Harm Reduction or Abstinence — which is better in Addiction Treatment?
Primarily, there are two addiction treatment strategies available for drug addicts and alcoholics — harm reduction and abstinence.
Proponents of both these methods claim high success rates by quoting medical research and statistics.
It is relevant to compare the two modalities to enable the individual to choose what suits him or her best.
Harm Reduction in the UK
Harm reduction aims at reducing the harm that people do to themselves and others from their substance use.
Harm reduction started in the U.K. in the 1980s in response to the alarming increase of cases of HIV among the drug injectors.
The primary aims of the UK 2017 Drug Strategy are to reduce the use of illicit and other harmful drugs and to increase rates of recovery.
It aims at the prevention of drug-induced deaths, infectious diseases, comorbidity, and other health consequences.
The strategy promotes needle and syringe programmes (NSPs) in helping to reduce the harmful consequences of drug dependency.
Scotland, Wales, and Northern Ireland have their own national drug strategies, each including several harm reduction-related objectives.
Initiatives that aim to prevent a large number of drug-related deaths is addressed by the distribution of the overdose reversal drug naloxone to those at risk of overdose.
Nationwide naloxone programmes are implemented in Scotland, Wales, and Northern Ireland.
In England, the distribution of naloxone is standard. Data from Scotland and Wales show that over 12,000 naloxone kits were given out in the past 12 months and over 56,000 kits have been circulated since the start of the programmes.
NSPs are available across all regions of the United Kingdom; however, data are available only for Scotland, Wales, and Northern Ireland.
The latest available estimates of the number of syringes distributed are 4.4 million for Scotland in 2016–17; almost 2.6 million for Wales in 2017/18; and about 310 000 for Northern Ireland in 2016–17.
Harm reduction initiatives include:
Needle exchange schemes — providing sterile needles for people who inject drugs, thereby reducing the transmission of blood-borne diseases such as hepatitis and HIV and enabling the safe disposal of syringes.
Drug Consumption Rooms — places where illicit drugs can be taken under the supervision of trained staff, thereby reducing the chances of overdose.
Drug testing in Clubs — conduct forensic testing of drugs at U.K. festivals and nightclubs.
Providing information on safer drug use — for general public awareness.
Criticism of Harm Reduction
There are varied opinions over the morality of harm reduction. Some people believe that it condones or promotes drug use, while people who support it say it is realistic, helps keep drug users safe and respects individual choices and freedoms.
If you view it from the government’s perspective, it reduces ‘crime rates’, prison admissions and associated costs, and diminishes the pressure on government-supported health facilities such as NHS.
Much of the abstinence-only addiction recovery community points out that the harm reduction method enables addicts to continue their substance use.
Harm reduction focuses on ‘safer’ drug use, including educating people about drug addiction, rather than telling them to ‘Just say NO’.
Perhaps the most significant criticism of harm reduction is that it does not hold much weight when dealing with illicit substances, such as heroin or cocaine.
Can we recommend doing less heroin, crystal meth or cocaine as a treatment strategy? A single episode of binge drinking is less likely to be fatal than when using heroin.
In 2013, of the 38 million admitted binge drinkers in the U.S., there were only 2,200 deaths due to alcohol poisoning. In the same year, 8,260 individuals died from heroin overdoses.
What is Abstinence-based Addiction Treatment?
Abstinence is defined as the complete cessation of drug or alcohol use. This strategy has long been heralded as the best and most effective way to defeat addiction.
Even dating back centuries, before addiction was treated as a medical condition, the traditional approach to break drug or alcohol dependencies was through abstinence.
Abstinence addiction treatment relies on ten fundamental tenets:
- The first tenet is that addiction is an involuntary and primary disease. It is describable and diagnosable.
- Addiction is a progressive and chronic disease.
- While this disease cannot be fully cured, it can be managed.
- While some people are more or less motivated to get addiction treatment, this does not determine the success of the treatment outcome.
- Since addiction can impact all areas of the individual’s life, holistic treatment that addresses physical, mental, social, and spiritual dimensions is most effective.
- A successful addiction treatment approach should include the addict being treated with respect and dignity.
- Addiction should be treated by a team of multi-disciplinary professionals.
- The primary counsellor is one of the most critical factors of the treatment. He or she should ideally be of a similar demographic as the patient and perhaps a former addict as well. This would promote an environment of self-disclosure, mutual identification, mutual support and cultural understanding.
- The most effective treatment for addiction as evidenced includes an orientation to 12 Steps (first introduced by Alcoholics Anonymous). These principles include peer support, set expectations, and informal guidance by an experienced group member.
Criticisms of Abstinence-Only Treatments
The most common indictment against abstinence-based addiction recovery approach is their strict adherence to the 12-steps model, which focuses on faith-based addiction treatment.
Not all people are comfortable with the idea of praying or focusing on spirituality. The founders of the 12 Steps recognised this factor and the largest chapter in their basic book Alcoholics Anonymous is titled “We Agnostics”.
Moreover, contemporary treatment models include psychological and behaviour modification tools along with medical, psychoanalytic, and psychiatric assessments for effective recovery
The argument of individual’s choice is also cited. However, there are two factors to consider here:
- Can we depend on the individual’s rational choice to seek treatment when his or her judgement is already impaired by substance use?
- Denial is a symptom of addiction. Addicts mostly believe they do not have a problem, so why would they seek support for it?
Alcoholics and addicts who self-identify the need to address their drinking may tend to choose harm reduction as a better strategy.
It is less intensive, less expensive, less invasive and does not close the door on social drinking or recreational drug use.
It does, however, require a level of self-control that is uncommon in alcoholics and addicts. How many drinkers can even recall how many alcoholic beverages they had the night before?
How realistic is it for a drinker or a drug addict to pause in between drinks or drugs and write down in a notebook when he or she has consumed a substance?
Why You Should Consider Abstinence-based Treatment
Families looking for substance abuse treatment for a loved one must honestly assess the enormity and gravity of the problem.
Since addiction is a chronic disease, abstinence treatment is the only way to ensure that the disease remains in remission.
If an individual is abusing illicit drugs or prescription drugs, abstinence-only treatment is likely to be most effective.
Likewise, if a person has caused significant damage to his or her life or the lives of others, abstinence-only treatment is the most advisable course of action.
Addictions UK — Proven Abstinence Treatment
Addictions UK believes that a reduction of a problem and its impact is not as good as the elimination of the problem.
The abstinence-based addiction treatment provided by Addictions UK is customised to suit the individual’s unique background and requirements.
There is no coercion at any stage. It is delivered with the highest standard of ethics and empathy.
The therapy is eclectic, addressing the physical, psychological, social, and spiritual aspects. It is also client-centric, gender-specific and culturally sensitive.
The therapy process helps in assessing the individual’s personality, addresses deeply embedded blocks such as distorted thinking, reviews belief systems, processes childhood traumas, develops individual relapse prevention strategies, making amends with broken relationships, addresses any co-occurring medical or psychiatric issues and helps cope with ongoing challenges.
At Addictions UK we believe that abstinence opens the door of opportunity for growth for the individual. He or she need no longer live with guilt, shame, fear, and stigma.
The past is processed, and the future holds promise. Innumerable individuals who have utilised these services are now responsible, self-sustaining, and drug-free members of the community, pursuing further education, prospering in careers, and finding new joy and respect in families and society.
Get Freedom from Addiction!
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