This is a paper I wrote for an English class in the fall of 2019. I wanted to share it because it is my opinion on the subject and provides some credible sources about the effectiveness of harm reduction as it pertains to recovery. For what it’s worth, I did get an A. Ultimately we all have our own opinions, but this is a comprehensive view of mine.
Changing the Conversation within Abstinence-Based Addiction Recovery Models
If you found yourself grappling with the realization that you were struggling with substance abuse or addiction (now referred to as substance use disorder) where would you turn? What options exist to help you get on the other side of the life you are leading? For many in this position it is not a choice but a court mandated requirement to seek help. In my personal experience, and that of many others I know, the first line of defense is attending an Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meeting or attending an in-patient rehab facility. Both of these options entail being introduced to and fully expected to adhere to the twelve-step model of recovery. This model of recovery works very well for those who connect with the twelve-step program however, it does not work for many others. It did not work for me and it did not work for many people I care about, a portion of whom have since died from drug/alcohol abuse or substance use disorder. Alternative approaches to recovery, such as harm reduction therapy (HRT), have been effective for many in overcoming the battle of addiction/substance abuse. In the US we are currently in the midst of an opioid crisis which is taking countless lives, mainly due to contamination of the drug supply and the effects of a poorly realized and highly politicized “war on drugs” (Murray, J). In addition to the opioid crisis, “alcohol [is] the third leading preventable cause of death in the United States” (Alcohol Facts and Statistics). Clearly, the current methods of addressing and treating substance use disorder/substance abuse are not as effective as we would prefer. As people continue to die on a daily basis, it is likely that people would encourage discussions regarding any and all possible solutions. While it may be uncomfortable to discuss alternative options in a space meant to be exclusive in its value system, the time for change is imminent. If the long-standing traditional twelve-step groups continue to dismiss any discussion of alternative options for recovery at any stage – active or inactive addiction – it will do more harm than good, it is my observation that it already is. Normalizing the discussion about HRT in recovery spaces will ultimately lead to lives saved despite the discomfort that may be experienced, which is trivial when compared to death. While personal autonomy is attempted to be controlled through the legal system, humans ultimately possess free will. People can and will choose to do what they please regardless of elements of control at play. I see more deaths occurring as a result of trying to convince people what’s best for them rather than giving them the dignity to decide for themselves.
The long-standing traditional twelve-step recovery models benefits the health of so many people and saves countless lives that would have otherwise been lost. Twelve-step recovery programs are firmly based on the foundation of abstinence from all mood or mind-altering substances and doing very deep internal self-reflective work with the guidance of another member or “sponsor” who has gone through the program themselves. This model for recovery is proven effective for those who are able to connect with the program. While a significant number of people are able to connect, a significant number of people are unable to connect. This is my personal observation and that of others within the recovery community. The combination of only having access to abstinence-based recovery models and the inability to connect to those models spells continuous relapse for many and abandonment of sobriety attempts altogether for many others. Unfortunately, due to the anonymous nature of 12-step programs and the elusive nature of deaths associated with substance use disorder, it is nearly impossible to quantify data for this claim. There are people working in an attempt to create statistics, but I don’t know if it would be possible to find truly accurate information, as the knowledge of this claim is very observational.
The concept of HRT is controversial for those in the spaces of twelve-step recovery; based on their own experiences total abstinence and working the steps are the only way to find and maintain sobriety. “Harm reduction is a toolbox of strategies and theories that can reduce negative consequences associated with drug use. It does not ignore the negative consequences of drug use, but rather, accepts that people use drugs for complex reasons and need advocacy and support to stay alive” (Punch, 2019). In today’s current climate this concept is controversial because for a very long time twelve-step recovery models were primarily the only available option. Much of our society is conditioned to think that abstinence from all substances is the only acceptable outcome for someone struggling with substance abuse/substance use disorder as a result. As Dr. Carl Hart, Jr – a professor of neuroscience and psychiatry at Columbia University – states in his TedMed talk, “I believe science should be driving our drug policy and drug education about drugs even if it makes you and me uncomfortable” (Hart Jr., Dr. Carl). Here, Dr. Hart Jr. is discussing the criminalization of drugs based on misinformation surrounding the addictive nature of drugs, it is extremely interwoven with the misunderstanding of why HRT could be an effective option for so many. Dr. Hart Jr. also does a good job of breaking down the reality that the criminalization of drugs has its origins in racist ideology, is outdated, and exacerbates the problematic nature of finding effective solutions for the addiction problems our society is facing.
We are now seeing studies proving the effectiveness, at least short-term, of HRT for alcohol and opioid use disorders. (Collins, Susan E). There are also personal testimonies of credible people within the healthcare field who are seeing positive outcomes as a result of utilizing HRT methods. (Mammen, Priya E.) One area to consider the effectiveness of HRT is the introduction of needle exchange programs to reduce the amount of disease being transmitted with intravenous drug use. (Vlahov, D. and Junge, B.) It is a valid alternative option that should be up for discussion when it comes to recovery from substance use disorder. That is not to say that other options are not also valid, but the idea that “one size fits all” is harmful when it comes to recovery from addiction. There is also the aspect that if someone can utilize HRT methods and come to a place to better connect with a twelve-step program, it could be beneficial for those who previously rejected the twelve-step models. Abstinence from a substance that will lead to unnecessary premature death is ultimately the desired outcome for anyone caught in the grips of addiction and there are multiple pathways to realize that success.
There are reasons why it is uncomfortable and frowned upon to discuss HRT as a valid option in AA/NA spaces. A lot of the concerns, understandably, stem from a place of fear or simply ignorance surrounding the reality of HRT. Many think it gives people an excuse to continue using their drug of choice (DOC) and avoid doing the very important and necessary work long-term sobriety requires. When in fact, working with a therapist who is familiar and strongly connected to the concept of HRT, the work long-term sobriety requires is being done even though a person may still be using their DOC (Tatarsky, Andrew). Another obstacle when discussing HRT is accessibility. This is a very valid concern, as HRT requires having the financial means and the luxury of free time to support working with a professional. Many struggling with substance use disorder/substance abuse are members of marginalized communities, either through no fault of their own or as a result of their problematic behavior. Accessibility could be a very real obstacle, however that should not minimize the value of creating awareness that alternative options exist. Each person should be able to decide for themselves the best route for them to address their problem.
If those who are firmly established within the rooms of AA/NA/rehab centers could find it in themselves to accept that not everything will work for everyone, and be honest about what that may look like, it could bring some very positive change to the way people seek out what recovery option will be best for them. I have met some of the most upstanding, morally sound, and loving people within the rooms of AA and I do not doubt that they only want what is best for each person who walks through the door of a meeting. It can be difficult to see past what works so completely for many people and validate alternative options, especially when the end result could likely be imprisonment or death. It is my observation that many, many people are needlessly being thrown in jail or dying prematurely, when another option may have saved them from their own demise. It may be scary to think about promoting drug use in any way when you have found a fulfilling life based on abstinence, but people will do what they will with their bodies and reducing the harmfulness of those behaviors will ultimately end up saving lives.
Works Cited
Collins, Susan E., Seema L. Clifasefi, Lonnie A.Nelson, Joey Stantona, Silvi C.Goldstein, Emily M.Taylor, Gail Hoffmann, Victor L.King, Alyssa S. Hatsukami, Zohar LevCunningham, EllieTaylor, Nigel Mayberry, Daniel K.Malone, T. Ron Jackson (2019, May) Randomized controlled trial of harm reduction treatment for alcohol (HaRT-A) for people experiencing homelessness and alcohol use disorder Retrieved from: https://www.sciencedirect.com/science/article/abs/pii/S0955395919300039
Hart Jr., Dr. Carl (2015, May 19) Let’s quit abusing drug users Retrieved from: https://www.youtube.com/watch?v=C9HMifCoSko
Murray, Jessica (2019, February) The Ideological Conflict between the Criminalization of Drug Use and Harm Reduction Programming Retrieved from: https://ir.library.dc-uoit.ca/bitstream/10155/1046/1/IdeologicalConflict-DrugCriminalizationVS.HarmReduction%20%28Murray%20Master%27s%20Project%202019%29.pdf
Mammen, Priya E. (2019, September 11) Harm reduction saves lives now and in the future Retrieved from: https://www.inquirer.com/opinion/commentary/harm-reduction-philadelphia-emergency-medicine-20190911.html
National Institute on Alcohol Abuse and Alcoholism (2018, August) Alcohol Facts and Statistics Retrieved from: https://www.niaaa.nih.gov/alcohol-facts-and-statistics
Punch, Alexandra (2019, May 12) We Should Promote Harm Reduction to Combat the Opioid Overdose Crisis Retrieved from: http://lernercenter.syr.edu/we-should-promote-harm-reduction-to-combat-the-opioid-overdose-crisis-by-alexandra-punch/
Tatarsky, Andrew (2019, September/October) The Challenge of Harm Reduction Retrieved from: https://www.psychotherapynetworker.org/magazine/article/2395/the-challenge-of-harm-reduction/eb92ce6f-b742-4205-93dc-6751391f17b1/OIM
Vlahov, D. and Junge, B. (1998, June 11) The role of needle exchange programs in HIV prevention Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1307729/
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