Stepping Stone of San Diego, a long-time beacon for the GLBT recovery community, has announced that in light of encouraging data it will continue, and expand, an outreach effort known as “harm reduction”, as a complement to the program’s long-term residential recovery and prevention services.

In conjunction with Pride last summer, Stepping Stone launched the aggressive outreach campaign that focused on targeting gay men and methamphetamines. The harm reduction outreach effort has helped Stepping Stone augment their abstinence-based residential treatment programs.

“Harm reduction is the theory of meeting clients where they are, meaning physically, mentally and spiritually,” said Chris Thomas, prevention and outreach coordinator of Stepping Stone. “Finding out where they are in the stages of change continuum, or relapse, and finding out what they are willing to do.”

Some in the recovery community are hesitant to accept harm reduction theory, seeing the practice of addiction “management” as threatening to the notion of sobriety and true recovery. Though Thomas, being in recovery himself and a certified addiction specialist, agrees that harm reduction is not a permanent solution, he insists that any kind of intervention and education is better than none at all.

Treatment and recovery services, he said, reach approximately 20 percent of the substance abusing populations. The other 80 percent do not necessarily identify as an addict or alcoholic, but are still experiencing some negative consequences of their behavior. That is where harm reduction comes in.

“It is important to emphasize that harm reduction is a door into sobriety, not a door out of sobriety,” Thomas said. He has given talks and has had to remind the community that Stepping Stone’s residential program and day program do not do harm reduction. “They have always and will always be abstinence-based treatment programs,” he said. “So we’re not taking anything away from treatment and recovery services.”

Harm reduction is grounded in James Prochaska, John Norcross and Carlo DiClemente’s Stages of Change Theory, which follows a continuum from pre-contemplation, to contemplation, to action and finally to maintenance. Also incorporated into harm reduction is the Health Belief Model, originated by psychologists Godfrey Hochbaum, Stephen Kegels and Irwin Rosenstock, which developed a systematic method of explaining and predicting preventative health behavior, focusing on the relationship of health behaviors, practices and the implementation of health services.

Condom use is a good example.

“It’s all about finding out if somebody is willing to use condoms,” Thomas explained. “If they are, I am going to give them condoms; if they’re not, it’s about finding out why they don’t use condoms and helping them reduce the risk of high-risk sexual behaviors. It’s the same thing with seat belts. The government mandated that everyone has to wear seat belts – that’s harm reduction: They’re not saying don’t drive, they’re saying wear seat belts if you’re going to drive to help reduce the harm.”

The continuum of harm reduction runs from excessive use, to managed use, to abstinence. “We’re going to support people wherever they are on that continuum, with abstinence as the end goal,” said Thomas.

Stepping Stone’s Positive Support Services, the outreach department, handles harm reduction. They have an intravenous drug-use prevention case manager and an outreach educator who goes to bars, bathhouses, streets and parks offering condoms, safe-sex packets and referrals to alcohol and drug abuse services, hepatitis vaccinations, the gay men’s health clinic at Family Health Centers and STD screenings.

Thomas is in charge of a Ryan White Care Act program that targets HIV-positive men and women who have substance abuse issues. They offer outreach, intervention and referrals, individual counseling and support groups. “There is a harm-reduction component to that, in that these people do not have to be in treatment to come to the support groups,” he said. “They have to have substance abuse issues and have identified some negative consequences of that.”

The successful social marketing campaign last summer was encouraging, allowing Stepping Stone to reach substance abusers beyond those who had “hit bottom” and sought help on their own.

“We had a focus group of gay men who were either currently using methamphetamines or were in recovery,” Thomas said. “We asked them what type of messages could we present that would get the attention of gay meth users. We proposed cartoons, pictures and images. They gave us some really strong feedback.”

From those focus groups, Stepping Stone created five ads that ran in the Gay & Lesbian Times and Buzz, as well as on Hillcrest area billboards and bus stops, and in bars and coffee shops. Before the posters went out, Stepping Stone conducted a random-catch sample survey, going to Rich’s, David’s Coffeehouse, the Brass Rail, PECS and other bars and coffee shops to collect information about recreational drug use and demographics.

Eight weeks after the ads came out, Stepping Stone conducted another round of the survey, and again at 16 weeks. “We got some really important data,” said Thomas. “What we got from the data collection was that friends of meth users were more likely to see the ads and talk to their friends about it. They were also more likely to understand the message of the ads. That gives us an idea of a target audience we might want to look at in the future.”

Thomas said Stepping Stone received approximately 50 phone calls from gay male crystal meth users who wanted one-time information over the phone about the effects of methamphetamines on the body. Five or six others actually met with Thomas, identified themselves as addicts and went into treatment.

“I also met with a few people who didn’t have a long history with crystal meth and who weren’t using it very frequently, so they did not meet the criteria for being chemically dependent,” he said. These individuals wanted some education about how to remain HIV-negative while using crystal meth, as well as how to protect their teeth – smoking crystal meth can cause rapid tooth decay.

One respondent from the ad campaign that Thomas worked with for six months wrote an anonymous testimonial about his experience with harm reduction. “In that time,” the testimonial reads “my vocabulary has been enhanced with new terms and phrases: ‘trigger’, ‘take the power out of the urge’, ‘esteemable [sex]’ and ‘nurture yourself’. My drug use has decreased and become more controlled.”

A drug and alcohol abuse/harm reduction ad campaign aimed at lesbians is one of the next social marketing strategies Stepping Stone is developing.

“People use drugs – that is never going to change,” Thomas said. “If I could save the world, I would. But people are using drugs, so instead of turning a blind eye to that fact, we’re just acknowledging that fact. We’re not going to shame them or guilt them – drug users have been marginalized for way too long. I’m not going to say, ‘Come back when you’re homeless’, you know? I say ‘Let’s deal with what you’re willing to do’.”