What is meant by the term “harm reduction” as a part of addiction treatment? Most agree that harm-reduction strategies are intentional interventions to reduce or minimize the harms of continued addictive use for those not committed to abstinence-based recovery. Harm-reduction methods are based on the understanding that habits exist on a continuum ranging from damaging use to abstinence, and that any steps toward decreasing use (& risks from using) represent movement in a healthy direction. Common examples include methadone or suboxone interventions for opioid users, needle-exchange programs for injection drug users, & nicotine-replacement therapies for smokers. Those espousing this type of intervention are quick to point out that swapping out dirty needles for clean ones reduces the risk of blood-borne infections such as HIV, which is also one of the sought-after reductions in risk of harm when swapping out injectable opioid use for oral opioid replacements such as methadone or suboxone. In the case of tobacco smokers, it is argued that chewing nicotine gum or wearing a transdermal nicotine patch reduces some of the risk of harm that smoking poses to an individual, in the form of breathing impairments & lung cancer.
So far, so good. Now let’s consider the bigger picture, over the longer term. Most supporters of harm-reduction strategies agree that if it is possible for individuals to attain an abstinence-based recovery status that reduces the risks of harm associated with using down to zero, that would be preferable. It is just that not every addicted individual finds themselves ready, willing, or able to work toward abstinence-based recovery. This is precisely where problems start to arise. How does any individual know in advance whether or not they are capable of abstinence-based recovery? Even more significantly for treatment purposes, how does any practitioner know in advance whether or not someone else is capable of abstinence-based recovery? There are many presently enjoying the full reduction of all using-related harms, thanks to abstinence-based recovery they previously doubted was possible. The early recovery journeys of many individuals from the chronic-relapsing condition known as addiction, in fact, do include chronic relapsing! If folks were convinced at those times that a harm-reduction strategy was the best they could hope for in recovery, that would qualify as harm-enhancement rather than reduction. Settling for “less harm” versus “no harm” cannot be defended as harm reduction. Those identifying as in abstinence-based recovery from the harms of addiction to methadone or suboxone have instructive stories to tell.
So perhaps a wise & effective way forward would include the more careful use of harm-reduction strategies, always initially in a time-limited rather than long-term manner, while still holding out the possibility of the outcome that represents that most reduced harm of all — abstinence-based recovery.