Everything you need to know about harm reduction, if you didn’t know much.
You wouldn’t let your son or daughter trap themselves in the basement because they’re afraid of the deadly sun, would you? No. You’d probably just tell them to put on some sunscreen and wear a hat. Well, good for you. I’d like to welcome you to the world of harm reduction.
Harm reduction typically refers to any non-judgmental, compassionate and shame-free policy, program, or practice that seeks to reduce the harms associated with drug use, compulsive behaviors, potentially dangerous activities and mental health struggles. It centers on meeting people where they ARE, not where you’d like them to be.
Sound familiar? (If not, you should really spend more time reading my other posts.)
In the same vein as handing out condoms to young people (because, let’s face it, they are going to have sex) to keep them free of STDs and unplanned pregnancies, or wearing seatbelts to reduce the occurrence of deadly accidents (because you’re going to drive either way), harm reduction in the addiction sphere aims to support people who are using drugs by providing less harmful, less risk, and healthier ways to access and use drugs. It’s a recovery approach that treats those struggling with drug use with compassion and dignity.
Why do we need harm reduction? Because America has a big drug problemand shaming or punishing people because of their addiction does NOT help them. When we show compassion we give people in recovery hope, acceptance, and support.
What does harm reduction look like in reality?
Harm reduction aims to provide a safe context for people who struggle with addiction to get help. This can be seen in the classic harm reduction form of safe injection sites and needle exchange programs, which keep people (and needles) off the streets and helps those who are using stay safer and those in the community become less exposed to risk as well.
It also means providing alternate methods of treating addiction like:
- Methadone and buprenorphine which greatly reduce withdrawal symptoms for opiate users, remove some of the social issues (crime, violence, etc.) associated with accessing drugs and giving people more regulated drugs than the ones bought off the street (as in not laced with fentanyl or a whole slew of other potential dangerous drugs), thereby reducing overdose risk.
- Non-abstinence treatment and support approaches such as Moderation Management, The Sinclair Method for alcohol reduction, or our work at IGNTD.
- Marijuana as a replacement substance for opiate users would be another example of reducing the potential harm (overdose and crime) associated with street opiate use or problematic prescription use.
Decriminalizing drug offenses is another form of harm reduction which aims to help people with an addiction on the path to recovery rather than punishing them and locking them up.
Portugal has seen success in their harm reduction policies which involved decriminalizing all drugs in 2001 and as a result, the country has experienced a considerable decrease in overdoses, drug-related crimes, and HIV infection. Remarkable, right! By simply eliminating the punitive approach to drug addiction and providing people with compassion and support, the drug problem in Portugal has dramatically reduced.
Top 10 Harm Reductionists: How they’ve changed the world
Who are the people driving the harm reductionist approach to drug use and what impact have they had on addiction treatment in America? Let me introduce 10 of the big players in the field who are revolutionizing addiction treatment. I am fortunate to call many my friends, colleagues, or mentors, and their work has, and is, changing the world.
Andrew Tatarsky. Psychologist and founder of New York’s Center for Optimal Living, Tatarsky has been dedicated to psychotherapies and addiction treatment for more than three decades. He developed an effective substance abuse treatment program called Integrative Harm Reduction Psychotherapy (IHRP) to address substance use and related behaviors that do not necessarily require abstinence.
Follow him here: @AndrewTatarsky
Stanton Peele. A psychologist who has been a pioneer behind the idea that addiction occurs in the context of a range of experiences and a natural process of recovery is required through a harm reduction approach. Peelehas been a leader (and a rebel) in the harm reduction and alternative approach to addiction war for decades.
Follow him here: @speele5
Mark Willenbring. Addiction psychiatrist Mark Willenbring is renowned for treating addiction with over 30 years in the field and instigating change in treatment methods in America. He is the founder and CEO of Alltyr, a center for Transforming Treatment for Addiction.
Follow him here: @AddictionDrW
Follow her here: @1MILover
Maia Szalavitz. Maia is a big name in the field of childhood trauma and and addiction and she co-wrote the infamous book, The Boy Who Was Raised as a Dog, with Bruce D. Perry. She is also highly regarded in the addiction field with her new way of thinking about the nature of addiction on a personal and political level and recently wrote the book The Unbroken Brain, which challenges the traditional conceptualization of addiction.
Follow her here: @maiasz
Patt Denning. At the Center for Harm Reduction Therapy, clinical psychologist Patt Denning is one of those behind the development of Harm Reduction Therapy as well as being a specialist in dual-diagnosis (drug use and mental health disorders) in America since the 1980s. Harm reduction therapy is a client-centered approach to substance addictions incorporating psychotherapy so clients can address both the addiction and the underlying causes.
Tom Horvath. One of the founding members of SMART Recovery—a 12-step-alternative self-help group—and the founder of Practical Recovery, Dr. Horvath has been “meeting people where they’re at” for many years. As one of the original group of non-traditional addiction practitioners, Tom’s work has been seminal in spreading the word that there are multiple ways to approach addiction problems.
Sarah Wakeman. Medical Director at Mass General hospital, Sarah Wakeman is committed to a modern treatment approach to addiction and changing the conversation around opiate addiction. She is also a teacher and consultant on addiction and associated health care costs and resources.
Follow her here: @DrSarahWakeman
Kim Sue. A recent addition to the harm-reduction fight is 2015 Harvard graduate Kim Sue, whose work in the field of medical anthropology (which includes the justice system, addiction policies, and mental health and drug treatment) has shed light on the poor treatment of women with substance addictions in the prison system and on the streets. She aims to help inform policies for women who transition out of the criminal justice system.
Follow her here: @DrKimSue
Zachary Siegel. Though not a clinician, writer and journalist Zachary Siegelhas recently made a name for himself as an important player in progressive addiction advocacy. Through his writing, he highlights the intersection of public health and the criminal justice system for people who have an addiction. He is keen to demystify substance addiction, especially how it is portrayed in the media.
Follow him here: @ZachWritesStuff
Doesn’t harm reduction send the wrong message to people?
While harm reduction has many benefits for people who struggle with addiction and for the greater community, many oppose the idea. After all, doesn’t harm reduction just condone drug use? The fact is that, just as condoms do not condone sexual behavior, but instead protect those who engage in it from unwanted pregnancies and STIs, people are going to use substances, as evidenced by centuries of human history. This is no different to the approach we take on many other social and physical issues we face: To protect our skin from the sun, we don’t hide out in a dungeon, we simply wear some clothing, put on a hat, and slap on some sunscreen…