A recent article offered a gruesome synopsis of this past decade and drug overdoses, “Prince. Tom Petty. Men and women, young and old, rich and poor. Maybe someone you knew or loved. All gone, among the 467,000 drug overdose deaths in the US counted so far this decade, with another 67,000 more that will likely be added to that staggering total when this year ends (BuzzFeed News, 2019).” As the overdose epidemic grew during the past decade, the “harm reduction” approach to addiction was brought into the spotlight to reduce overdose deaths by meeting individuals “where they are at.” This method is in stark contrast to the traditional approach of abstinence-only treatment, which advocates that there is no safe amount of substance use for people in recovery. 

As drug overdose numbers continue to rise, many wonder how has each approach fairs in this crisis. While there is no definitive answer to this question, we can examine the history of each approach as well as how each method is viewed in the addiction recovery community.

What is Harm Reduction?

With its initial identification in the 1980s, harm reduction was used for individuals who were interested in reducing, but not eliminating, their use of drugs or alcohol and were excluded from programs that required abstinence (National Institutes of Health, NIH). According to the Harm Reduction Coalition (HRC), “Harm reduction is a set of practical strategies, policies, and ideas aimed at reducing the negative consequences associated with substance use. Harm reduction is also a movement for social justice built on a belief in the rights of people who use drugs.” The main principles of harm reduction do not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use (HRC). Some of the strategies this approach promotes include:

• Syringe Access/Exchange Services – syringe access programs (also known as clean needle exchanges) are created to reduce the rate of HIV/AIDS transmission and other blood-borne infections among people who inject drugs. 
• Overdose Prevention and Response Education – this education includes training of the use of Narcan, an overdose reversal medication, to the medical staff at safe injection spaces. 
• Safe Injection Sites – these are legally sanctioned spaces for individuals to use illicit drugs intravenously under medical supervision. 

On a more individual level, some addiction counselors utilize Medical Assisted Treatment (MAT) drug treatment, such as naltrexone for alcohol use disorder or Suboxone and methadone for opioid-use disorder, as a form of harm reduction. MAT medications are used in combination with counseling and behavioral therapies to help people stabilize brain chemistry, help with withdrawal symptoms and cravings, and block the euphoric effects of certain drugs and alcohol.

Abstinence in Recovery

In terms of addiction, abstinence is defined as the complete cessation of drug or alcohol use. AA (established 1939) was the first abstinence-based approach to recovery from alcoholism program. AA follows the Twelve Steps, which are a group of principles, spiritual in their nature, which, if practiced as a way of life, can expel the obsession to drink and enable the sufferer to become happily and usefully whole (AA). Other recovery groups and organizations have followed this blueprint over the years, but have modified it to fit their mission.

In terms of abstinence-based addiction recovery programs, clients entering these centers initially undergo detox to rid their bodies of all alcohol and drugs. The next phase of the program includes individual and group therapy as well as various treatment options designed to model a healthy lifestyle. Clients are expected to stay away from using all mind-altering substances and learn new strategies for living in the real world without turning to drugs and alcohol as a coping mechanism. In abstinence-based programs, addiction is recognized as a chronic disease whose symptoms can not be cured but can be controlled. 

Abstinence, Harm Reduction – or somewhere in the middle?

Some addiction treatment professionals feel that abstinence is the only pathway to recovery. They believe that people with substance use disorders are always at risk of using and that the safest way to prevent relapse is to avoid drugs or alcohol entirely. Additionally, some experts believe that if someone’s health and well-being have been severely compromised through alcohol and drug use, abstinence is the only answer as further exposure to substances could be life-threatening. They also believe that using MAT in the treatment of substance use disorders is trading one addiction for another.

Some professionals in favor of harm reduction methods feel that abstinence is too rigid in terms of recovery. They believe that even if people are not ready or able to stop using alcohol or drugs, they can start getting help through harm reduction strategies to start making positive changes in their lives. Some addiction professionals have a more balanced approach to treatment. They believe that harm reduction strategies may be most effective for some people, while complete abstinence may be the best solution for others. For example, some experts see the value in MAT and believe treatments such as Suboxone serves a legitimate purpose as they recognize opiate withdrawal is horribly painful. Yet, they also understand that it is not medically dangerous. 

They believe using MAT in a multi-day taper to help with withdrawal symptoms has its place in recovery. However, they do not believe using it as a maintenance medication. The Kimberly Center also considers medication as a last resort, and never as the first line of defense. We also recognize that when it comes to different forms of addiction treatment, whatever you choose is a deeply personal choice and respect your journey. We utilize an evidence-based program to restore the individual to a healthier life, completely free from substance dependence and abuse and destructive behaviors. We treat our clients on an individual basis to ensure their overall well-being. Call us today to begin your new life in recovery at 855-4-KCENTER (855-452-3683).