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Harm Reduction for Treating Addiction

Harm reduction is a strategy — often a public health policy — that strives to minimize the negative impact of drug and alcohol use without expecting complete abstinence.

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With harm reduction, the goal is to help you live as healthy of a life as possible while managing the negative consequences of harmful drug abuse.

Harm reduction can include needle exchange programs to limit the spread of infectious diseases through the use of dirty needles as well as supervised injection facilities that aid in reducing the number of drug overdose fatalities. The practice seeks to lower problematic drug use and improve lives.

It typically involves community resources, as it seeks to reduce stigma related to drug addiction and serve everyone without discrimination.

Harm reduction accepts that complete abstinence is not always an option. With this mindset, it offers social strategies and programs that can have a positive and even lifesaving impact.

What Is Harm Reduction?

The journal Paediatrics & Child Health publishes that harm reduction began as a public health policy aimed at the population of people for whom completely stopping drug use was not a possibility.

Drug addiction has relapse rates of 40 to 60 percent, the National Institute on Drug Abuse (NIDA) explains, and it is a chronic disease. Complete abstinence is not always feasible for everyone. In response, harm reduction provides resources to everyone who needs them while reducing the stigma surrounding drug use and addiction in a nondiscriminatory fashion.

Harm reduction strategies can:

  • Reduce the rate of fatal overdoses.
  • Lower the risk for contracting an infectious blood-borne disease.
  • Minimize criminal behaviors related to drug abuse.
  • Help to moderate drug use in general.

There is some controversy around harm reduction programs since they do not expect participants to stop using all drugs. There are many who believe full abstinence is the only path to recovery.

Despite this, harm reduction programs, practices, and policies have been shown to be cost-effective. They positively impact communities, and they are evidence-based programs, per Harm Reduction International.

Needle Exchange Programs

Using needles that are used, not sterile, or unclean can increase the risk for getting a serious potentially incurable infectious disease. The Centers for Disease Control and Prevention (CDC) reports that needle exchange programs (NEPs) can lower the risk for contracting blood borne infections, such as viral hepatitis and HIV.

These programs are community-based. They provide sterile needles and syringes to people who inject drugs to limit use of dirty needles. Most of the time, needles and syringes are provided at no charge, and safe disposal sites are also available to drop off used injection drug paraphernalia.

In addition to new and sterile syringes and needles, NEPs can also provide:

  • Information on safe methods of injecting drugs.
  • Screening for sexually transmitted diseases.
  • Referrals to HIV testing and/or treatment services.
  • Condoms, preventative products, and education on safe sex practices.
  • Overdose prevention information.
  • Referrals and links to treatment services for drug use and addiction.

Medication-Assisted Treatment (MAT)

MAT programs include both medications and therapies as part of a treatment plan for opioid abuse and addiction. Medication-assisted treatment is often offered through opioid treatment programs (OTPs) that are regulated and accredited by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Medication-assisted treatment involves the use of maintenance medications, such as methadone or buprenorphine-based medications, to sustain recovery and minimize the abuse of more potent and shorter-acting opioids like heroin and prescription painkillers. Federally regulated OTPs include counseling, education, medical care, and additional treatment as needed. MAT services can be offered in the following settings:

  • Substance abuse treatment centers
  • Correctional facilities
  • Clinics
  • Offices
  • Remote clinics
  • Hospitals

Naloxone Programs

Nearly 50,000 Americans died from a drug overdose involving an opioid drug in 2017. This accounted for about two-thirds of all drug overdose fatalities, per the Centers for Disease Control and Prevention (CDC).

The high rate of opioid overdoses is a public health emergency. Naloxone is an opioid antagonist medication that helps to reverse an opioid overdose when administered quickly. It can be distributed through injection or as a nasal spray.

Many states have standing orders in place that allow naloxone to be dispensed from local pharmacies to people in need, even without a prescription. This means that if your loved one battles opioid addiction, you can often get a prescription for Narcan (naloxone). This may enable you to save their life in the event of an overdose.

Naloxone programs are often part of community-based operations. Many offer training and education on how to spot an overdose, how to dispense naloxone safely, and resources for treatment services.

The CDC says that dispensing naloxone to laypersons can save lives. It is a cost-effective public health service.

Supervised Injection Facilities

A supervised injection facility is a place where people can go to use drugs in a safe environment with clean needles and syringes. Often, health care professionals are on site, and they can administer aid in the event of an overdose.

There is a lot of controversy surrounding these programs. It is commonly believed that these locations enable drug abuse and make it easier to abuse drugs. There are some who feel users may push dosage limits even higher because medical staff are on site.

The Journal of the American Medical Association (JAMA) publishes that these facilities can decrease the transmission of infectious diseases that are spread by the use of dirty needles, and they can reduce drug-related morbidity and mortality.

A supervised injection facility can provide:

  • A safe environment off the streets for drug use.
  • Clean and sterile injection paraphernalia.
  • Safe disposal of used needles and syringes.
  • Medical intervention for overdose reversal.
  • Referrals to treatment services.

Moderation Management

The majority of people who drink alcohol do not battle alcoholism, but many struggle with problematic drinking. Most of the treatment options and support groups, including 12-step programs, address alcohol addiction and the need for complete abstinence. The nonprofit Moderation Management, or MM, is different.

Moderation Management strategies address risky drinking patterns and seek to improve overall quality of life by reducing negative behaviors and consequences related to problematic drinking. It does not require 100 percent sobriety, and it allows drinking in moderation. The group’s strategies aim to teach members to cope with triggers, set attainable goals and limits, and manage their drinking to keep it from getting out of hand.

Moderation Management programs let members make the choice on how they want to cut back on their drinking. MM publishes that about a third of the people who go through the evidence-based and behavioral management program do decide to proceed to a program that is abstinence-based after taking this initial step to control their drinking.

MM does not work for many people. Notably, the group’s founder Ashley Kishline relapsed, stating that drinking in moderation did not work for her. She served time in prison after she killed two people while driving drunk.

Harm Reduction Education

Harm reduction recognizes that sobriety is not always the only choice and that people who use drugs may benefit from educational tools and resources to better help with some of the negative outcomes that come from risky patterns of drug abuse. The Harm Reduction Coalition publishes educational resources on different types of drugs to help people recognize and prevent overdose as well as tips on how to use drugs as safely as possible.

Any amount of illicit drug use can be harmful and potentially dangerous, but harm reduction education can help to minimize fatal overdoses, the spread of infectious diseases, and criminal behaviors.

Co-Occurring Disorders

Just over 8 million people in the United States struggled with both addiction and mental illness in 2016, the National Survey on Drug Use and Health (NSDUH) publishes. If you struggle with both a mental illness and addiction at the same time, both issues can complicate each other. Drug use can make depression or anxiety worse, for example, and mood disorders can contribute to more negative side effects when using drugs.

Harm reduction techniques are not able to treat co-occurring disorders effectively.

Addiction treatment programs use an integrated treatment approach that is able to manage drug abuse at the same time as a co-occurring mental illness. The conditions are so intertwined, it is virtually impossible to treat them separately. If you only address one issue and leave the other untreated, relapse on both fronts is likely.

Do You Need Formal Addiction Treatment?

Harm reduction strategies can help to manage issues related to drug use. They can even help you to moderate use and lessen the negative consequences that can result from drug use.

Addiction, however, is a complex disease with many facets. A formal addiction treatment program will provide the stability and resources needed to help you reset your life. It can also address mental health, medical issues, and emotional side effects of drug abuse and addiction.

While harm reduction has a place in society, it is not sufficient to help people achieve recovery.

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