When it comes to substance abuse, the recommended course of action by most clinicians is abstinence. For example, an alcoholic would be encouraged to refrain from their addictive behavior, meaning that individual would simply stop consuming alcohol. Abstinence is promoted by most substance use support groups and those who treat substance abuse. However, abstinence does not always indicate complete recovery, and the chance of relapse is still high (34%) for individuals abstinent for 1-3 years (Drug and Alcohol Rehab), and then drops after abstinence for 5 years. Others who treat substance abuse have started to look into Harm Reduction Therapy. This treatment focuses on reducing the consequences for those who use drugs, and one of the big concepts of this treatment is to use substances in moderation, rather than complete abstinence.
The principle of harm reduction is to address drug use, as well as its conditions (Harm Reduction). Patients are allowed to choose abstinence from drug use, but it is not mandated by the treatment. This is especially important because not all drug users are ready for complete abstinence. The goal is to reduce the risks of drug use and increase healthy behaviors. Psychotherapy is used to help patients find goals and achieve them through behavior and cognitive change. This behavior change is key to reduce the amount of a substance being used or to use less frequently.
The psychotherapy component of harm reduction focuses on addressing barriers to behavior change (NIH). For example, substance use disorder is often comorbid with other psychological disorders like major depressive disorder. Those with depression may self-medicate with drugs like alcohol, leading to a substance use disorder. Psychotherapy attacks these barriers so that patients feel they have the ability to decrease substance use. Without addressing emotional problems or environmental factors that led a person into using the substance in the first place, relapse risk remains high. The therapist will also work with the patient to identify strategies to reduce drug use, as well as short and long-term goals. These goals might include abstinence, moderation of use, or simply to cut down on the amount of substance used. The therapy gives patients a cognitive framework to meet these goals and increase the self-efficacy of the patient.
Harm reduction does not focus solely on these behavioral changes. It also focuses on increased safety for substance use. Needle exchange services can prevent sharing of needles and potential HIV infections. Safe injection sites allow for illicit drugs to be consumed in a hygienic environment with sterile needles, and they also are supervised by medical professionals to prevent overdose (American Family Physician). Safe injection sites have led to a decrease in mortality (due to onsite medical care) and a decrease in healthcare costs due to drug use. Free drug testing strips can also be beneficial to ensure that drugs are not laced with more harmful substances like fentanyl. This allows drug users to know what they are taking and reduces overdose deaths. Drinking and driving laws are also an example of harm reduction policies to prevent those under the influence of alcohol from driving. These policies can help reduce negative consequences from drug use.
Harm reduction can help people with substance use disorders, and research has proven its effectiveness (Psychology Today). This mainly has to do with the compassionate stance that those involved in harm reduction have toward the substance user. It also recognizes that people will use drugs, so it works to decrease the harms associated with drug use instead of simply shaming users and requiring complete abstinence. The use of harm reduction should be increased to provide humane conditions for substance users and encourage behavior change without judgement.
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