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Harm Reduction: Does It Work?

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Harm Reduction: Does It Work?

If you’ve spent any prolonged amount of time in the recovery community, you’ve probably arrived here with a bias either for or against harm reduction. Maybe you vehemently fight against it as a deluded fantasy divorced from the reality of the ravaging disease of addiction. Or maybe harm reduction changed your life for the better and you’re sick of hearing AA’s trash talk against it. As a life and death issue, addiction naturally polarizes us into these often (though not necessarily) exclusive thought camps. Is harm reduction a viable option? Or is total abstinence the only way to achieve a happy, functional lifestyle for people in recovery?

Does Harm Reduction Work?

Pitiful & Incomprehensible Demoralization

First let’s address the elephant in the room. We’re looking at you, Alcoholics Anonymous.

Many assume that AA is a rehab program. It’s not. AA offers support and guidance for people who “have a desire to stop drinking.” One of its underlying assumptions is that, for all intents and purposes, people have come to the group having already attempted harm reduction. AA defines alcoholics (for our purposes, that includes addicts) as:

Men and women who have lost the ability to control our drinking. We know that no real alcoholic ever recovers control. All of us felt at times that we were regaining control, but such intervals—usually brief—were inevitably followed by still less control, which led in time to pitiful and incomprehensible demoralization. We are convinced to a man that alcoholics of our type are in the grip of a progressive illness. Over any considerable period we get worse, never better.

In simpler terms, AA offers a roadmap to abstinence for people who could not find success with harm reduction techniques. But AA members often suffer from a problem of conflation.

Conflating Alcoholics

Objectively speaking, each person’s circumstances are different. The Big Book offers a lot of great wisdom across the board, but it also encourages people among its ranks to pigeonhole alcoholics.

This typically comes from a place of concern and empathy. People in recovery know rock bottom all too well. And in many cases, attempts at harm reduction just create more problems. The Big Book abounds with examples of harm reduction that lead to full relapses:

Here are some of the methods we have tried: Drinking beer only, limiting the number of drinks, never drinking alone, never drinking in the morning, drinking only at home, never having it in the hose, never drinking during business hours, drinking only at parties…

The list goes on. For many alcoholics and addicts, such attempts at harm reduction just spark a familiar cycle of regression. Or as we mentioned earlier, that long term pitiful & incomprehensible demoralization. AA claims that this brand of alcoholic is the only brand that exists. That anyone who finds success with some combination of intensive therapy and harm reduction are just “not real alcoholics.” So it’s understandable why they so vehemently deny that harm reduction can work. After all, it didn’t work for them… so how could it work for anyone else? And if harm reduction does bring success, somehow that person’s struggles with alcohol dependency becomes less legitimate.

It’s an exclusionary view of recovery that potentially does more harm than good.

Therapeutic Pragmatism

12 Step Book Alcoholics Anonymous

Belief in abstinence as the end-all, be-all answer to recovery relies on the assumption that all addicts possess the same physiological makeup and psychological profile. That those same addicts respond (or don’t respond) to the same types of therapy and lifestyle adjustments. And as addiction specialists learn more and more about the disease, we learn that assumption simply isn’t true.

Recovery, in its broadest sense, represents a return to happy, functional living. Whether the halls of AA likes to admit it or not, harm reduction approaches like SMART recovery and medication-assisted treatment as a transitional tool work for some people in some cases. The operating word here is SOME. But since addiction is a life and death issue, we emphasize the importance of addressing the underlying drivers of addiction before making any decision about the viability of harm reduction.

Harm Reduction Means Running with Scissors

The early phase of recovery (let’s say less than 5 years sober) represents an incredibly vulnerable time. At this stage, people are still shaking off toxic ways of thinking. It’s difficult to focus on transition (i.e. learning better coping skills, improving daily activities of living, crisis management) when mired in old self-destructive habits. While harm reduction has been known to work, it too often functions as the vehicle for relapse.

Think of it this way: harm reduction exists somewhere between miserable rock bottom and functional abstinence. Where it falls exactly depends on each individual. For many people in recovery, harm reduction isn’t much higher than rock bottom. And it certainly doesn’t return them to a happy, functional life. Others may eventually be able to utilize it in limited ways. But either way, harm reduction means running with scissors. It’s a gamble with your life that may land you somewhere between death and pitiful & incomprehensible demoralization.

Abstinence should never be eschewed completely. Especially when the foundation for sobriety still needs work. If you or a loved one is seeking help for a substance abuse problem, New Start offers 12 step modality to build a foundation for recovery. Our addiction counselors are available 24/7 for free case consultations: (833) 433-0448


Posted in Addiction, Health and Wellness, Recovery, Relapse