When it Comes to Addiction, What is the Best Path to Recovery - Abstinence or Harm Reduction?

Posted September 24, 2019 by Renee Fierro, LPCCs, Director, Outpatient Behavioral Health Services

Addiction recovery is a deeply personal journey, and different strategies work for different people. The two most common, and very different, recovery philosophies are abstinence and harm reduction. The following is a brief description of each of these approaches.

Abstinence

Abstinence-based recovery dates back centuries, long before addiction was determined to be a medical disease. This recovery philosophy expects an individual to completely stop the use of alcohol and other drugs as part of the treatment process.The concept of abstinence is connected to the Alcoholics Anonymous (AA) model that utilizes complete abstinence as a cornerstone of their program.  AA principles include the concepts of powerlessness, spirituality and family involvement as a foundation of its program.For many years, addiction treatment programs worked (and many still do) hand-in-hand with AA and other 12 step programs, often requiring attendance at meetings as a component of treatment.Someone following this recovery philosophy would be expected to completely stay away from using any, and all, mind-altering substances.

Abstinence-based addiction treatment is predicated on the idea that there is no “safe” amount of drinking or drug use for people in recovery.Addiction is viewed as a condition that can’t be cured and relapse is always a possibility.Individuals often participate in individual and group therapy as a component of treatment.There is a strong emphasis on community support and AA or NA (Narcotics Anonymous) meeting attendance is highly recommended, if not required.Often times, an abstinence program will also include physical, social and spiritual wellness components, like adding in regular workouts or joining a church. The idea is that this program will replace a person’s “bad habits” with more positive activities.

One of the biggest criticisms of abstinence treatment is that it is often based in faith, and not all people are comfortable with the idea of focusing on spirituality. Opponents also point out the rigidity of these programs that will discharge people from treatment if abstinence is not maintained, or meeting attendance does not occur. This seems to be in contrast with the understanding of addiction that relapse is often a part of the recovery process. Abstinence-based programs often have an expected recovery process made to fit all, as opposed to individualized treatment that meets people where they need to be met as they traverse recovery. 

Harm Reduction

Harm reduction, on the other hand, is a philosophy that focuses on educating people about safer substance use when an individual is not ready to commit to abstinence. The harm reduction philosophy accepts the existence of substance use, and rather than punishing (discharging) people who use drugs, the approach focuses on minimizing the harmful consequences of substance use by educating people about safer consumption methods. 

Harm reduction was first popularized in the 1980s in Europe when government officials were searching for ways to combat the growing HIV epidemic. This resulted in the development of needle exchange programs and methadone treatment for opiate addiction.  Rather than condemning people who use drugs, the harm reduction method says that we should put time and energy toward minimizing the harmful consequences of users’ actions. More recently, the opioid epidemic, that includes a significant increase in overdose deaths in the U.S., has led to an increase in Medication Assisted Therapies (MAT).MAT is a harm reduction treatment model for opiate and alcohol addiction that offers the possibility to greatly reduce overdose deaths.

Safety is the first step of harm reduction, focused on controlling the situation when drugs are being used. Some examples of this focus include:  not drinking or using drugs while driving; preventing overdoses including being aware of the signs of an overdose and having naloxone on hand to be able to administer if necessary;testing drugs for Fentanyl by using testing strips before using a drug; and, reducing the transmission of diseases through dirty needles.

The second step of someone following the harm reduction model is to focus on decreasing the amount/frequency of alcohol or drug consumption. This piece of harm reduction focuses on self-accountability along with peer support and utilizes meetings and online services.

One of the biggest criticisms of the harm reduction philosophy is that it relies on people being honest with their peers and themselves. It is not uncommon for a person to lie about how much they are consuming. It is the individual’s responsibility to be aware and maintain their own path. The harm reduction method is also highly criticized because it doesn’t help prevent people from using illegal drugs and it doesn’t educate patients on how to manage their pain without the use of drugs.

What’s Best?

The best treatment philosophy is still under debate in the treatment and recovery community.It is fully dependent on the individual’s needs and is the one that the person will stick to in the long run. It’s important for someone who is looking to treat drug or alcohol addiction to meet with a behavioral therapist/counselor to identify their individualized needs.Even if an individual is not ready for complete abstinence, the harm reduction methodology is a good start in getting help and making positive changes that can lead to safer and healthier choices.

Summa Health has various addiction treatment programs available, including the First Step Opiate Addiction Treatment Program and the Addiction Medicine Intensive Outpatient Program. Take the first step and contact us today to make an appointment.