When someone struggles with an alcohol or substance use disorder, there are always ramifications. Outside factors also affect the individual user. The law, programs, social prejudices and viewpoints, and other institutions and practices in the private and public sectors have measurable consequences for substance use and recovery. The work done to mitigate the negative impact of these factors on recovery is called harm reduction. Resources are available to learn more about harm reduction and other treatment-related topics. These resources include The National Rehab Hotline, which can connect you with treatment providers and valuable information via a phone call.
What Is Harm Reduction?
For many people experiencing a substance use disorder, “harm reduction” is a new and unfamiliar term. This is in part because there is currently no universal or standard definition. As a result, many scholars, organizations, legal experts, and clinicians have attempted to derive their own interpretations. The advantage of this is that many disciplines and viewpoints are brought to bear on the idea, allowing it to be dynamic and useful across many situations.
For example, according to the National Institutes of Health (NIH), in the early stages of substance use intervention, harm reduction can make the first steps to recovery far less stressful. This is because it seeks to reduce the substance use behavior over time rather than immediately eliminating it.
Harm reduction can be thought of as a cluster of “best practices.” While there is no single list that will cover every use of the term, the following helps show what harm reduction can mean when it is applied to substance use disorders. Such a preliminary list includes:
• A focus on gradual reduction in substance use rather than an abstinence-only approach
• Reducing accusatory, hurtful, and stigmatizing language in favor of “I feel” statements when speaking to a substance user
• Focusing on a rehabilitative (therapeutic) approach to substance use disorders in lieu of a punitive (prison-based) one
• Fighting the social stigma of substance use disorders, revealing them to be diseases rather than moral failings or crimes
• Emphasizing the community’s power to help a substance user heal rather than penalizing the user through isolation
• Foregrounding treatment of the whole person instead of just the substance use disorder, thereby improving the subject’s overall health and reducing the likelihood of relapse
For the past several decades, most therapeutic models for substance use treatment have focused on zero-tolerance policies toward substances and total abstinence from future use. Harm reduction, on the other hand, takes a more gradual approach through the understanding that ending substance use does not and cannot happen immediately.
Why Is Harm Reduction Important?
Harm reduction’s importance exists on two levels. On the personal level, it affords substance users the dignity and the basic rights they are entitled to. This prevents the shame that can greatly complicate recovery. According to the NIH and the “Five Rules of Recovery,” shame can be a significant obstacle to recovery and can even trigger a relapse.
Harm reduction moves the focus from past abuse to a patient’s current efforts and future goals. It further provides evidence-based actions that are tailor made to the individual and his or her psychological profile. Past struggles, psychological backgrounds, relapse histories, and types of support systems can be used in tandem with measurable data and broader treatment options. It is proactive and preemptive, helping to arrest past substance use behaviors and to build newer, healthier, sober ones.
In addition, harm reduction is geared toward treating both the symptoms and the effects of substance use disorders. While primary therapies such as AA and NA, inpatient rehabilitation, counseling, group therapies, and other interventions are meant to cease the substance use behavior by identifying causes and triggers, harm reduction works to lessen the effects that the substance use has on the individual, family, and community. In this way, it can be considered a secondary or auxiliary therapy technique.
Does Harm Reduction Work?
A recent study by the journal “Drug and Alcohol Review” cites a high efficacy (effectiveness) rate for harm reduction, especially when it comes to illicit drug use. There are also measurable benefits in the use of other substances and across a diversity of populations.
As an example, college students represent the greatest alcohol consumption by age group. After interventions with harm reduction were put in place, weekly drinking among the college students tested was reduced by 40-50%. Similar success rates were found among users of prescription and illicit drugs, with some quantifiable level of efficacy in all age groups, genders, races, and ethnicities.
What Are Some Examples of Harm Reduction?
You will notice that while only some of the examples below treat substance use disorders directly, they all help to ease the impact these disorders have on patients and those close to them. Harm reduction samples include:
• Needle replacement programs to prevent the spread of diseases like hepatitis, HIV, and MRSA
• Opioid replacement therapy (ORT, also called opioid substitution therapy), which replaces stronger opioids like heroin with longer-acting but less euphoric ones like methadone and suboxone (buprenorphine)
• The use of muscle relaxants or benzodiazepines to treat withdrawal symptoms of illicit or prescription drugs
• The use of barbiturates or Propofol to treat alcohol withdrawal symptoms like delirium tremens (DTs)
• A “draw-down” or “weaning off” period during which less and less of the problematic substance is used until it is out of the user’s system
• Drug and alcohol “checking programs” in which substances are verified to prevent poisoning or overdose
• Arranging for a designated driver or cab service at parties where alcohol and drugs will be used
• Keeping sexual protection on hand during parties where there will be drugs or alcohol
• Eating a meal and drinking water before consuming alcohol or drugs
What Are the Benefits of Harm Reduction for the Substance User?
For someone who struggles with a substance use disorder, attaining sobriety is usually an extensive process. However, most therapeutic treatment models push for abrupt, continual, and total abstinence from the substance or substances. While models like these have helped millions get and stay sober, they also prove that there is no “one-size-fits-all” treatment.
For many people who struggle with alcohol and substances, a more gradual process is helpful. It may be because quitting a substance will lead to withdrawal symptoms. It may be because a person wants to quit using but has a strong chemical or physical dependency on the substance. Or it may be because a compassionate understanding of substance use on the part of a user’s support system is vital to recovery.
What Are the Principles and the Goals of Harm Reduction?
Best practices in any field cannot exist without guiding principles, parameters, and objectives. According to Harm Reduction International, the following principles and goals are necessary to maximize harm reduction while improving a patient’s health and reducing the chances of relapse.
Principles
1. Respect for the Rights of Users – No matter a person’s actions, he or she is entitled to dignity, respect, and basic human rights. Those who support harm reduction work to prevent cruelty during treatment, arbitrary or unfair imprisonment, and social stigmas about people with substance use disorders.
2. A Dedication to Evidence and Facts – The approaches that make up harm reduction are time tested and backed by science. They show measurable results in the form of statistics, testimonies, and efficacy ratings.
3. A Dedication to Practical Action – Most types of harm reduction should be easy to utilize in most locations and at low cost. They should be completely safe. They should also be effective across the broadest possible demographics. Accordingly, they should improve both individual and public health.
4. A Dedication to Justice and Cooperation – Treating each other justly is essential to human dignity. Someone who lives with a substance use disorder deserves no less. That person is innocent until proven guilty, even if accused of a crime. Just because he or she struggles with substance use does not automatically mean he or she is dishonest or a criminal. Furthermore, help toward recovery should be easily acceptable, free of discrimination, and available to all. Those with substance use disorders should also have a voice in the design and implementation of recovery programs.
5. A Continual Effort to End the Stigma of Substance Use Disorders – There are many assumptions and stereotypes that come with substance and alcohol use. Criminality, dishonesty, weakness, and immorality are all prevalent but erroneous assumptions about those who are simply suffering from a disease. Even worse at times is the self-stigmatization that can cause despair and eventual relapse. Harm reduction works to restore the humanity of those with substance use disorders, defining them not as problems but as people.
According to the NIH and the Substance Abuse and Mental Health Services Administration (SAMHSA), 10% of substance users do not seek treatment because they are worried about their confidentiality or privacy being compromised. Another 10% do not because they are worried about how neighbors, friends, or the community will view them. Another 8% worry that admitting that they need help with substances may reflect on their employments or lead to terminations.
What Are the Benefits of Harm Reduction to the Family, Community, and Society of the Substance User?
Ultimately, harm reduction provides an alternative form of treatment leading to total sobriety. While complete abstinence from alcohol, prescriptions, or illicit drugs is often the end goal of harm reduction, it is done in such a way that stress is reduced, withdrawal symptoms are mitigated, and progress is broken down into a series of small, manageable, and achievable goals.
Total abstinence models, while also effective, may require a widespread disruption to one’s life. Time off of work may be needed. Temporary relocation to a rehab facility may be necessary. The emotional and financial impacts can be significant. Harm reduction does not alleviate possible negative effects just for the substance user, but improvement is also provided to his or her family, friends, coworkers, neighbors, and community.
General Guidelines for Harm Reduction
After exploring the principles, goals, strategies, and benefits of harm reduction, you may begin to see some underlying values emerge. These values provide doctors, caregivers, and mental health specialists with the kind of “prescription” for substance use treatment. According to the Harm Reduction Research and Treatment (HaRRT) Center at the University of Washington, these values include:
• Discovering and implementing just, moral, and ethical treatment practices
• Fostering positive relationships between patients and caregivers, patients and family, and patients and their communities
• Displaying and encouraging others to take personal responsibility for their decisions, actions, and futures
• Creating and nurturing treatment teams, self-help groups, and new harm reduction specialists
• Increasing a sense of value within communities, especially when it comes to a community’s public health
• Learning to value, respect, and honor the experiences, thoughts, knowledge, and insight of others
As of 2016, 19 million Americans are in need of treatment for an alcohol or substance use disorder, but only 11% of this number are receiving the help they need. Harm reduction is a relatively new avenue of treatment that provides more options, smaller steps, and more measurable goals than many traditional abstinence-only substance use treatment approaches. With new options comes new hope.
For more information on this and other innovative treatments, contact The National Rehab Hotline at Post navigation