Harm reduction – Why the bad press for addiction treatment that works?!

condoms can help protect again STDs

How many of you think that giving a crystal meth user condoms will increase their drug use? Probably not many. What if instead the question had to do with giving that same user clean needles rather than having them share a dirty one? Or having him reduce his drug use instead of stopping completely? I bet there would be a little more disagreement there.

Some of you may have heard of the harm-reduction approach to drug abuse counseling and treatment, but many of you likely haven’t because the term itself is essentially taboo in the United States. The idea is to approach the patient (or client) without the shaming or expectations of abstinence that normally come with drug treatment. Instead, the counselors hope to reduce as much of the negative things associated with the drug use.

For example, almost all drug injecting users end up with hepatitis C due to dirty-needle sharing. As in the above example, harm reduction practitioners would seek to provide users with clean needles, thereby reducing needle sharing and the transmission of disease. Risky sexual behavior is often associated with methamphetamine, and crack use; instead of targeting the use itself, often, interventions attempt to reduce unprotected sex, reducing HIV transmission in the process.

hypodermic-needleHarm reduction has many supporters, but unfortunately, there are at least as many people who are against it. The claim is that harm reduction doesn’t stop drug use, and that we shouldn’t be in the business of making drug use easier. In fact, though they have no data to support it, some people argue that giving users clean needles is likely to exacerbate their drug use. My argument is that life as a drug user is pretty difficult as is, and if we can provide a way to show drug addicts that people actually care about their well-being, we might help some of them see the light.

Even more to the point, my thinking is that HIV, Hepatitis C, and other conditions often helped by harm-reduction, have to be considered as additional societal costs of drug abuse. If harm reduction helps us tackle those collateral costs, I’m all for it as an additional tool.

The bottom line is this: If we can use multiple tools to solve a problem, why limit ourselves unnecessarily to only one? If harm reduction helps, why not use it in conjunction with abstinence treatment?

As I’ve mentioned in previous posts, it’s time for us to stop resorting to ridiculous moral judgments and start focusing on solving the problem. If we can help an addict use less, use fewer drugs, or use more responsibly, I say we should go for it!!!

Is abstinence the only answer? Quality of life in addiction recovery.

Contributing author: Chelsea Crow

Abstinence should not be the only standard by which we measure success in addiction recovery.

There’s no doubt that for some addicts, full abstinence is necessary for recovery. Still, it would be hard to deny that even if they can’t stay completely clean, addicts who reduce their use substantially can see great improvement in their quality of life. I think that improvement shouldn’t be ignored.

I’ve been advocating for the use of other measures for success in addiction treatment for a while now, and a recent article gets us a step or so closer to having others consider it.

The study was conducted in New York City. All participants had a history of heavy illicit substance use for at least a year, and all self-reported abstinence for at least one month. The researchers then followed them for a period of two years, using a baseline interview at the beginning, after one year, and at the end. The interviews consisted of participants’ self-reported abstinence, Quality of Life , change in life satisfaction, as well as their commitment and motivation to abstinence.

Not surprisingly, the study found that those who reported greater life satisfaction at the baseline interview were likely to stay abstinent for longer. However, they also found that overall life satisfaction for participants remained high for most. What they didn’t look at was whether or not participants’ life satisfaction decreased with all levels of use or whether a severe relapse was necessary to cause such a reduction.

I think this should be one of our next explorations. I have a feeling that with reduced use comes greater life satisfaction and quality – even if the abstinence is not complete. I think that by beginning to explore that connection, we’ll be able to make much more refined discoveries about methods of treatment that can save lives. There’s no question that even reductions in use can allow the body, and brain, at least a partial recovery from the effects of heavy drug use.

I’ll keep you updated.


Laudet, Alexandre B., Becker, Jeffrey B. & White, William L. (2009). Don’t Wanna Go Through That Madness No More: Quality of Life Satisfaction as Predictor of Sustained Remission from Illicit Drug Misuse. Substance Use & Misuse, 44 (2), 227-252.