The term harm reduction can cause a stir amongst the abstinence based recovery professionals. Usually because the term is directly associated with drug and alcohol use. However, the true meaning of harm reduction includes many other adverse effects of drug and alcohol use, so it is a larger concept than abstinence.
For example, harm reduction practices are designed to reduce overdose, HIV, hepatitis C, addiction, and incarceration. And while abstinence would also have significant impact on these factors, the simple fact remains that, for may, abstinence will not be their choice.
So the question remains: what, then, do professionals working with individuals using substances do?
Perhaps this question is best answered with another question; the question of mindset.
As an addiction treatment professional, I struggle with this myself. I must remind myself of the truths of our world, and get into a practical mindset based on those truths. For example, licit and illicit drugs are a part of our world; many people use them and abuse them. Also, many people use them and do not abuse them. So, is it my place to condemn drug use for those who gain legitimate relief from undo suffering? And if I am to forgive drug use for those suffering, then how do I define suffering? Is suffering restricted to those in severe physical pain? What if the physical pain is caused by the drug use? And if suffering is not confined to physical pain, then how do I quantify mental anguish, anxiety, or fear? There are simply too many variables for me to claim a thorough understanding of suffering.
Just as suffering is complex and multi-faceted, so is the continuum of drug use. I have experienced individuals who abused drugs on occasion, but did not meet the criteria for substance abuse or addiction. Likewise, I have experienced individuals who meet all the criteria of advanced addiction. And, while drugs are dangerous in my view, there are clearly ways of using drugs that are safer than others. So, I need to understand that people will make their own choices about drug use, and in understanding this phenomenon I can shift my mindset to informing them of the dangers rather than condemning their use of the drugs.
It is also clear that variables such as poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequities affect people’s decision-making in using drugs. As a white male who was raised in a very good neighborhood, I need to remember that I cannot understand all of the intricacies of an individual’s circumstances and decision-making criteria. I need to hold, as a possibility, that for a few people, abstinence may not be an option. And in these instances a harm reduction approach may be more practical than condemning their drug and alcohol use.
However, harm reduction practices do not condone the minimization of the very real and tragic harm that can come from licit and illicit drug use. Being honest with clients about these dangers may give them the necessary information to avoid overdose, disease, or addiction. People need to know the facts, provided in a non-judgmental and informative way, so they may make up their own mind about their use of drugs. And while providing the information may not satisfy my own desire for them to abstain for the use of alcohol and drugs, it does give me some satisfaction that I am helping them to avoid further negative consequences, and that I am helping them to make decisions that will improve their quality of life should they choose to take action.
At the very least, a healthy shift in mindset can have a valuable impact on how I work with those struggling with the negative impact that drugs and alcohol have on their lives.
So, as an abstinence based addiction professional, I must work to change my mindset about harm reduction. I need to understand that harm reduction has its place and is a valuable tool in the right circumstances. I need to remain open to the possibility that an improvement in quality of life can come in many shapes and sizes. And I must do my part and keep doing the work.