Harm Reduction: A Second Look Analysis of Harm Reduction as a viable option for substance users.

1. Burgess G. Brown
A Second Look

2. Harm Reduction has a functional place in the
continuum of care based on:
The historic ineffectiveness of abstinence-based
treatment
The benefits garnered from utilizing the Harm
Reduction model of treatment
The needs of the consumers who choose the
Harm Reduction model of treatment

3. I know what you are thinking… “No! Harm Reduction does NOT
have a place in the continuum of care!”
I had these same thoughts. As a Professional Addiction
Therapist, my life’s work has focused on trying to help substance
abuser end their destructive relationship with substances and
create lives worth living.
Sometimes I am successful and my efforts worthwhile. But there
are too many times when I am unable, despite my best efforts,
to initiate anything that even remotely resembles a positive
outcome. The futility of my labor leaves me wondering if there
may be another option to help.
Hence, my willingness to re-examine the Harm Reduction Model.
I have compared the traditional abstinence-based model of
treatment with the Harm Reduction model to see if there is any
merit to this model which I share in the following.

4. Harm Reduction
Harm Reduction proposes
individuals who abuse
substances can improve their
quality of life if they are given
access to certain specific
services irrespective of
whether or not they continue
to use substances.
Abstinence-based
Abstinence-based treatment
postulates that individuals’
must discontinue use of all
mind-altering substances in
order to improve their lives.
The methodology to treating individuals who struggle with
substance abuse varies between the two approaches.

5. Harm Reduction
Harm Reduction allows recipients to
define treatment goals based on
improving their quality of life.
Harm reduction accepts each
individual is capable and responsible
for choosing their own path.
Harm Reduction does not attempt
to manipulate or coerce participants
into abstinence.
Individuals may choose abstinence
for a particular substance, continue
to use all substances, or choose to
not use any substances at all.
Abstinence-based
Abstinence-based
treatment defines
abstinence as the
irrefutable main goal and
those unwilling to work
toward that goal are
deemed inappropriate for
treatment.

6. Harm Reduction
Counseling and education
Needle exchange
Free kits
Condoms
HIV testing
Safe rooms to use
Opiate replacement
(Methadone, Suboxone,
Subutex)
Referrals for social services,
treatment, vocational
rehabilitation, employment and
housing (Einstein, 2007).
Abstinence-based
Counseling and education
Condoms
HIV testing
Medications including use of
benzodiazepines, Suboxone and
Subutex for detoxification, and
craving reducing medications
such as Vivitrol and Topamax
Referrals for social services,
treatment, vocational
rehabilitation, employment and
housing

7. Harm Reduction
Reduced transmission of
HIV/AIDS and Hepatitis C
Improved public health
Lowered crime rates
Connecting substance abusers
with needed referrals
Improved self-efficacy which
enables individuals to manage
their own lives, make better life
choices, and meet their own
goals.
Positively affects the number of
deaths associated with
substance abuse.
Abstinence-based
Reduced transmission of
HIV/AIDS and Hepatitis C
Improved public health
Lowered crime rates
Connecting substance abusers
with needed referrals
Improved self-efficacy which
enables individuals to manage
their own lives, make better life
choices, and meet their own
goals.
Positively affects the number of
deaths associated with
substance abuse.

8. Harm Reduction
Meets all clients where they
are
Does not attempt to apply
judgments or moral directives
Allows clients to define
whether they are capable of
moderating their own use
Enables clients to seek
whatever changes they feel
are necessary at any time
they feel they are ready
Abstinence-based
In order to be allowed in
treatment, the client must
verbalize a willingness to abstain
from all mind-altering substances
Clients who do not maintain
sobriety are labeled “resistant”
and are most often discharged
from treatment

9. Harm Reduction
Harm Reduction may reduce
some of the unintended effects
of using such as
• Contracting communicable
diseases
• Engaging in criminal behavior
• Having criminal charges and
the attending consequences
• Interpersonal issues
• Unemployment
• Homelessness
(Kleinig 2008)
Abstinence-based
Abstinence completely
eliminates all future unintended
effects of substance abuse
Abstinence improves many of
the past consequences of use

10. Harm Reduction
Harm reduction offers
substance users who may be
marginalized an opportunity
to begin to reengage in their
communities
(Einstein 2007)
Abstinence-based
Abstinence-based treatment
encourages participation in
society especially with others in
recovery for support

11. Harm Reduction
Needed services for both models of treatment include medical
personnel, treatment providers, housing options, financial assistance,
and employment.
Abstinence-based
(Einstein, 2007)
These social services are typically extremely limited.
If there is a lack of available services, neither program can meet
its function.

12. Harm Reduction and Abstinence-based treatment share
many of the same modalities, services, benefits, and even
some goals. The major differences is in the demand for
abstinence.
This difference however is vast.
While the abstinence-based providers minimizes the
efforts of Harm Reduction, they must admit their own
inadequacies in providing services that meet their goals
across the board.
It is in those moments when the reduction of harm seems
more beneficial then no improvement at all.

13. Einstein, S. "Harm And Risk Reduction: History,
Theories, Issues, And Implications." Substance Use &
Misuse 42.2-3 (2007): 257-265. Academic Search
Premier. Web. 14 Nov. 2014.
Kleinig, John. "The Ethics Of Harm Reduction."
Substance Use & Misuse 43.1 (2008): 1-16. Academic
Search Premier. Web. 12 Nov. 2014.