Enabling Abuse, or Empowering Recovery?
What is Harm Reduction?
Harm reduction is the principle of meeting a person struggling with addiction where they currently are. This includes the idea that others should accept, for better or worse, that a person uses drugs and help them take steps to reduce the risks of harm. 1
The theories over harm reduction started in the 1970s and 1980s. 2 This was a concept that emerged as an alternative to telling people who struggled with drug abuse that they should quit or else. For some people, that approach isn’t realistic.
It doesn’t take a medical expert to know that addiction and substance abuse is a complicated issue. Most people don’t want to struggle with drug abuse. Harm reduction is a principle that helps a person try to stay as safe as possible until, ultimately, hopefully, one day, a person can become sober. But until that time, harm reduction can help prevent negative long-term consequences.
Concepts of Harm Reduction
An article published in the Journal of Harm Reduction described the common threads or concepts that surround most harm reduction policies.
These concepts include: 3
People who struggle with drug abuse deserve the right to be treated with dignity and respect. They’re individuals who are struggling and deserve care.
No person is perfect, and no one does perfect things for their health. It isn’t realistic that a person will make healthy choices in every situation in their lives.
Every person has their own health needs and behaviors. Every person may be in a different place in their lives with regard to how they feel about their drug use.
A person has the right to learn about different treatment options and make their own decisions about how they want to care for their health.
Any positive change that can enhance a person’s health is a good one that should be encouraged.
Accountability Without Termination
A person shouldn’t have to fear being “fired” from healthcare or services because they use drugs.
Most harm reduction policies use at least one or more of these concepts to create policies and provide education to those who use drugs recreationally or habitually. Harm reduction can be used for a variety of methods, not just drug abuse. The concepts have been used in healthcare, such as helping those who are overweight.
According to the authors, “While we confirm that the patient should be held accountable for his harmful health behaviors, understanding the underlying factors contributing to risk is critical to working successfully with patients.” 4
Principles of Harm Reduction
There is a national organization called the Harm Reduction Coalition that outlines some of the major principles associated with harm reduction. According to their website, harm reduction is “a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”
Some of the major principles surrounding harm reduction include:
Accepting that for better or worse, drug use is a part of a person’s life and a part of the world in general. Instead of trying to make a person feel bad or ignore they have a problem, a person and their family can choose to practice harm reduction to minimize harmful effects.
Understanding that drug use is a complex issue. A person may have different levels of drug use, and that doesn’t have to mean severe addiction. This also acknowledges that there are some safer ways than others – such as stopping sharing needles – to use drugs.
Using techniques to enhance the quality of life in a person using drugs instead of trying to focus on them stopping using drugs altogether.
Providing services to a person in a non-judgmental manner that isn’t constantly focused on them trying to stop drug use.
Making sure that treatment for a substance use disorder includes the person affected. People should have a role in their care and the programs they participate in. There isn’t any mandating or forcing a person to go into a certain program.
Giving people who have substance use disorders power over their own lives while helping them find strategies that help them reduce harm whenever possible.
Not Permission to Harm
It’s important to know what harm reduction isn’t – it isn’t giving a person who uses drugs permission to harm others or ignore the dangers and damage that can come from drug abuse. Instead, it operates on the idea that people don’t have to pretend that a person has a drug problem.
Is Harm Reduction Enabling?
Some health experts and loved ones are afraid that harm reduction strategies are the same as saying that drug use is okay.5 Another word for this concept is “enabling” or giving a person the tools they need to keep using drugs without facing a lot of consequences for them.
Alcoholics Anonymous Beliefs
According to The Washington Post, the concept of enabling originally comes from Alcoholics Anonymous, a 12-step recovery program. This program’s concept is that if friends or family support a loved one who uses drugs, this keeps the loved one from hitting rock bottom. They believe that until a person hits rock bottom, they can’t quit using drugs.
The idea of enabling and hitting rock bottom mostly comes from stories of people who have achieved sobriety, not from real research itself. While many people have found they have to hit rock bottom, others don’t even get the chance because they overdosed or experienced life-threatening health complications. The concept of harm reduction is one that tries to help a person maintain their health and avoid chronic health conditions until the person can make the decision to stop using drugs.
No Evidence for AA’s Philosophy
There’s no research to show that harm reduction programs cause new people, such as young people, to use drugs. For example, needle exchange programs in cities aren’t associated with people starting to use drugs because they find them safe thanks to the existence of needle exchange programs.
Maria Szalavitz, a journalist and author, wrote her opinion on harm reduction strategies, sharing the following theory:
When people feel valued rather than judged, regardless of whether they continue to take drugs, they begin to value themselves move. Once people feel safe and cared for, it’s much easier to make changes that otherwise frighten them.”
Harm Reduction is Helpful to Families
When many people take time to learn about the effectiveness of harm reduction strategies, they gain a greater understanding of their potential effectiveness as an ultimate drug abstinence strategy.
Some families whose loved ones struggle with drug abuse may benefit from knowing more about harm reduction policies. They can learn about how to keep a person safe without feeling like they have to completely kick them out of their lives. It doesn’t mean they’re giving up on the idea of the person ever being sober, just that they know they will need different kinds of help until they can achieve their sobriety.
How Effective is Harm Reduction?
Doctors and therapists have used harm reduction for many years to help against many behaviors. Harm reduction strategies have been shown to be effective in reducing the risk of:
Needle Exchanges Reduce Infectious Disease and Overdose
According to an article in the journal Paediatric Child Health, the harm reduction measure of introducing needle-exchange programs have reduced the number of people with HIV compared to those who don’t have needle exchange programs. Also, methadone maintenance programs where a person takes the drug methadone instead of using heroin or illegal pain pills have reduced deaths from overdoses and other causes.
Housing Reduces Medical Costs and Drug Abuse
Another study found that housing programs that provide safe housing to a person even if they don’t stop using drugs are associated with reduced medical costs and even reduced substance abuse rates. Infection rates for IV drug users decreased from 50 percent to less than 3 percent when the New York state started to introduce syringe access programs.
According to the North Carolina Harm Reduction Coalition, harm reduction programs have been helpful in accomplishing:
Safer for Law Enforcement and Healthcare Workers
The NCHRC also points out that harm reduction strategies may also be protective toward healthcare and law enforcement personnel. According to their website, harm reduction may help to reduce risks for injuries from having to handle hypodermic needles.
Examples of Harm Reduction
Teenagers are a common age group for harm reduction measures. Doctors know teenagers are prone to risk-taking behaviors as well as experimentation. The likelihood that they won’t try alcohol or sexual experimentation isn’t likely for many. For example, a report found an estimated two-thirds of high school students in Ontario have used alcohol at least once in the past year. For these young people, telling them not to try alcohol isn’t realistic.
Harm Reduction for Teenagers
Harm reduction strategies wouldn’t try to make a person not use alcohol at all, but would instead focus on making better decisions. They might include:
Discouraging a young person from doing drugs or using alcohol
Encouraging a young person to stop whenever possible
Providing a teenager with information on how alcohol or drugs could harm them
Telling a teenager if they have been drinking or are in a scary situation with drugs involved, that they can call you for help
Needle Exchange Programs
Another harm reduction example is a syringe exchange program. This program allows a person who struggles with drug abuse to avoid unwanted side effects like contracting hepatitis or HIV by exchanging used needles for new ones.
Other Types of Programs
Other examples of harm reduction programs include:
Keeping naloxone (Narcan) in a person’s home in case of overdose
Safer injection facilities
Opioid substitution programs, such as methadone and Suboxone
Overdose prevention programs
Providing primary care and treatment to those who use drugs
These are just some examples of harm reduction strategies that healthcare providers may use while caring for a person with a substance use disorder.
Organizations that Advocate for Harm Reduction
Harm Reduction Coalition
The Harm Reduction Coalition is a national organization dedicated to promoting the health of individuals and improving communities whose members are impacted by drug use.
Examples of the issues the Harm Reduction Coalition works to address include:
Some of the major programs the Harm Reduction Coalition performs, include, providing access to clean syringes, engaging in overdose prevention programs, and educating more people about drugs and the people who use them.
The coalition makes a lot of efforts to help others understand that drug abuse affects a lot of people who are members of vulnerable populations. This includes the homeless and those who live in poverty. These people often do not have a voice in their own care, or the policies made that affect them.
The coalition has two offices in the United States. One is on the East Coast in New York City and the other on the West Coast in Oakland, California. For more information on the Harm Reduction Coalition, visit HarmReduction.org.
Drug Policy Alliance
Another example is the Drug Policy Alliance, a non-profit organization based in New York City. The major harm reduction issues the Drug Policy Alliance advocates for include:6
Reducing Discrimination Against Drug Users
The Alliance believes people should take a compassionate and judgment-free approach to those who use drugs.
Accidental drug overdose is the current leading cause of death in individuals under age 50. By promoting education and help for those struggling with drug abuse, the Alliance hopes to prevent overdoses in this population.
Naloxone is a medication that can reverse the effects of opioid overdoses. When a person takes it, it knocks off the opioids taking up the receptors in the body and can be life-saving. Some people have access to it without a prescription in pharmacies and doctors’ offices to keep in case they or a loved one overdose. Some people in the United States still can’t get it as easily. The Alliance advocates for greater access to naloxone to prevent overdose deaths.
Protection for Good Samaritans
Unfortunately, some people using drugs refrain from calling 911 if they witness an overdose because they’re using drugs themselves. The Alliance pushes for protections for good samaritans so that they’re protected against prosecution and don’t fear to call for help.
Access to Syringes
Using clean needles lowers the risks for hepatitis C and HIV transmission. Supporting access to sterile syringes and safe places to dispose of them helps to cut down on people contracting these deadly diseases.
The Alliance advocates for drug-checking programs that provide testing supplies and sites to ensure harmful substances such as fentanyl aren’t added to drugs or that the pills contain what they say they do.
The Alliance also advocates for supervised consumption services. This includes overdose prevention centers and supervised injection facilities where people use drugs under medical supervision. For more information on the Drug Policy Alliance, please visit drugpolicy.org.
Harm Reduction Shows Positive Results
Harm reduction is a principle that operates under the idea that as long as there are drugs, there will be people who struggle with them. Instead of trying to push drug use into the shadows, harm reduction principles try to provide safer ways for a person to use drugs until they’re ready to get clean. Those who advocate for harm reduction don’t see it as enabling; they see it as a way to treat someone humanely when they are struggling.
Thus far, harm reduction data shows positive results by preventing diseases like HIV and hepatitis. It can also reduce risks for healthcare workers and police officers by providing safe disposal of syringes.
Harm reduction involves education on the part of the person using drugs and the people around them. By trying to foster a better, safer understanding of drugs and drug use, harm reduction can ideally help reduce drug abuse.