Over the last few years, the way substance abuse is treated has shifted from total abstinence-based programs that implement the 12-step program toward methods of harm reduction.
The difference between harm reduction and abstinence is in methods of treatment and the overall perception of modern substance abuse.
In abstinence-based addiction recovery, people must refrain from the use of all mind-altering substances except for some emergencies where pain killers are used short-term following a major surgery. Even still, any substance should not inhibit a person from the neck up.
Abstinence focuses on total drug cessation and using the twelve steps (in most cases) as the best method for recovery. For decades, abstinence has been heralded as the best way to treat addiction and includes the following principles:
- Addiction is an involuntary, primary disease that is describable and diagnosable
- Addiction is a chronic and progressive disease
- Addiction is not curable, but the disease may be dormant
- The nature of the initial motivation for treatment, its presence or absence, is not a predictor of treatment outcome
- The treatment of addiction includes physical, psychological, social and spiritual dimensions
- The successful treatment of addiction requires an environment that offers the person suffering dignity and respect
- People suffering with substance abuse are vulnerable to the abuse of a wide spectrum of mood altering drugs, which is viewed as chemical dependency
- Chemical dependency is best treated by a multi-disciplinary treatment program is developed to meet the individual needs of a person
- A primary counselor, often someone who is in recovery him or herself, is assigned to the individual and offers emotional support and guidance
- The most effective treatment for addiction includes involvement in a 12-step program that combines individual counseling and dynamic learning environment
According to the Harm Reduction Coalition, the purpose of harm reduction is to offer practical strategies and ideas for reducing negative consequences associated with substance use. Harm reduction is also perceived as a movement for social justice established with a belief and respect for people suffering with substance abuse.
According to the Harm Reduction Coalition, the concept of harm reduction:
- Accepts licit and illicit drug use as part of our world
- Believes it’s better to work toward minimizing harmful consequences rather than condemning them
- Views drug use as a complex, multi-faceted phenomenon encompassing a range from severe abuse to total abstinence; as such, some ways of using drugs are clearly safer than others
- Believes that for the quality of individual and community well-being, total drug cessation is not always the best answer
- Calls for non-judgmental, non-coercive resources for people suffering with substance abuse
- Ensures that drug users and those with a history of drug use maintain a voice within the creation of future services and programs
- Affirms drugs users themselves as the primary agents of reducing the harms of their drug use
- Seeks to empower people with a history of drug use to share information and support each other in strategies relative to their conditions
- Recognizes that socio-economics play a vital part in substance abuse and seeks for that to be a priority of consideration
- Does not attempt to minimize the harm or danger associated with licit and illicit drug use
So, what’s better between the two?
According to an article in Psychology Today, a move toward harm reduction based treatment could potentially yield adverse consequences. Because harm reduction supports medication-based treatments, the danger of one substance being traded for another substance obviously presents itself.
One of the main controversies surrounding harm reduction as a treatment is in its use of operations like free needle exchange or giving drugs like Suboxone or Methadone as alternatives to the illicit versions in order to minimize the risk surrounded illicit use and behavior. In this way, substance is used to defeat substance, with the idea that the alternative substance is safer and less risky to acquire or use.
According to a Times article, harm reduction has been shown to be successful. The writer notes: “While harm reduction may make politicians queasy, the data clearly supports the most commonly used measures like needle exchange, methadone, and Suboxone, and so far suggests possible benefit from more controversial measures like heroin provision, safe injecting rooms, and ‘wet houses.’”
Despite positive research, many doctors and researchers still see harm reduction as a harmful answer: people remain dependent on substance, and the benefit becomes one of economics, not of the individual. Because of the complexity of substance abuse and the varying needs of individuals, a definite answer remains unclear.
In many ways, the question seems to lie in whether we accept addiction as inherently human and a product of the modern world that is sometimes necessary, or if we maintain the view that addiction is a dissonance between the mind, body, and soul, and seek to offer substance-free treatment focusing on how to address individual needs from a bio-psycho-sociological perspective.
As is often the case, there may be value in combining the best principles of harm reduction and abstinence. Most recently, some researchers are looking at how harm reduction can be used to work toward abstinence. At Fair Oaks Recovery Center, we take an abstinence-based approach, but we also recognize the individuality of our clients and work together to develop treatment plans that will work for them. We believe that a life free from dependence and addiction has the most potential for happiness and health.