Talking about reducing risks with substance use

These suggestions can help you to have a supportive, person-centred, and informative conversation: 

1. Understand the perspective of the person you are speaking to 

• Listen actively and let them lead the conversation as they are the expert on their own situation.

2. Be supportive and non-judgemental

• Create a safe space: Approach conversations not with judgements but with empathy as this will allow people to be honest and open.
• Maintain confidentiality. 

3. Focus on wellbeing

• Holistic approach: Address physical, mental, and relational aspects of wellbeing, not just substance use.
• Respect their goals: Understand that reducing or stopping use may not be their immediate goal. 

4. Learn from their expertise

• Value their knowledge: People often know a lot about the substances they use, how they are affected by substances, and ways to prevent problems from developing. Listen carefully for what you can learn from them, either for yourself or to share with others.  

5. Ask for permission before advising

• Check readiness: Ensure they are open to receiving advice before sharing information. 
• Respect their choice: Tailor your guidance based on their willingness to hear it. One harm reduction kaimahi reflected that, "Sometimes people need reassurance about the harm reduction actions they're already taking."

6. Tailor your approach with empathy

• Be flexible: Adapt your approach based on their knowledge and background. 
• Explore together: If needed, research and learn alongside them. 

7. Use non-stigmatising language

• Choose your words wisely: Use respectful, person-centred language and avoid negative stereotypes 
• Respect their terms: If they use certain language, it’s their choice; you should maintain respectful language. 

8. Avoid interruptions and strong reactions

• Stay calm: Resist the urge to react strongly or interrupt, as this may hinder honest communication. 
• Focus on support: Aim to reduce harm and improve wellbeing rather than pushing for change. 

9. Consider information sharing

• Anticipate sharing: Understand that they may share the information you discuss with others. Be prepared to answer questions they might pass along. 

Use these strategies to engage effectively and provide support that aligns with their needs and experiences.
 

Suggested conversation flow

This flow prioritises the perspectives of the person you’re supporting, recognising them as the expert of their own situation. It encourages them to guide the conversation towards the information or support they need and can be adapted for various topics related to health, social, and legal issues. 

1. You: 
Start with the perspective of the person you're supporting.

In this framework, "you" refers to the person you're supporting - not you as the person having the conversation.

• Listen actively: Begin by hearing their view of the situation, what’s working, their concerns, and the support they seek.
• Encourage sharing: Provide space for them to share tips and information that could assist you in your role.

Example conversation prompts: 

• What safer use tips would you suggest we share with others?
• What’s important to you in this situation?
• What’s working well for you?
• What’s your experience with this substance? What was enjoyable or challenging? 
• Do you have any questions for us?
• Our service focuses on [e.g., wound care, housing]. What’s on your mind about this?

2. Them: 
The conversation then moves to explore the people around the person you’re supporting (e.g., their friends, whānau, household members). 

Consider the perspectives of the people around the person you’re talking to. A common concern includes being worried that a friend is becoming more reckless and could be hurt. What might others around them think of their situation, like what is going well, concerns, uncertainties, and a need for information or support. 

Example conversation prompts: 

• Do you have any questions to ask on behalf of other people in your life? 
• What have your friends, whānau, or household members spoken to you about recently? 
• What would be helpful for your friends, whānau, or household members to know? 
• Do you have any questions to ask about your friends, whānau, or household members’ substance use? 
• What harm reduction tools have you heard about or seen other people use that you’re curious about? 
• What are some of the things people around you do to keep well? 
• What are some of the things you’ve seen or heard other people who use substances do to keep themselves safer? 
• Have you ever had any worries about someone else’s substance use? What made you worried? Are there any similarities between that situation and others in your life? 
• Sometimes people get asked to come here. Has anyone asked you to see us today? What would they like us to be talking about? Would you like to talk about that? 

3. Me:
The conversation can now flow into you sharing your  perspective. 

“People are too worried about what people will say and how they’re treated … they won’t always open up about it. We need to provide that help and have the hard conversations. People sit at home in pain with worsening wounds without them getting checked. Stigma is overwhelming.” 

– Needle exchange kaimahi 

Asking for permission before sharing ensures the person is ready to hear your perspective. Share your expertise in a supportive way with empathy as they are still the expert in their situation, and they are the person who will enact any actions from the conversation.

Reflecting what you’ve heard them say so far in the conversation before you share your perspective can also be helpful. 

Sometimes you need to have direct conversations with people, like if you notice that they have worsening wounds from injecting. You also have a duty of care to provide information and outline options for further support if needed (e.g., a service that can support medical withdrawal from alcohol). 

Example conversation prompts: 

• I’ve spoken to many people who use substances and they’ve shared some tips about ways they stay safer. Can I share some of these with you to see if you would find these useful too? 
• Can I share some information with you about what happens when a person uses these substances at the same time, and things that can help you be safer? 
• Can I share some information about services that might be helpful with you? 
• It sounds like you might lose your place to stay if you continue to smoke methamphetamine in the house. Could we explore how you might reduce the risk of losing your house? 
• It sounds like relationships at home are tense right now. How might you ease that tension? 
• It is easy to take too much of this substance and overdose. Do you and the people around you know how to use naloxone (if an opioid substance)? 
• I’ve spoken to many people who use MDMA, and most say they measure out about 100mg for the first dose and half of that if they take a second dose later in the night. You said you usually use 350mg each night that you use MDMA, which means you use much more than the people I’ve spoken to and are more likely to feel some of the more anxious or disoriented effects or things like vomiting and seizures. How does that fit with your experience? 
• You spoke about wanting to take a break from drinking. With the amount that you have been drinking over the past few years, stopping straight away would be dangerous. We can talk through options to help you do that in a safe way. 

4. Responsibility: 
Hand back responsibility to the person

You can close the conversation by checking out whether the conversation was useful and whether they have any other questions. Remind the person that you’ve spoken about a lot of things and that it is their choice what they decide to do. You might want to outline where they can go for further information or support, and invite them to come back to talk with you again.