Harm Reduction and Recovery
Written by Robert Ashford, MSW, PhD-C
Published on October 8, 2020
According to Harm Reduction Coalition, harm reduction is “a set of practical strategies and ideas aimed at reducing negative consequences associated with” substance use. This includes strategies like safer use, managed use and abstinence. In this sense, harm reduction includes what is generally thought of as recovery. However, since the advent of abstinence-based recovery programs, harm reduction and recovery have come to be viewed separately by some, and are often accompanied by some controversy. Harm reduction can include anything from information and supplies for safe use of substances, safe places to use substances and unadulterated supply of substances, to medical and dental care, clothing and housing. Unlike many available human services, harm reduction is meant to be low-barrier and is provided without judgment or prerequisite. Harm reduction theory values the dignity and autonomy of the individual even when they use substances.
The idea and practice of harm reduction in recovery has an interesting history. Many early treatments for substance use disorders were designed to reduce harm and involved medications, many of which were simply controlled doses of the same substance. Even the founders of Alcoholics Anonymous, the program perhaps singlehandedly responsible for the proliferation of “sobriety”, practiced harm reduction when working with people using alcohol. From the perspective of treatment, harm reduction is practiced in several other areas of medicine, including in the treatment of diabetes. Treatment and recovery in the United States have been heavily influenced by abstinence-based and spiritually-based recovery programs, which has resulted in some stigma being applied to harm reduction approaches that would otherwise make sense. This culture combined with “zero-tolerance” punitive legal consequences often results in a societal context that relegates harm reduction approaches to the fringe.
Recovery itself can be initiated in so many different conditions and circumstances, and the transformational tipping point or moment for an individual is difficult to predict. Harm reduction practices increase the likelihood of recovery initiation simply by virtue of preserving the life of the individual. One example of this is the proliferation of access to naloxone across the country. In addition, harm reduction programs have been shown to increase engagement with treatment services among attendees. While many individuals use more traditional approaches to recovery, so have many others begun and maintained their recovery using harm reduction information and practices. Harm reduction is a valid pathway of recovery and the stigma surrounding it should be eliminated.