ADDC 1101: Introduction to Addiction
Abstinence vs Harm Reduction

One of the most talked about debates in addiction counseling is between abstinence and harm reduction. In general, Abstinence-focused addiction counseling believes that recovery only exists if the addictive substance is completely removed from the life of the individual it affects. The issue is seen as largely black or white: either you drink/use drugs and deal with the consequences, or you abstain and live a life in recovery. Harm Reduction-focused addiction counseling generally follows the belief that not everyone is in a place to completely abstain; and therefore, it is best to take steps to reduce the risks to the person and others when the individual chooses to partake in the addictive substance. The notion is that some people may not currently be willingly or able to completely give up the substance of their addiction
(www.new-hope-recovery.com).

For people seeking help, total abstinence is an ideal goal but given their circumstances and motivation for change, that goal may be unreachable when they first seek help. Many abstinence-based facilities are moving away from kicking out a client after one positive urine screen, which was not always the case. Often the treatment team reassesses the situation and decides if the treatment plan is still appropriate and if the client is receiving the proper level of care. Similarly, abstinence-based facilities are also increasingly using or allowing pharmacotherapy as an adjunct to treatment. Many treatment facilities now work with clients who are on Suboxone, Vivitrol, Naltrexone, etc. Allowing these medications is a harm-reduction approach to treatment, but in practice those modalities are becoming more acceptable across the board
(www.new-hope-recovery.com)
There are many types of harm reduction modalities including: drug replacement therapy such as methadone or needle exchange programs, designated drivers, substituting “less harmful drugs”, testing illicit drugs for harmful additives and behavior modification to control intake. Because harm reduction philosophy and practice resides in the gray area of the continuum, research on the topic has been muddled, largely due to the lack of a consistent definition as to what harm reduction is and how it should be measured. This makes sense even if you only consider the expansive list provided above as types of harm reduction The general focus of harm reduction is not whether an individual does or does not do a particular behavior, it is about reducing the potential problems associated with it. Substance use under the harm reduction approach is not black/white, either/or; it is the gray area in between. If a person chooses to drink or use drugs, the focus is on ways to reduce the risk from using. An important concept that some people and policy makers do not understand is that the harm reduction approach should not be seen as condoning risky or illegal behavior. Rather, it understands that risky behavior is inevitably going to occur, so it is more beneficial to curb the negative consequences incrementally as best as possible (www.new-hope-recovery.com)