Two Schools of Thought
At most drug or alcohol rehab centers, the goal is to help clients stop using alcohol, prescription drugs, or illicit substances. The concept that a person is expected to entirely abstain from using as part of the recovery process is called abstinence.
There is another approach that also seeks to help people who struggle with addiction, without requiring that they stop all alcohol or drug use. This method is called harm reduction.
What Does Harm Reduction Involve?
There is no one universally accepted definition for harm reduction, though there are some basic tenants that distinguish the approach from treatment plans that advocate abstinence.
Principles of harm reduction include:
- For better and or worse, licit and illicit drug use is part of our world.
- We should minimize the harmful effects rather than ignoring or condemning substance abuse.
- Drug use is complex and multi-faceted. Anything from severe abuse to total abstinence falls on this spectrum.
- Some ways of using drugs are safer than others.
- We should seek to improve quality of individual and community life and well-being–not necessarily cessation of all drug use
- Services and resources should be provided to people who use drugs without judgment or coercion.
- Drug users and those with a history of drug use should routinely have a real voice in the creation of programs and policies designed to serve them.
- Drugs users themselves are the primary agents of reducing the harm of their drug use. Drug users should be employed to share information and support each other in strategies which meet their actual conditions of use.
- 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.
- The real and tragic harm and danger associated with licit and illicit drug use should not be ignored.
Harm Reduction Approaches
Harm reductionists don’t take the same approaches to substance use that others in the field of drug treatment might take. Because harm reductionists feel that abstinence is not always viable for every person at all times, they believe in finding ways to make drug use safer for those who continue to use, such as:
- Selecting respectful terms to talk about people who face addiction. For example, harm reductionists commonly use “drug user” instead of “addict” because there is a great deal of stigma attached to the latter term.
- Identifying abstinence from drugs as one of several acceptable outcomes for a drug user to choose, but encouraging drug users to be honest (without stigma or punishment) if this is not the outcome they select for themselves, so their supports can help them according to what they want and need.
- Providing needle exchange opportunities, so that drug users won’t use dirty needles. This reduces their chances of developing infections and contracting diseases such as HIV and Hepatitis C.
- Giving fentanyl testing strips to drug users, so that they can determine if the substance they are considering using contains a much more potent substance than the heroin, cocaine, meth, or Adderall they thought they were acquiring. Harm reductionists argue that knowing if fentanyl is present in their drugs can allow drug users to make a more informed decision about if and how to use the drug, thus reducing their chances of overdosing.
- Training drug users, their families and friends, paramedics, law enforcement, etc. to use Narcan to revive people who’ve overdosed on opioids and providing them with Narcan.
- Training drug users to never use alone, so that someone can be present to administer Narcan and/or call 911 if they overdose.
- Placing the bulk of Narcan supplies directly into the hands of current drug users, as they are the most connected to other drug users and most likely to be present at the time someone overdoses.
- Promoting Good Samaritan Laws that allow drug users to be exempt from legal action, if they are caught in possession of drugs, due to reporting an overdose they witness.
- Advocating that insurance companies cover Narcan and that pharmacies be allowed to make it as accessible as possible, without stigma.
- Promoting medication assisted treatment (MAT) as a route to abstinence, for those drug users who feel ready to pursue that option.
- Supporting Hepatitis C treatment for drug users who’ve contracted it, even if they are not already abstinent from drugs. Some insurance plans will not pay for the treatment unless the infected party is already substance free. Harm reductionists site a low reinfection rate for active drug users who are treated for Hepatitis C, when they also have access to clean needles. They also note that when Hepatitis C is left untreated, it can cause liver issues including cancer and cirrhosis. For people with HIV and Hepatitis C, liver damage is even more likely.
- Promoting supervised injection sites where drug users can be attended by medical professionals while using, thus expediting their access to medical care should something go wrong and also giving the medical professionals an opportunity to educate drug users about safer practices than they might already be using.
- Advocating for laws that legalize substance use or are at least less punitive toward drug users.
Criticism
Critics of harm reduction often point out that not using at all will always be safer than trying to use while following practices which are simply less dangerous. They also sometimes feel that harm reductionists are enabling an unhealthy choice and therefore, keeping people who struggle with addiction sick, when they might otherwise be able to stop using drugs. A third argument against harm reduction is that it allows people to make bad choices without taking responsibility for those choices.
Seeking Addiction Treatment at Safe Harbor Recovery Center
Safe Harbor Recovery Center works to create individualized treatment plans designed to fit personal needs and recovery goals. We have a team of substance abuse professionals who are available to answer your questions about substance use and the abstinence-based treatment methods we employ.