Harm reduction therapy for addictions

Drug and alcohol use exposes people to many harms. How do addiction professionals use harm reduction therapy to address them? We explore here.

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Many people will choose to drink or use drugs (rather than quit) even in the face of negative life consequences.  For these people, the choice between strict abstinence from drugs or alcohol VS. continued use results in choosing to continue to drink/take drugs. Self help drug treatment is not yet an option.  But drug or alcohol use exposes people to many harms.

What are these harms?  And how can addiction counselors and professionals work to reduce harms of drug or alcohol use? We explore here.

Harms of drugs or alcohol use

The harms of drug or alcohol use not isolated to the user. Drunk driving, infections, increased medical costs and other harms can involve many other people. By giving drug users a middle option, we keep everyone healthier. Even if they never achieve full recovery, the progress they make continues to benefit all us. So what exactly is harm reduction?

What is harm reduction?

The harm reduction approach to addiction recovery places almost no requirements on alcohol or drug users. In practice, harm reduction recovery often includes continued use of most or all of the substances that have been used, with new ways of using them in order to “reduce the harm” associated with use.

Harm reduction techniques

Perhaps the most well-known harm reduction programs are the “needle exchanges” where drug users may exchange dirty needles for clean ones, or the “wet houses” where chronic inebriates are allowed to live and drink as they wish, with very few rules regulating them (e.g., no fighting, no breaking things). Some other harm reduction interventions include:

1. Alcohol harm reductionA drinker might get just as drunk, but have made advance arrangements about not driving during that drinking episode.

2. Drug use harm reduction A crack user might give up crack, but continue with pot and alcohol, which the user judges as much less harmful than crack.

3.  IV drug use harm reductionAn IV drug user might begin using clean needles with every injection, rather than running the risk of infection.

Does harm reduction help addicts?

Applying the theory of harm reduction, clients who choose to use drugs or alcohol are supported in the pursuit of progress in recovery as they define progress. However, harm reduction programs are controversial. The support of a user who continues to use can be viewed as “enabling.” Enabling (the shielding of a user from the natural negative consequences of use) is problematic because it is the buildup of negative consequences that persuades someone to change. Why would anyone change a behavior that is fun but not harmful?

To respond to this question, consider the possibility of a “perfect drug.” This imaginary drug is very inexpensive, fully legal, causes no health problems, and is socially accepted. Although the state of intoxication it produces is as wonderful as any state of intoxication might be, that state can be stopped at any moment by a small act of willpower. Nor does state in itself cause any problems such as lack of coordination or poor judgment.

Would you use this drug? Of course you would! By definition, it is perfect: All benefits, no costs. All of us would use, because there would be no reason not to.

Although we might fantasize about life with this drug, it is only a fantasy. A perfect drug does not exist. All have negative consequences, and that is why we stop using them. When we use enough of a drug for long enough, the costs start to build up, and eventually we stop (or die, get institutionalized, etc.).

So if harm reduction prevents negative consequences from building up, it would appear to get in the way of natural recovery. For this reason, harm reduction has been less than fully popular.

However, there is another perspective to consider. Harm reduction can prevent the most disastrous of the negative consequences of drug use: getting infected by a dirty needle, killing someone in a drunk driving crash, going psychotic on crack or meth use. The harm reduction approach suggests that if we can prevent the most serious negative consequences, perhaps the other negative consequences can still do their work, aided by normal maturation and development. We perhaps can keep people alive, and relatively safe, until recovery “catches up with them” and they start asking , “How do I stop drinking?” by and for themselves.

Harm reduction questions

Do you still have questions about applying harm reduction theory to addiction treatment? Please leave us your questions and comments below. We will try to answer your questions in a personal and prompt reply.

About the author
Practical Recovery, in San Diego, California, offers self-empowering, non 12-step addiction treatment across all levels of care (outpatient, sober living, rehab). Treatment focuses on underlying problems, and is provided by a multi-disciplinary team of mostly doctoral level providers who collaborate with clients to create completely individualized and empirically supported treatment plans based on the client's goals, values and situation.


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  1. Elyse,

    Thanks for your post. I appreciate your concerns.

    Perhaps you will gain a different perspective on recovery by consulting the NESARC:


    Among the findings of this very large government study (over 43,000 subjects) are:

    “Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence.”

    It is time for the field to stop thinking that recovery = abstinence. Indeed, a careful reading of the DSM-IV reveals that remission does not require abstinence, although this fact continues to be widely unknown.

    As to “pushing for sobriety,” once you are in the field awhile I suspect you will realize that generally the individuals who accept such pushing are the ones moving in that direction anyway. How will you work with the others? Keep pushing too far in a direction they don’t want to go, and you will lose all influence (because they will stop seeing you). Harm reduction is an approach that allows you to maintain your alliance with the client, doing what can be done. What can be done is often reducing other problems, thereby increasing an interest in addiction resolution. When other problems resolve, addiction becomes easier to resolve, because it is less needed (e.g., to cope with depression or the aftermath of trauma).

    I’m glad you have an interest in harm reduction. I think you will see that, upon examination, all addiction treatment is harm reduction oriented, even though the provider may not realize it. What is “chemical dependency” treatment if not reducing the harm from alcohol and illicit drugs, while still allowing harms from over-eating, smoking, g@mb1ing or other problems the client is not yet ready to address?

    Good luck in your studies! I appreciate professionals-to-be with a strong desire to explore and learn.

    Tom Horvath

  2. Hi Elyse. I’m getting in contact with Tom Horvath, the author of this article and will ask that he respond to your question directly.

  3. The harm reduction model, although controversial, is intriguing to me and I do not know much about it. I am a graduate student in clinical psychology and I am just wondering if research suggests that if by implementing this method, individuals are indeed more likely to eventually want to work towards sobriety or, is the tendency for them to remain using? Something that I struggled with as I read this article is that although the goal is to reduce the major harmful effects, I would have a hard time seeing an alcoholic continue to drink (or any drug user) and consequently, their own health continue to be at stake. Even though they are taking precautions by say, not drinking and driving, if their health were to decline rapidly, as a mental health provider, I think I would have a hard time not pushing for sobriety.

    Based on the article, it also appears that the harm reduction model can be tailored to the individuals needs and/or particular addiction. Similar to the drug user example, I am wondering if an alcoholic would ever give up alcohol and use another drug, such as marijuana or something else deemed as “less harmful” in order to target their alcoholism. However, in these instances where the substance user begins using other substances in order to give up their most problematic drug, I would be concerned that their addictive tendencies would just be transferred to the new drug. Despite being a little skeptical, I am interested in learning more about this model, how it can be implemented, and if there are certain types of addicts that this philosophy would work best for.

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