Written by: Dr Alana Roy, Chloe Simpson and Eleanor Andrews
What is The Signs of Life Psychology’s stance on Harm Minimisation?
The Signs of Life Psychology’s focus is on the clinical application of psychedelic medicines. However, SOL psychological service practitioners are trained to address your mental health needs in regard to risk assessment, psycho-social-spiritual safety, your functional capacity and self-care needs.
Can you advise me on what dose I should take in a recreational setting?
We cannot advise you on what dose of psychedelics you should take outside of a clinical context. We can talk to you about the potential risks associated with substance use and how you can mitigate risk and seek psychological support.
Harm minimisation is the current policy in Australia, which oversees all drug-related laws and responses. Harm minimisation aims to address alcohol and other drug issues by reducing the harmful effects of alcohol and other drugs on individuals and society. Harm minimisation considers the health, social and economic consequences of alcohol and other drug (AOD) use on both the individual and the community as a whole (Department of Health, 2004).
Our Harm Minimisation policy is guided by Australia’s National Drug Strategy (2017- 2026) which aims to foster safe and healthy communities through the minimisation of health, social and economic harms to individuals, families and communities, arising from the use of alcohol and other drugs (YouthAOD Toolbox, 2020). Harm Minimisation in no way advocates for use of illicit substances, but rather offers insight and solutions into managing the inevitable use of alcohol and other drugs within society.
The values and beliefs underpinning harm minimisation policy are varied, but the current approach is based on;
• Both licit and illicit drug use is inevitable within society and we cannot stop individuals from using AOD
• Drug use within society varies in use, from occasional use to drug dependency
• There are a range of harms linked to the different categories and patterns of drug use
• There are a range of tactics that can be taken to respond to harms associated with AOD use
Harm minimisation understands that alcohol and other drug use results from the interaction between four mechanisms: the individual; social, economic, physical and cultural elements of the environment; and the drug itself. As a result, strategies used in harm minimisation are focused on these interacting factors and their effect (Department of Health, 2020).
A systems approach is also taken when adopting strategies of harm minimisation. This theory puts greater emphasis and importance on the environmental factors involved with AOD use, by growing an understanding and awareness surrounding societal and cultural factors related to AOD use and how different systems must be looked at in order to develop successful interventions and harm reduction techniques. Successful harm minimisation should focus on the systems and behaviours associated with AOD use, not just the AOD use alone. That way, a broader range of harm minimisation strategies may be implemented, rather than strategies that focus purely on reducing or eliminating the use of AOD (Department of Health, 2020).
According to the 2010-2015 National Drug Strategy, there are three key areas pertinent to harm reduction, which are:
(http://fileserver.idpc.net/library/National%20Drug%20Strategy%202010- 2015.pdf)
• Harm Reduction – Strategies aimed at reducing the harm arising from AOD use for individuals and the wider community, including peer and community education, needle and syringe services (including safe injecting rooms), methadone programs and clear labelling on alcohol products and cigarettes. Such strategies do not necessarily work to eliminate or reduce AOD use, but rather make it safer, thus reducing harm.
• Supply Reduction – Strategies that look at reducing the making and supply of illicit drugs, For example; legislation, policy development and legal prosecution/law enforcement.
• Demand Reduction – Strategies that look at preventing drug use. For example, community development and education, media advertising and campaigns
The Harm Reduction Coalition (2020), lists its principles of harm reduction as;
• Accepting, for better and/or worse, that licit and illicit drug use is part of our world and chooses to work to minimise its harmful effects, rather than simply ignoring or condemning them.
• Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviours 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 harm.
• Ensures that drug users and those with a history of drug use have a real voice in the creation of the programs and policies that are designed to serve them.
• Affirms drug 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 that meet their actual conditions of use.
• Recognises 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 minimise or ignore the real and tragic harm and danger associated with licit and illicit drug use (Harm Reduction Coalition, 2020).
Within the wider community, the idea of harm minimisation is often misunderstood as accepting or overlooking illicit drug use, rather than attempting to keep individuals and the community safe by minimising the risks and harms associated with AOD use. The implementation of more community education programs regarding the purpose of harm minimisation may help in gaining greater community support for the policy (YouthAOD Toolbox, 2020).
Harm minimisation and psychedelics
Taking psychedelics can result in overwhelming and uncomfortable experiences, more likely to occur with high doses, amongst first-time users, and without adequate preparation or setting (Zendo Project, 2020). The experience of using psychedelic medications, such as Psilocybin and MDMA, often results in the user having a shift in thinking. Users may experience a heightened awareness of emotional thought, which can be both uplifting and positive or sad and difficult to process.
Such extreme effects on emotion are one of the reasons the use of psychedelics in therapy indicates promising results. Such experiences have been linked to resolving and understanding trauma, strengthening relationships as well as assisting users to feel more trusting and able to face challenges and fears (MAPS, 2020).
As part of harm minimisation, there are some strategies that can be implemented specifically relating to the use of psychedelics, including a variety of methods to help prevent and transform difficult experiences while in a non-ordinary state of consciousness (Zendo Project, 2020).
The Multidisciplinary Association for Psychedelic Studies (MAPS) believes there are four defining ideologies underpinning harm minimisation regarding the use of psychedelics, which are:
• Create a safe space – to minimise harm, a psychedelic experience should take place in a safe space, free from fear and judgement. The space should also offer basic necessities, such as food and water, as well as being dry and comfortable. It is advisable that the space be free of any potential physical dangers and that a support person/medical professional/social worker be present with the user throughout the experience.
• Sitting, not guiding – this notion suggests that any person present during a psychedelic experience, be it, support person/psychologist/medical professional/ social worker/etc, respects the experience the user is having as being individual and allows the user to shape and navigate the journey independently (sits with) and respects the user’s beliefs and wishes. Providing this supportive environment will allow maximum benefit to be taken from the experience.
• Talk through, not down – digesting what is occurring during a psychedelic experience may not always be comfortable or easy. In the event of a difficult or unpleasant psychedelic experience, if the client/user and their support person take time to unpack and work through the experience, it gives an opportunity for the client/user to experience personal development and change.
• Difficult is not the same as bad – while not all psychedelic experiences can be defined as easy or smooth, with thorough preparation and a sound understanding of the physical and mental processes that can occur during the experience, a difficult or unpleasant psychedelic experience can often provide the most benefit for the client. Difficult experiences can be caused by a myriad of factors, such as; past experience with trauma, an unsafe or disordered therapy space/environment or raw emotional responses to the therapeutic psychedelic experience. If properly managed and worked through, the client/user should experience great benefit from the experience and may build greater resilience (MAPS, 2020).
According to the Multidisciplinary Association for Psychedelic Studies (MAPS), it is not unusual for psychedelic users to encounter problematic or difficult psychedelic experiences. This is most likely to occur in the instance of people using psychedelics for the first time, without preparing appropriately or seeking adequate guidance.
However, making use of the above-mentioned harm minimisation/harm reduction techniques will help in lessening the instances of harmful or difficult psychedelic experiences (MAPS, 2020).
The use of psychedelics is often said to make the user aware of their subconscious thoughts and feelings. This may include such things as; exposure of repressed or hidden memories, feelings regarding life situations and thoughts relating to fears or fantasies.
It is important that people who opt to undertake psychedelic-assisted psychotherapy, understand they may experience such thoughts, and feelings and should be encouraged to embrace them in an open and thoughtful manner. Having prior knowledge regarding the possibility of exposure to such thoughts or feelings and being informed about what may happen during the psychedelic experience may help minimise harm to the user (MAPS, 2020).
It is also advised that psychedelics be taken in the company of someone who is not also under the influence of the substance, (often referred to as a guide), to prevent the user from attempting any dangerous or potentially harmful activities. In a medical or therapeutic session, a guide may be a psychologist, social worker or adequately trained volunteer (Drug Policy Alliance, 2020). It is also advisable that a person using psychedelics or engaging in psychedelic-assisted therapy, familiarise themselves and build a rapport with those who may be present during their psychedelic experience, as this will allow for a more open and comfortable experience, free of judgement.
As all people respond differently to psychedelics, experts advise that clients/users who have a personal or family history of mental illness, should make this history known to their therapist, doctor or support person and also go into their psychedelic experience aware that their past or present exposure to mental illness increases the prospect of a phycological episode being bought on by the experience (Drug Policy Alliance, 2020). In addition to this, the use of psychedelics has been known to be harmful to people suffering from some mental health conditions. As such, psychedelic-assisted psychotherapy is not recommended for individuals who have been diagnosed with schizophrenia or other psychotic disorders (unless they are substance-induced or due to a medical condition), as well as clients suffering from bipolar disorder. Providing this information to involved medical professions, will ensure client safety and make sure they are appropriate candidates for the therapy (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056407/).
In addition to providing a mental health history, it is important to be aware that some medications have been known to interact with or alter the results of a psychedelic experience.
Tricyclic antidepressants and some anti-psychotic medications have been found to increase the potency of psychedelic medications, making them a safety concern for some clients. Long-term use of other medications, such as serotonin reuptake inhibitors (SSRI’s), commonly used in people with depressive disorders, have been found to decrease sensitivity to psychedelics (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056407/)and as such may decrease the benefit of psychedelic-assisted psychotherapy.
Understanding these interactions and informing medical professionals involved about all medications currently being taken by the client, will help ensure that psychedelic-assisted psychotherapy is a safe and viable option for clients, as well as allow for the most benefit to be taken from an experience (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056407/).
Being aware of possible physical reactions resulting from the use of psychedelics is an important protocol in harm minimisation. During a psychedelic experience, a person may experience a range of physical symptoms, such as dizziness, weakness, tremors, nausea, sleepiness, blurred vision or pins and needles (among others), (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056407/).
In addition to this, users may also experience other symptoms such as; changes in perception, sense of time and space, and emotion (possibly including anxiety, fear, panic, and paranoia) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056407/). As a part of harm minimisation, it is important that people going into a psychedelic experience are provided education and made aware these symptoms and changes may occur. This will lessen the possibility of the client/user experiencing anxiety that there is something very wrong with them or that they are in danger. Knowing this will pass, allows for a smoother transition into the experience and reduces the risk of harm to the client.
It is recommended that clients preparing to undertake psychedelic-assisted psychotherapy or go into a psychedelic experience, first build rapport and trust with those who are going to be with them or guide them during the experience. Having a trusting relationship prior to the experience will allow the client to feel comfortable and feel free of judgement going into the session and decrease the risk of the client being scared or anxious during the experience.
When developing this relationship, it is often advised that the client share details of their life, including childhood, relationships and beliefs, as this will not only allow for the client to feel more comfortable with the guide, it will also reduce the likelihood of them experiencing paranoia during the experience. Having a background history also allows the therapist or support person to assist the client in working through any strong emotions or feelings about their relationships or past arising from the experience and better understand the meaning of their psychedelic experience. Harm minimisation also suggests that the space used to facilitate the session needs to be comfortable and secure, and free from possible dangers, such as sharp objects, potential weapons and objects with sharp edges. As it is impossible to know in advance what type of experience the client may have, it is best to do this to ensure the client and support person remain free from harm during the experience. The room should also offer basic necessities, such as food, water and warm blankets. Having music available to the client may also help enhance or benefit the session. It is also advised that the client be familiar with the space before the session takes place, as this will assist in them feeling comfortable and reduce anxieties going into the experience.
In addition to this, peer support brings a community model of harm reduction, which encompasses caring for one another, and for ourselves in times of challenge and applying basic emotional first aid to psychedelics (https://maps.org/event- calendar/8089-psychedelic-science-2020-webinar-series-psychedelic-peer-support- models-of-community-care-online). A harm reduction approach whereby clients are empowered to make informed choices and educate themselves about the risks and benefits of various ways they might engage with psychedelics (Portlant Psychotherapy, 2020). Similarly, providing education about different psychedelic tools and their effects, identification of one’s intentions behind engaging in the psychedelic experience, and exploration of alternative means of accomplishing these goals, are strategies used in harm reduction and psychedelics (Portlant Psychotherapy, 2020).
A guide to harm minimisation – before and after a psychedelic experience
The following provides a practical guide to harm minimisation regarding the use of psychedelics. It would be useful to those wanting to, or about to undertake psychedelic-assisted psychotherapy, or for anyone wanting to understand psychedelics and safety. The guide includes strategies to be implemented before and after a psychedelic experience.
Strategies to be implemented before
• Go into the experience knowing what you want to take from it. Setting a clear goal or intention often leads to a more valuable experience, as you can use this idea to guide you during the process. Following the experience, your goal can be altered to include future ideas about how, what you took from the experience can be used to better your life (Murphy, 2017).
• Make sure the people involved are aware of any mental health history and know about any medications you are currently taking. Doing this will ensure psychedelic-assisted psychotherapy is a safe practice for you and will be free of any possible drug interactions in order to be practised safely and produce the maximum benefit.
• Educate yourself on the physical and emotional or psychological changes that may occur during the experience. Physical and psychological changes, such as; as dizziness, weakness, tremors, nausea, sleepiness, blurred vision, anxiety, paranoia, changes in perception, may be alarming and a cause of fear, but going into an experience with prior knowledge that these symptoms can be a natural part of the process, will allow for a smoother, more valuable experience (Murphy, 2017).
• Ensure you have a safe and trusting relationship with the people or guides going into the experience with you and that they are familiar with your history and life situation (including childhood, family, relationships, and beliefs). This will help in making the experience more comfortable and open and allow your guide to better help you process and understand emotions and changes arising from the experience, enhancing the sessions benefit (Johnson.et.al, 2020).
• Make sure the space being used for the experience is comfortable, safe and familiar to you before going into the session. There should also be food, water and warm blankets easily available during the experience. Also having access to music or other stimuli may enhance and benefit the experience (Johnson.et.al, 2020).
Strategies to be implemented after
Studies have shown that the benefits of psychedelic-assisted psychotherapy or a psychedelic experience can be seen in the days and weeks following the session. Reflecting on a psychedelic experience, unpacking and understanding what was learnt and applying these learnings to everyday life is a process known as integration. Undertaking this integration process and applying self-care after a psychedelic experience, are vital elements of harm minimisation. Here are some self-care and integration exercises, which may be useful following a psychedelic experience.
• Take some time out and allow time to reflect on the experience, before jumping back into everyday life. Doing this lets your brain reset and allows for any new information taken to be absorbed and understood more clearly. Allow time to return to yourself and for your identity or ego to realign. Changes may be felt emotionally, physically, psychologically and they need time to be balanced and processed. Take a few hours or even a few days to rest and nurture your body. Sleep and replenish and recharge by drinking tea or similar and eating nourishing, non-processed foods. Avoid driving or similar activities until you have taken some time to come back to yourself and re-energise (Murphy, 2017).
• Take time to work through any emotions triggered by the experience. While it may not be possible to work through this all at once, acknowledging these emotions and changes is vital in moving forward and building from the experience. Proper processing will help in ensuring psychological stability and aid in healing post-experience. Negative emotions and other psychological effects need to be worked through and understood in order to avoid any long- lasting unwanted psychological damage (Johnson.et.al, 2008).
• Record your experience through either a journal, painting, drawing or even through dance. A written or visual representation of your experience can be used as a therapeutic tool for growth and recovery. This creative process helps to better understand the experience and rationalise it and allows for ongoing healing. Often, forgotten images can resurface during a psychedelic experience, and recording this can help in trauma processing and recovery. Recording your experience as soon after the experience as you can, will allow for a much clearer representation (Murphy, 2017).
• Following a psychedelic experience, some people may want to talk about it with people other than the professionals involved with their therapy. It is best to do this with someone you know and trust. Some people may want to seek advice or opinions following their experience, whereas some may just want to vent and need someone to listen, without judgement. Let the person you are speaking to know what kind of conversation you need, as this will allow for better processing and understanding post-experience. Alternatively, sometimes it is best to hold off from talking too soon after an experience. This allows time to process and digest any new information before speaking about it. Whatever your feelings regarding debriefing post-session, always hold off for a while before making any major life decisions or confronting people from your past. These situations should be approached with a clear head and rational thought (Murphy, 2017).
• Taking up a peaceful activity, such as yoga, meditation, walking or something similar is known as taking on an awareness practice (Murphy, 2017). Doing this has been shown to assist in emotional healing and integration. Practising awareness helps in acknowledging and recognising the healing process and assists in sifting through emotions triggered by the experience and allows for an opportunity to let go and heal. Taking up a practice before an experience to familiarise yourself with it and continuing it after, will allow for the most benefit, as reflection is key in getting the most out of psychedelic-assisted psychotherapy.
• Take positives from a bad experience. some people may have a painful or difficult psychedelic experience, but this does not necessarily mean it was not worthwhile. While an experience like this may bring up forgotten or memories or past traumas, which can be painful, it may also be used as a catalyst for healing and change (Murphy, 2017). An experience like this can be used to define a new “you” and move forward in life.
Providing clients education and understanding around the safe use of psychedelics and implementing the above-mentioned harm minimisation strategies, will hopefully assist in making psychedelic-assisted psychotherapy as harm-free as possible.
Harm minimisation organisations in Australia
The following is a list and brief biography of agencies within Australia working with harm minimisation.
Harm Reduction Australia (HRA) – HRA is a national organisation for persons throughout Australia to come together in their commitment to reducing the health, social and economic troubles associated with drug use.
www.harmreductionaustralia.org.au
Harm Reduction Victoria (HRVic) – Victorian branch of Harm Reduction Victoria,
www.hrvic.org.au
Additional services/programs offered by Harm Reduction Victoria include:
• Dancewize – a peer-based drug and alcohol harm reduction program that delivers services for music events and festivals
www.hrvic.org/dancewize
• Drug Overdose and Prevention Education Workshops (D.O.P.E) – Education program in harm reduction/minimisation offered to current drug users
www.hrvic.org/overdose/the-project
Alcohol and Drug Foundation – The Alcohol and Drug Foundation is an organisation committed to preventing and minimising the harm caused by alcohol and other drugs. Organisation offers education and community-based programs regarding harm minimisation and strategy intervention.
www.adf.org.au
Australian Institute of Health and Welfare – The Australian Institute of Health and Welfare (AIHW) is an independent statutory agency. They produce authoritative and accessible information and statistics to inform and support better policy and service delivery decisions, leading to better health and well-being for all Australians.
www.aihw.gov.au
Drug Policy Australia – Drug Policy Australia is an organisation responsible for raising awareness of the harms to both individuals and the Public Health associated with the use of psychoactive substances and undertakes education, research and advocacy of proven harm-reduction strategies to minimise that harm. Drug Policy Australia believes that the current prohibitionist approach to psychoactive substances does more harm than good to public health.
www.drugpolicy.org.au
References
• Australian Government: Department of Health 2004, ‘What is harm minimisation?’, https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front5-wk-
• Department of Health 2020, The Australian Government Department of Health, www.health.gov.au, www.1.health.gov.au
• Department of health 2020, National Drug Strategy 2010-2015, 2017-2016, https://www.health.gov.au/resources/collections/national-drug-strategy
• Drug Policy Alliance 2020, https://www.drugpolicy.org/drug-facts/reduce-harms-lsd
• Gael, S 2020, Psychedelic Science 2020 Webinar Series, ‘Psychedelic Peer Support: Models of Community
• Harm Reduction Coalition 2020, ‘principles of harm reduction’, https://harmreduction.org/about-us/principles-of-
• Multidisciplinary Association for Psychedelic Studies (MAPS) 2020, www.maps.org
• Multidisciplinary Association for Psychedelic Studies (MAPS) 2020, https://maps.org/news/bulletin/articles/410-bulletin-winter-2016/6467-hand-in- hand-how-psychedelic-harm-reduction-is-making-a-difference-now
• National Centre for Biotechnology Information 2020, Johnson M, Richards W & Griffiths R, 2008, Human Hallucinogen Research: Guidelines for Safety, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056407/
• Portlant Psychotherapy 2020, ‘Psychedelic Integration and Safety Services’, https://portlandpsychotherapy.com/psychedelic
• YouthAOD Toolbox, 2020, www.youthaodtoolbox.org.au
• Zendo Project 2020, ‘About’, https://zendoproject.org/about/