As the opioid epidemic shows no signs of abating, the term “harm reduction” has entered into the lay media. We hear about mentioned in all sorts of places. It has support in conservative parts of the country. People speak of it when discussing individuals released from prison. And increasingly, there is evident tension between harm reduction and traditional abstinence-based treatment and self-help approaches. I believe that this tension is overblown, and the similarities between the two methods are overlooked.
Advocates of both approaches believe that individuals suffering from addiction are better off:
Alive, not dead.
With family & friends, not alone.
Employed, not unemployed.
Domiciled, not homeless.
Independently functioning, not institutionalized.
Healthy, not ill with infectious diseases.
Most harm reduction advocates probably believe that patients would be better off abstinent than not. But they would add that addiction treatment professionals and self-help groups must meet the patients where they are in their recovery journey. Most abstinence advocates would probably agree with that caveat. For example, quitting drinking is not a requirement to attend Alcoholic Anonymous groups, the quintessential abstinence-based self-help program. The only requirement is a desire to stop drinking.
I have worked with many addiction counselors who were steeped in abstinence-based treatment. Their commitment to their that way to recovery was no less intense than their attachment to their faith. Yet, the best and most effective ones among them always meet the patients where they are. They cheer every positive change, no matter how tiny. They are very good harm reductionists without realizing it. So what is the difference between them and those who would call themselves harm reductionists? The only difference I see is that the former are not likely to buy that it is possible to be physically dependent on a substance without being addicted to it.
That’s a tiny difference for people on the same side to fight over.
