver. We are not asking our loved ones to drink less or to stop altogether; rather, we want them to be safe.
When you talk to your loved ones about harm reduction, you can extend this idea of safety and reducing risks to all substances. There are proven ways to reduce the risks of substance use to prevent overdoses and death, the spread of diseases, reduce infections and more.
While not using substances is the safest course of action, harm reduction “meets loved ones where they are at”. Although you may want your loved one to stop using substances entirely, this approach recognizes that they may not be ready or want to connect with treatment or are unable to get help for a variety of reasons (e.g., unhoused, lack of insurance, no transportation, unable to take time off from work, etc.).
So, how do you bring up the topic of harm reduction without feeling like you are encouraging your loved one to use substances?
Using the Information Sandwich
Try using the Information Sandwich, which is a great way to share information, suggestions, opinions, requests and more. It can be very helpful when discussing a subject like harm reduction.
The top layer of the sandwich invites your loved one to have a conversation with you. For example, you might say, “Hey, I heard some interesting information today and would like to share it with you. Is now a good time?” If your loved one agrees, you can continue. If they say “no,” either drop it for the time being or ask if there is a better time to have the conversation.
The middle layer of the sandwich is the “meat” of what you want to say. In this case, you will use it to make a safety request related to their substance use. You may also decide to insert boundaries that are important to you.
The bottom layer of the sandwich seeks feedback on what you said. How did your loved one receive it? For example, you could ask, “What do you think about that?” or “Does that make sense to you?”
Always remember to choose an appropriate time to start the conversation. Wait until you have your loved one’s full attention rather than speaking to them right as they are about to leave the house or are watching their favorite team play on TV. It is also best to have the conversation in person or via phone or Facetime, which will encourage conversation more than texting.
Examples of the Information Sandwich
In this example, the individual starting the conversation is concerned about their loved one using substances alone:
Top layer invitation: “I heard something interesting today that I wanted to run by you. Ok?”
Meat of the sandwich: “I know sometimes you use heroin alone, which means you could overdose, and no one would be able to help you. There’s a free phone app that can alert anyone you choose if there is a problem. It’s called the Brave app. There’s also a free service called Never Use Alone. I’d like you to use the app or the service when you are alone.”
Bottom layer to check in: “What do you think?”
Here is another example from someone worried about their loved one drinking while nursing a baby:
Top layer invitation: “I heard something interesting about nursing I’d like to share with you. Is now a good time?”
Meat of the sandwich: “There are test strips you can buy to check your breast milk for alcohol. It’s a way to make sure the baby doesn’t get any alcohol if you have a drink.”
Bottom layer to check in: “What are your thoughts about using them?”
Your loved one may respond to you in a positive way and agree to try what you have suggested. If they do, be sure to tell them you appreciate their willingness to take this step and that you are here to support them in doing it.
However, they may not agree with what you have suggested, which can be disappointing. Listen to what they have to say and try to understand why they don’t want to do it. You can propose that they take smaller steps towards your suggestion: Would they be willing to think about it? Would they be willing to try it for a couple of weeks just to see how it goes? What would they be willing to do to be safer?
If they are not willing to do anything, take heart – there will always be another opportunity to raise the issue. You may consider suggesting a different way to reduce risks, as there are many actions to consider. Something as simple as giving them Narcan (naloxone) to use in the event of an overdose can save a life.
Your loved one might comment that you must approve of their substance use after all because of your suggestion(s). You can tell them that you are not in favor of it and wish they would cut back or stop entirely, but you want them to be alive and safe. This is about reducing risks, not approving substance use.