Which is better – harm reduction or abstinence-based recovery? Each have benefits, but one is definitely stronger than the other.
When discussing addiction one thing is certain: addiction is devastating not only to individuals, but also families, communities, and society at large. The havoc that addiction wreaks has reached epidemic proportions, leaving leaders around the world with decisions to make regarding how to combat its negative effects.
Historically, especially in North America, addiction treatment has centred upon an abstinence-based model. In order to be treated and recover from addiction most treatment centres and 12-step programmes such as the original Alcoholics Anonymous, assert that abstinence is essential. But more recently, in order to address the wide reaching and severe consequences of drug addiction, programmes that aim to reduce the harm caused by addiction without encouraging abstinence have been developed.
Harm reduction approaches are often solely equated with programmes that provide addicts with clean needles and education about safer drug use, which were first introduced as the spread of HIV and AIDS became a major public health concern. Because of this association, harm reduction models are criticised for enabling addicts and seen as a waste of resources that could be spent on rehabilitating those suffering from alcoholism and drug addiction through abstinence-based addiction treatment centres.
A more Comprehensive look at Harm Reduction
While the media highlights programmes such as the safe-injection site in Vancouver BC, and other large scale needle exchange programs, there is much more to harm reduction than programmes developed to combat the spread of HIV. A harm reduction approach to addiction recovery could be said to encompass any strategy that seeks to reduce the damage caused by addiction, less of course, complete abstinence.
The Harm Reduction Therapy Centre in Oakland CA, co-founded by psychologist Patt Denning, advocates for an approach to counselling and addiction treatment that does not see abstinence as the end goal or only option. Denning helps clients set small achievable goals in relation to their substance use, often first in the form of moderation. While her approach doesn’t deny that abstinence may be the healthiest option for some people, especially for those who are severely dependent, it does acknowledge that addiction falls along a continuum and abstinence may not be possible or desirable for everyone. She seeks to meet people where they are, and allows the client to open the discussion about using substances in a healthier way– whether that means in moderation or quitting altogether.
Methadone maintenance therapy is a harm reduction technique that has helped many people live more manageable lives and reduces the severe harm that intravenous heroin use causes in all areas of peoples’ lives. While still arguably controversial, methadone maintenance has become an acceptable and life-saving form of treatment for some individuals. But, methadone maintenance is not intended to be a lifelong solution, rather a method of harm minimisation that can help individuals later achieve complete abstinence.
Many assert that offering approaches to addiction treatment that are not focused on total abstinence are necessary and positive for the community for the following reasons:
- To get more people into treatment. The stigma of labelling oneself as an alcoholic or addict keeps many people from seeking treatment in the first place. Fear is a huge part of addiction, and by offering an alternative to the 12 steps, or an alternative to abstinence only, it is thought that more people may take that first step to get help. Further drug replacement therapies such as methadone maintenance are a manageable first step for many who want to free themselves from a life of addiction.
- Prevention. Harm reduction approaches to therapy can help people assess and moderate their drug and alcohol consumption perhaps before they become completely dependent or addicted, which may prevent new cases of addiction. Not only preventing more severe cases of addiction, but preventing the spread of HIV through clean needle programs makes for safer communities.
Addiction as a Disease and Abstinence-Based Recovery
One of the problems with a harm reduction approach, especially in terms of supporting moderation is that addiction is often characterized by a desire yet inability to reduce consumption of drugs. Addiction is a disease that follows a predictable pattern. While moderation may be possible for some people or for a period of time, the nature of addiction makes consuming in moderation an extremely difficult goal, which some suggest is equally as difficult as achieving complete abstinence – yet not as physically or emotionally rewarding.
Another argument for harm minimisation is that this approach meets people where they are, is less stigmatizing as it accepts people who are not ready to stop using drugs altogether, and provides resources that reduce an addict’s negative impact on themselves and society. Harm minimization is also frequently thought of as a budget-friendly option for governments to put in place when they can’t afford to send a large percentage of the population into residential rehab to achieve abstinence. However, evidence shows that people do not have to enter alcoholism and drug abuse treatment voluntarily, or be ready for treatment in order to be successful in recovery. In fact if many people attribute non-voluntary abstinence-based treatment to saving their lives, stating they would have likely died from their addiction before they were “ready” to change.
When we look at harm reduction more comprehensively we can see that abstinence-based addiction treatment almost always encompasses some form of harm minimisation techniques, and often harm minimisation programmes, such as methadone maintenance, are meant to be a stepping stone towards total abstinence. Many addiction counsellors incorporate a motivational interviewing approach even within abstinence-based treatment. This stage of change approach is sometimes associated with harm minimisation, but in counselling it is possible to “meet clients where they are,” while still asserting abstinence as a necessary aspect of treatment.
While programs aimed at reducing the spread of HIV and AIDS through promoting “safer” drug use are achieving that worthwhile goal, the quality of life of those suffering from addiction is still failing. At The Cabin we support complete recovery from addiction, defined by SAMHS (Substance Abuse and Mental Health Services Administration) as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” The Cabin is the best alcohol and drug rehab Asia has to offer and we believe that recovery can be accomplished through abstinence-based, individually tailored addiction treatment.
