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 are 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 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.
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 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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Unwanted Life readers.
Dermatis, H., & Galanter, M. (2016). The role of twelve-step-related spirituality in addiction recovery. Journal of religion and health, 55(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 dependence, 110(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 behaviors, 7(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 behaviors, 39(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 http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.462.8284&rep=rep1&type=pdf.