July 2018

Harm Reduction

By Scott Swanezy


Complete abstinence from addictive substances has been a key component of substance abuse treatment in the United States for a long time.  In fact, 12-step facilitation is used in some form by the vast majority of American treatment programs.


Some drug treatment professionals strongly believe that full and happy recovery requires total abstinence, and that a harm reduction approach, in which an addict may never completely stop using drugs, denies people the benefits of a full recovery.

Other substance abuse treatment professionals believe that while abstinence is a worthy goal, a harm reduction approach can prevent deaths and can keep addicts alive and healthier in cases when total abstinence has not worked.


Tweleve-step programs continue to play a major role in substance abuse treatment in America, and millions of people have been helped by them.  However, the fact is that they do not work for everyone.  Additionally, there are people who dislike that 12-step programs attach a moral dimension to a physical disease, implying that failure to recover using the programs is a personal, moral failure.


Cognitive behavioral therapy and motivational enhancement therapy are other treatment alternatives, and medication-supported treatment is considered particularly appropriate in cases of addiction to opiods.  An article in the AMA Journal of Ethics from 2016 concluded that while 12-step programs are appropriate for some seeking help overcoming addiction, they should not be the only approach considered.


Harm reduction in substance abuse treatment is aimed at decreasing negative consequences of substance use.  It includes elements of safer use, managed use, and medication-supported treatment plans.  Harm reduction is designed to address the circumstances of the addiction in addition to the addiction itself, striving to minimize the harmful effects of addiction rather than condemning them altogether.


Harm reduction should be considered as another therapy tool rather than a cure.  Substance abuse treatment professionals must have access to a range of tools for helping addicts.  When the  metaphorical “hammer” of total abstinence and 12-step programs is the only tool available, every addiction is often treated as the metaphorical “nail”.


First and most importantly, harm reduction does not in any way condone or promote substance use.  It simply asserts that to treat drug abuse effectively, multiple options must be considered.  Abstinence may ultimately be the right choice for an addict, but some people are not ready to become completely abstinent.


In some of these cases, reducing the risks of drug abuse is certainly better than avoiding treatment altogether, which is something an addict may choose when he or she believes the only option is yet another 12-step program.


Harm reduction respects the addict as a whole person and seeks to create and maintain an empathic alliance between treatment, counselor and patient.  Helping addicts recognize their strengths and  motivations toward positive change is a core concept of harm reduction.


North American experiences the world’s highest drug-related mortality rate and has a higher rate of opioid use than the global average.  Opioid substitution therapy using methadone and suboxone are more widely available than they once were.  Methadone and buprenophine therapy are available in all but two states as well as Washington D.C.


When harm reduction approaches first gained traction many years ago, main focuses were preventing the spread of HIV and hepatitis among people who inject drugs.  However, harm reduction has been shown to be effective in preventing overdoses as welll.  It saves lives and in some cases saves money by avoiding  repeated relapses and emergency interventions.


Ultimately, substance abuse treatment must be personalized, because each addiction and each addict is unique.


The harm reduction approach is to address this, helping addicts with evidence-based treatment that may involve therapaies like medication-assisted treatment, particularly in the case of opioid addiction.


Scott Swanezy is an addiction and substance abuse counselor in Westchester County. He can be reached at 914-434-9945 and visit

outofthefog.info for more information.



c2018 Shoreline Publishing, Inc.

629 Fifth Avenue, Suite 213, Pelham, NY 10803

P: 914-738-7869