Conversations with a Client: Meeting them where they are


Conversations with a Client: Meeting them where they are



Client: “There was a point in my life when I had to do coke every day. In my late teens early 20s and 30’s I had to do Coke every day, it was it just like heroin it was an everyday thing.  But recently it’s gotten to the point where it’s only every once in a while, I need to do coke. “

Dr. Cali: So, are you functioning on it? Getting things done, going to work, etc.?

Client: Yes, it’s in the house now, and I don’t even want to use it.  I don’t know if you want to hear this, because it is against the whole “Abstinence movement, but it’s in the house and I feel great. I don’t want to go touch it. I know I can do a bump anytime I want, but I feel good today.”

Dr. Cali: Yes, that is a harm reduction technique.

Client: I am scared to go do a bump because I’m going to go way up and then what happens if I start to crash and I start feeling like shit, so I keep that in my mind.  I only want to do it if I wake up in the morning and I feel I am out having a bad day, then it’s there.”

Dr Cali: So psychologically you know it is there if you need it but you choose not to use it.

Client: “Yes.”

Dr. Cali: Ok, so you are micro dosing with coke. That’s exactly what you’re doing. You are using it when you need it and how you need it, without using it all at once and getting really, really high.

Client: Yeah, it feels good to know it’s there, but I don’t want it. Is that normal?

Dr. Cali: Well, you are mastering it. I know some people can not have it in the house and you can without going overboard. So, let’s focus on that harm reduction technique.



Harm Reduction means lessening the harm and meeting the client where they are at currently. You can offer medically assisted treatments (Suboxone, Methadone, Vivatrol), controlled drinking, medical marijuana or even less usage of  drug or alcohol. It is not complete abstinence.


The largest goal of harm reduction is to meet the client where they are in real time. The second goal is to reduce harm, for example, clean needle programs have reduced HIV by 18% and MAT have reduced opiate overdoses by 50% according to the CDC.


MAT for short, is any opiate program where you replace one opiate or opioid medication for another. In this case Suboxone, Methadone and Vivitrol are the replacements along with therapy and counseling, to help a heroin or opioid pill addict recovery from years of use.


Controlled Drinking is teaching an alcoholic how to manage their use on a real-time, real-world basis. For example, having a glass of wine with dinner, but not getting drunk. While not every client can manage controlled drinking, there are many for whom this works. There are tricks they need to follow like drinking one class of wine or beer (no hard liquor), then one water per hour to minimize use.

If you or your loved one is interested in learning about our harm reduction techniques and our alternatives to total abstinence The Addictions Coach and Sober on-Demand are available to assist you with those services. Dr. Cali Estes has helped thousands of people tackle their addiction and vices by offering alternatives to the program of 12 step total abstinence. The 12 step program while effective for some is not effective for everyone and Dr. Cali Estes believes that one shoe does not fit all feet. So if you or a loved one want an alternative way to get your life back on track, give us a call today at 1.800.706.0318 ext 1

You can find out more on how to become a harm reduction specialist at The Addictions Academy.  Or call our team at 1.800.706.0318 ext 2.