Harm reduction vs Abstinence. What is better?

I often see this question on the web, so I will try to answer it as accurately as possible. Although, as with all complex questions, there is unlikely to be an unambiguous black-and-white answer. To draw reasonable conclusions about harm reduction vs abstinence, let’s first figure out what’s what.

What is Harm Reduction?

Harm reduction is a public health approach that aims to reduce the negative consequences associated with risky behaviors, particularly those related to substance use. The goal of harm reduction is to minimize the harm that individuals may experience as a result of their substance use, rather than trying to eliminate the behavior. Harm reduction approaches recognize that people may engage in risky behaviors despite efforts to prevent or discourage them, and focus on providing individuals with the tools and resources they need to minimize the harm they experience as a result of these behaviors.

Harm reduction strategies can take many forms, including providing access to clean needles and other injection equipment to reduce the risk of HIV and hepatitis transmission among people who inject drugs, or providing overdose prevention training and access to overdose-reversing medications like naloxone to reduce the risk of overdose among people who use opioids. Other harm reduction strategies might include providing safe injection facilities, where people can use drugs in a supervised and hygienic environment, or offering substance use treatment and support services to help individuals reduce their substance use or quit entirely. Also worth mentioning medication-assisted treatment (MAT) for addiction.

In my opinion, educational activities, dissemination of knowledge about substances, and the basic principles of neurochemistry, psychology, and psychiatry can also be attributed to harm reduction activities. What I plan to do here to the best of my ability.

Criticisms of the Harm Reduction Approach

The Harm Reduction approach has been criticized by some individuals and groups who believe that it does not address the root causes of substance abuse and addiction. Some critics argue that harm reduction measures, send the message that drug use is acceptable, and may encourage people to continue using drugs.

Others argue that harm reduction measures do not do enough to prevent or address the negative consequences of drug use, such as overdose or chronic health problems. Some critics believe that harm reduction should be focused more on promoting abstinence and encouraging individuals to seek treatment for substance abuse and addiction.

In general, I personally think that Harm Reduction is a pragmatic and compassionate approach that recognizes the reality of substance use and addiction. Harm reduction measures can help reduce the harms associated with drug use, such as the spread of infectious diseases or overdose, while also providing individuals with access to support and resources to help them manage their drug use and improve their health and well-being.

Ultimately, whether harm reduction is an effective approach to addressing substance use and addiction depends on individual perspectives and cases, as well as the specific policies and programs that are implemented.

What is Abstinence

Abstinence-based recovery involves complete abstinence from the substance of abuse. This approach is often associated with 12-step programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), which encourage people to acknowledge their powerlessness over their addiction and work towards complete abstinence from their substance of choice.

Such programs may involve individual or group therapy, support groups, and a range of other therapeutic interventions and activities designed to help individuals maintain abstinence from their substance of abuse. These programs often rely on the support of a recovery community and may involve the use of a sponsor or mentor to provide guidance and support during the recovery process.

Criticism of Abstinence-based Treatment

Abstinence-based treatment is often criticized for several reasons.

First, some critics argue that abstinence-based treatment is unrealistic and that it places unrealistic expectations on individuals who are struggling with addiction. Some people may be unable to achieve complete abstinence, and this can make them feel like they have failed.

Second, abstinence-based treatment can be difficult for people who have developed a physical dependence on certain substances. Abruptly stopping the use of drugs or alcohol can cause withdrawal symptoms, which can be severe and even life-threatening in some cases.

Third, abstinence-based treatment may not address underlying psychological issues that contribute to substance use. Individuals may turn to drugs or alcohol as a way to cope with mental health problems such as anxiety, depression, or trauma. Abstinence alone may not be enough to address these underlying issues and prevent relapse.

Finally, some critics argue that abstinence-based treatment is too focused on punishment and control rather than support and empowerment. This approach can be stigmatizing and may make it difficult for individuals to seek help and access the resources they need to recover.

I’ve been hearing a lot of criticism lately about the abstinence approach. Indeed, not everything always goes smoothly here. Also, many are put off by the association of anonymous groups with religion. However, many people, including my clients, successfully and lastingly cope with addiction thanks to such groups.

It is believed that in some cases of addiction, in order to break or extinguish the formed neural connection, a stronger and more powerful signal is needed. They may well be religious, volunteer, sports, or other activities, at least partially forming a new worldview. The main one is that it can suppress the dominance of craving and create new ways for the reward system in our brain to work. To beat a serious addiction, a person almost always needs to become a little fanatical about something. And it is absolutely normal if it helps them in life.

And yet, which is better – Harm Reduction or Abstinence?

Why does it seem wrong to me to directly contrast or compare harm reduction model vs abstinence model? Because it is a false dichotomy. Harm reduction and abstinence work in different directions, suitable for different people, different countries, different situations, and certainly for different substances.

That is a person who uses cannabis and feels that they is starting an unhealthy relationship with it can, with the help of harm reduction, creates a completely healthy pattern of consumption even throughout. There are many nuances here, but this is quite possible.

Or the already mentioned opioid addiction. Few of those who have not encountered this phenomenon understand how it is a life-changing state. In certain situations, there is nothing left but harm-reduction interventions.

On the other hand, for a person who is deeply stuck in an unhealthy relationship with alcohol, stimulants, and benzodiazepines, stopping use completely can really help get you out of a steep dive. It will be a difficult, long, and challenging journey.

A person is likely to change a lot, but personality changes in any case accompany the phenomenon of addiction. And in the end, we all change with time. The main thing is that these changes are productive and help us move towards the goal, whatever it may be.

Ultimately, the most important thing is for the individual to find the approach that works best for them and their unique needs. Some people may find that abstinence is the best path for them, while others may find that harm-reduction strategies are more helpful in supporting their recovery.

There is no one-size-fits-all answer to the question of Harm reduction vs Abstinence. The best path to recovery from addiction will depend on the individual’s unique circumstances and needs. However, it is important to note that both abstinence and harm reduction approaches can be effective in helping people recover from addiction.