Complete abstinence from addictive substances has been a key component of substance abuse treatment in the United States for a long time. In fact, 12-step facilitation is used in some form by the vast majority of American treatment programs.
Some drug treatment professionals strongly believe that a full and happy recovery requires total abstinence, and that a harm reduction approach, in which an addict may never completely stop using drugs, denies people the benefits of a full recovery.
Other substance abuse treatment professionals believe that while abstinence is a worthy goal, a harm reduction approach can prevent deaths and can keep addicts alive and healthier in cases when total abstinence has not worked.
Twelve-Step Programs Do Not Work for Everyone
Twelve-step programs continue to play a major role in substance abuse treatment in America, and millions of people have been helped by them. However, the fact is that they do not work for everyone. Additionally, there are people who dislike that 12-step programs attach a moral dimension to a physical disease, implying that failure to recover using the programs is a personal moral failure.
Cognitive behavioral therapy and motivational enhancement therapy are other treatment alternatives, and medication-supported treatment is considered particularly appropriate in cases of addiction to opioids. An article in the AMA Journal of Ethics from 2016 concluded that while 12-step programs are appropriate for some seeking help overcoming addiction, they should not be the only approach considered.
What Is the Harm Reduction Approach to Substance Abuse Treatment?
Harm reduction in substance abuse treatment is aimed at decreasing negative consequences of substance use. It includes elements of safer use, managed use, and medication-supported treatment plans. Harm reduction is designed to address the circumstances of the addiction in addition to the addiction itself, striving to minimize the harmful effects of addiction rather than condemning them altogether.
Harm reduction should be considered as another therapy tool rather than a cure. Substance abuse treatment professionals must have access to a range of tools for helping addicts. When the metaphorical “hammer” of total abstinence and 12-step programs is the only tool available, every addiction is often treated as the metaphorical “nail.”
How It Works
First and most importantly, harm reduction does not in any way condone or promote substance use. It simply asserts that to treat drug abuse effectively, multiple options must be considered. Abstinence may ultimately be the right choice for an addict, but some people are not ready to become completely abstinent.
In some of these cases, reducing the risks of drug abuse is certainly better than avoiding treatment altogether, which is something an addict may choose when he or she believes the only option is yet another 12-step program.
Harm reduction respects the addict as a whole person and seeks to create and maintain an empathic alliance between treatment counselor and patient. Helping addicts recognize their strengths and motivations toward positive change is a core concept of harm reduction.
What the Research Shows
North America experiences the world’s highest drug-related mortality rate and has a higher rate of opioid use than the global average. Opioid substitution therapy (OST) using methadone and suboxone are more widely available than they once were. Methadone and buprenorphine therapy are available in all but two states (North Dakota and Wyoming) as well as Washington, DC. However, barriers like cost limit accessibility in some regions.
When harm reduction approaches first gained traction many years ago, main focuses were preventing the spread of HIV and hepatitis among people who inject drugs. However, harm reduction has been shown to be effective in preventing overdoses as well. It saves lives and in some cases saves money by avoiding repeated relapses and emergency interventions.
Substance Abuse Treatment Must Be Personalized
Ultimately, substance abuse treatment must be personalized, because each addiction and each addict are unique. Complete abstinence from addictive substances works for many addicts, but it does not work for everyone. Furthermore, the moral connotations surrounding many 12-step programs alienate some addicts and can prevent them from receiving treatment altogether.
The harm reduction approach aims to address this, helping addicts with evidence-based treatment that may involve therapies like medication-assisted treatment, particularly in the case of opioid addiction.
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