Substance Abuse Harm Reduction

Substance abuse can negatively impact health, relationships, finances, school and employment. Some people hit bottom and seek treatment in an effort to recover. It is considered a disease without a cure. Treatment involves helping the individuals become and remain free from substances, ideally for the rest their lives.

But what if someone is not motivated to make a change? Or other life circumstances, such as poverty, domestic violence, and mental health challenges get in the way? Harm reduction is an alternative strategy that replaces the goal of abstinence with one of decreasing the adverse effects of continued use.

Concept

• The ideas behind harm reduction are simple. In spite of prevention and treatment programs, drug abuse will continue to exist in society. There is a continuum of use from recreational users and "functional" addicts (who can maintain their responsibilities to some extent) to those who live from pill to pill or hit to hit, forsaking all else. Past and present morals have taught us that substance abuse is wrong and therefore those who have a drug problem are bad. These people should get help and stop using. And while some do, others do not.

  The proponents of harm reduction suggest for the latter group that rather than judge the substance user and mandate services, helping professionals can take a different approach. Address the individual's drug use in a neutral manner and focus instead on resolving the negative issues that continued drug use creates. During this process, the professional and client will work together, with the client helping to plan these efforts.

Goal

• The goal of harm reduction is to minimize the negative consequences of continued substance abuse for the individual substance abuser and society at large. This means not making abstinence a requirement of care. From a public health standpoint harm reduction efforts can lessen health problems, social or legal backlash, and the financial costs of substance abuse. The substance users are accepted in care wherever they are in the continuum of use. If they wish to cut back, this is embraced; if they are not ready to change anything, then a plan is agreed upon to increase safety during use. Harm reduction is real world vs. perfect world.

Examples

• On a community level, harm reduction can take the form of a needle exchange program to reduce the spread of diseases such as Hepatitis C and HIV between intravenous drug users. Or a methadone maintenance program can replace heroin or opiate pain medications with a medically safer drug, which will reduce effects of opiate withdrawal and decrease cravings. On an individual basis, a marijuana user can agree not use in certain situations (at work, to drive while under the influence to avoid harming others). While the person is not substance free in any of these examples, the situation is a safer one.