START is an acronym, where each of the letters represents a particular way of reducing risk (below are examples in each area). People might discover that they already use some of the strategies but might not have considered others. Some strategies might not be relevant or appropriate for every person. And of course, people might think of new strategies that aren’t on this list. The goal of the acronym is simply to help with discussion and brainstorming, and to build motivation and commitment to change. A longer conversation might include an introduction to the concept of harm reduction, a readiness or importance ruler, a worksheet that allows people to see the various options, and a goal setting exercise where people pick the strategies that will work for them. A shorter conversation might simply involve a few questions about one or more of the areas. START is also a way to help providers remember the various options that are available to people.
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