A photo of a person sitting at the side of the road holding to bottles of alcohol and wearing a furry panda head to represent the topic of the article - Abstinence And Harm Reduction: The Two Addition Treatment Methods

Abstinence And Harm Reduction: The Two Addition Treatments

When it comes to addiction, there are two main treatment options: abstinence and harm reduction. The abstinence method is one of the world’s best known, thanks to AA and the 12 steps programme. However, the harm reduction method provides a lot of treatment flexibility, and thus, fewer chances to fail. But I’ll let you decided for yourself.





There’s not much to say about what this method is, as it’s pretty clear by the name, but the abstinence model is the complete cessation of any substance use (Addictions UK). With this model, you’re meant to endure withdrawals so you can become abstinent straight away.


Alcoholics Anonymous (AA) was the first programme specifically created for treating addiction using complete abstinence from alcohol. This has created a long history of substance abuse recovery being paired with abstinence. AA itself is based on the 12 step approach, so often you’ll hear the 12-step model rather than AA to separate it from its original religious connotations. As a result of AA (12 steps) being the oldest treatment programme, AA and similar 12-step programmes can be found across the globe.


Although the religious element has been removed from most AA groups, it’s been replaced with a spiritual element instead. That’s because they believe the spiritual element is important to the treatment of addiction in AA and the 12-step model (Dermatis and Galanter, 2016). However, there are atheist 12-step alternatives out there.


The 12-step model can be pretty easy to set-up, which helps explain why it’s so widespread. All you need is the space to set up the peer support group and at least one person to chair the group who knows the 12 steps. Job done.


Because the AA based 12-step model is peer led groups, the groups can be made available outside of work hours (Kelly, Dow, Yeterian, and Kahler, 2010). Therefore, they can provide relapse prevention support when professional support isn’t available.




Harm Reduction


Harm reduction is an umbrella term used for interventions aiming to reduce the problematic effects of behaviours, so although it was originally applied to addiction, it can apply to almost any behaviour (Logan and Marlatt, 2010). In fact, I applied it to self-harm in a pervious article.


Simply put, the harm reduction approach seeks to reduce the harm that people do to themselves and others from their substance use and problematic behaviours (Addictions UK).


Where the abstinence model sees failure, a harm reduction model can see and acknowledge progress (Logan and Marlatt, 2010), even when there’s a lapse. For example, someone with alcohol dependency who drank seven days a week, drinking at least three drinks each time, would be considered a failure if they were still drinking alcohol in four months’ time with the abstinence approach. However, with the harm reduction model, if the same person had reduced the number of drinks they drink per drinking session or reduced the number of days they drink, this would be a success.


This is seen as a success because the client is making progress, even if the end goal still hasn’t been reached. Progress is progress, no matter how small. Whereas the abstinence method is pure black and white, the harm reduction method exists in the colours in between. A realistic model for the complicated nature of human life.


The picture is split in two with the top image being of a white woman slumped from the sofa onto the floor with a glass of wine next to her. The bottom image being of a black woman lying on the floor covered with a coat with her bra and a knocked over bottle of wine near her. The two images are separated by the article title - Abstinence And Harm Reduction: The Two Addition Treatment Methods


With an abstinence model practitioner, there is only one goal to discuss, and that’s abstinence. But the client might not want to be abstinent or might not be ready to accept that as their goal, yet. With a harm reduction practitioner, along with the client, they can set realistic, practical, and more readily attainable goals, without the constraints of being solely about abstinence (Walch and Prejean, 2001). As such, clients who aren’t ready to be abstinent can still talk to a harm reduction practitioner to get support, support they’ll get based on their needs.


This is supported by Rollnick and Heather (1982) who discussed the Bandura’s self-efficacy theory, which states that if people believe that a certain course of action will lead to a certain outcome, then it’s more likely to happen. However, if they have doubts about the performing the activities need for the outcome, that can influence their behaviour. Therefore, harm reduction allows people to take on a sequence of more realistic goals in their recovery so they don’t get set up to fail, as failing can cause people to give up trying.


Most people who need help with their alcohol dependency start from a position where they don’t think they can succeed. If they believed they could do it, they likely wouldn’t be looking for support. If they go in thinking they can’t succeed with giving up drinking, then telling them they have to go abstinence from that moment on is an extremely tall order. But setting up a series of reduction goals will seem doable. And, with each success, it’ll build up their confidence, making it easier to reach a state of abstinence and maintaining it.


Helping people to avoid feeling like they’re a failure in their recovery is important because between 40-60% of people with substance dependency return to substance use within a year of giving up (Mclellan, Lewis, O’brien, and Kleber, 2000).


Because of the high relapse rate, harm reduction practitioners have a distinct advantage. They can help clients before they’ve reached a point where they think abstinence is their only chance. Thus, clients might avoid a lot of unnecessary stress for themselves and their loved ones. 




There is a possibility that a client could return to a none dependant state of substance use using the harm reduction method (Subbaraman and Witbrodt, 2014). Although it’s more likely that the harm reduction process will allow the client to see abstinence as the answer to their issues. An answer they might not have been ready to see at the start of their recovery journey.


Using a harm reduction method also gives you a far greater range of interventions to support someone trying to change their problematic behaviours so they can overcome their addiction. One of the most obvious plans, which I’ve been hinting at, is doing a 10% reduction over a set time period. For people with alcohol dependency, once you’re drinking over 25 units daily, 10% daily reduction is the maximum someone can do to avoid seizures or worse. Alcohol is the only substance of abuse you can die from going cold turkey.


Some critics believe the harm reduction approach to substance use is just enabling people to continue to use. The reality is, you’re giving people the chance to succeed without constantly feeling like they’re failing. Furthermore, people don’t have to endure unbearable withdrawals with this approach.


I strongly recommend that if you’re consuming over 25 units of alcohol daily, then you should talk to a doctor so you can have a medically assisted harm reduction plan created.




Abstinence Vs Harm Reduction


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As always, leave your feedback in the comments section below. Also, feel free to share your thoughts (and experiences) of abstinence and harm reduction in the comments section below as well. Don’t forget to bookmark my site and if you want to stay up-to-date with my blog, then sign up for my newsletter below. Alternatively, get push notifications for new articles by clicking the red bell icon in the bottom right corner.


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Dermatis, H., & Galanter, M. (2016). The role of twelve-step-related spirituality in addiction recovery. Journal of religion and health55(2), 510-521. Retrieved from https://link.springer.com/article/10.1007%2Fs10943-015-0019-4 and https://www.academia.edu/35094544/The_Role_of_Twelve_Step_Related_Spirituality_in_Addiction_Recovery.

Kelly, J. F., Dow, S. J., Yeterian, J. D., & Kahler, C. W. (2010). Can 12-step group participation strengthen and extend the benefits of adolescent addiction treatment? A prospective analysis. Drug and alcohol dependence110(1-2), 117-125. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885484 and https://doi.org/10.1016/j.drugalcdep.2010.02.019.

Logan, D. E., & Marlatt, G. A. (2010). Harm Reduction Therapy: A Practice-Friendly Review of Research. Journal of Clinical Psychology, 66(2), 201–214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928290, https://onlinelibrary.wiley.com/doi/10.1002/jclp.20669, and https://www.researchgate.net/publication/40848783_Harm_Reduction_Therapy_A_Practice-Friendly_Review_of_Research.

Rollnick, S., & Heather, N. (1982). The application of Bandura’s self-efficacy theory to abstinence-oriented alcoholism treatment. Addictive behaviors7(3), 243-250. Retrieved from https://doi.org/10.1016/0306-4603(82)90051-X, https://www.sciencedirect.com/science/article/abs/pii/030646038290051X, and https://www.researchgate.net/profile/Nick-Heather/publication/223854193_The_application_of_Bandura’s_self-efficacy_theory_to_abstinence-oriented_alcoholism_treatment/links/59e9cb21a6fdccfe7f060671/The-application-of-Banduras-self-efficacy-theory-to-abstinence-oriented-alcoholism-treatment.pdf.

Subbaraman, M. S., & Witbrodt, J. (2014). Differences between abstinent and non-abstinent individuals in recovery from alcohol use disorders. Addictive behaviors39(12), 1730-1735. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164587 and https://pubmed.ncbi.nlm.nih.gov/25117850.

Walch, S. E., & Prejean, J. (2001). Reducing HIV risk from compulsive sexual behavior using cognitive behavioral therapy within a harm reduction framework: A case example. Sexual Addiction & Compulsivity, 8(2), 113-128. Retrieved from https://doi.org/10.1080/10720160127563.

Mclellan, A. T., Lewis, D. C., O’brien, C. P., & Kleber, H. D. (2000). Drug Dependence, a Chronic Medical Illness Implications for Treatment, Insurance, and Outcomes Evaluation. Journal of American Medicine Association, 284(13). Retrieved from https://jamanetwork.com/journals/jama/article-abstract/193144, https://www.researchgate.net/publication/12307532_McLellan_AT_Lewis_DC_O’Brien_CP_Kleber_HD_Drug_dependence_a_chronic_medical_illness_implications_for_treatment_insurance_and_outcomes_evaluation_JAMA_284_1689-1695, and https://citeseerx.ist.psu.edu/viewdoc/download?doi=

55 thoughts on “Abstinence And Harm Reduction: The Two Addition Treatments

  1. Interesting post, and agree I don’t think making people feel like they’ve failed is the best way to go, addiction isn’t as simple as just stopping. Noting is black and white. I wouldn’t say I was alcohol dependent but had started to drink more in recent years, it wasn’t doing my brain any good so massively changed habits at the start of this year and feel much better for it physically and mentally

  2. I worked at an addiction clinic for a few months during my internship, visited a pre-trial diversion program while I was there, and I think what I observed in those contexts was the Harm Reduction model being used as a vehicle to achieve Abstinance. In graduate school and all three of my internships I never heard Abstinance presented as a black-and-white method, but always an end-goal that takes time, effort, and “learning experiences (relapses) to achieve. This presentation of the Abstinance model probably does exist in treatment today, but it really strikes me as an out-dated iteration of the model, which in some circles has evolved with our growing comprehension of the neurology and interology of addiction.

  3. I don’t have much experience with substance abuse but I feel it shouldn’t be one approach versus another. I suspect either works for different people. I think it is great that both approaches are available. ?

  4. What a fascinating article, I once had a problem with alcohol as a self medication tool for a few years, thankfully I managed to stop through abstinence and although I may have the occasional drink at xmas I was not addicted. I can see how both methods would prove useful depending on the person. Thanks for sharing.

  5. Such a great read! I have never suffered with substance abuse, but I do agree that there is no black and white treatment that could work for everyone as a whole. Everyone is different.

  6. Very interesting! I was wondering about the psychology behind these methods. Usually abstinence would imply that you’re not supposed to think about the addiction (for example, drinking), but then the fact that you’re not supposed to think about it makes you think about it even more. Is this the same with harm reduction?

    • With the harm reduction method you have a lot of options to manage withdrawals, so you should be less consumed about the addiction. However, they still will think about it

  7. I don’t know a lot about treatment methods for substance abuse. But most people say: one size doesn’t fit all. The same is true for substance abuse treatments, The effectiveness of each treatment methods you presented may work for some, but not all. On the other hand, a combination of several treatments methods may be more effective.

  8. Such a interesting and informative post, thank you so much for sharing with us! Xo

    Elle – ellegracedeveson.com

  9. That was a very interesting read! From what I could see and if I personally had to go through one of them, it would be the harm reduction. I think it would help people more to have goals set and not feeling like a failure in case of relapse or missing the goal itself. Thanks for sharing!

  10. I always enjoy your posts as I learn something new and interesting every time. I don’t have any personal experience here but I do believe that each person is built different therefore there isn’t simply one solution for all. I think you should be able to do whatever works best for you as long as you get treated, right? The whole point is for you to feel a lot better and get past the addiction.

  11. This is such as interesting post! I’ve heard of AA and their 12-step program before, but despite the great work that they do, I have always had an issue with any one-size-fits-all strategy. You raised some great points here, such as their program is very black and white, which is not going to work for everyone. Also, many addicts who start this program, might fall off after a few months, and then they’d be called a failure. A slow reduction might actually benefit some types of people better. I know a friend of mine who was a borderline alcoholic, but she slowly cut down her alcohol consumption down and is heaps better for it now. Thanks for sharing this post. It shines a new light on different ways to treat addiction.

    • I’d be surprised if there were people who hadn’t heard of AA or the 12 step program. Whenever addiction is featured in films or TV shows, they always use the AA and 12 step model to depict it.

      I’m glad your friend was able to find a method that worked for them

  12. Thank you for sharing and educating. A lot of people don’t understand addiction or have no experience with someone going through it. I myself never heard of harm reduction so I’m glad you shared this!

  13. It is interesting to see the contrast between these two methods, as I have heard of AA and know it is what many people need and use to help them recover, but I personally find myself leaning toward harm reduction as the method I would support. It sounds less aggressive and hard core, which is also what many other people need: slow steps instead of big steps.
    Thanks for sharing your perspective!

  14. Great post pointing out two methods of recovery from alcohol and substance abuse. I like that you point out how important it is to help the person trying to go through recovery build confidence in themselves, especially at the beginning. Their belief that they can’t succeed would be just as strong of factor in making them fail as the addictive qualities in the alcohol and drugs are.

    • Indeed. They come looking for help because they believe they’re no longer in control and can’t stop. The best way to show them that’s not true is by building up their confidence in their abilities as they complete realistic recovery goals

  15. You always outshine yourself with thorough research. If the treatment method for addiction is mishandled, it can leader to further mental health depression, and at times suicide.
    This is a resourceful article.
    I have bookmarked it, shared on Keen too, and it is making top resourceful blogs to bookmark.
    H E

  16. I have friends who drink a lot but luckily not reaching the border line close to addiction. When they’re reminded by the health effects they could get, that’s enough for them to abstain for a couple of weeks lol. This is a timely and important post right here. Great research as always! Thanks for sharing.


  17. I’ve worked in environments that have used both approaches. Currently I’m working in a harm reduction environment and, while I do prefer it, I do also see the benefits to both programs. In the end, what truly matters is the addict and them being empowered to choose what will work for them. I also believe that if the underlying issues associated with addiction are not addressed, then neither program will work. Thanks for sharing about this topic. It’s a really important one!

  18. Thanks for this informative post. I agree that both methods can be used to attain the goal. Also its a matter of having a strong will to be out of addiction.

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