Though this writer presents herself as having no attachment to a particular treatment approach, she’s clearly a harm reduction advocate. However, she does a good job making the both/and argument and recognizes that motivation and client preferences often change frequently.
What she fails to address is that context and the culture of services have enourmous influence on the addict’s choices and motivation. Does the system subtly and patronizingly discourage abstinence as unrealistic? Does the system reject and judge clients who are unwilling to embrace lifelong abstinence? Does is offer unwaivering hope for full recovery and honestly review options with clients?
Drug-free treatment has historically failed to accept addicts who were not ready to embrace abstinence and harm reduction providers too often define the addict by their illness and place so much emphasis on accepting them as they are that there is no emphasis on what they can become. We know that radical transformation is possible–we see it every day. A system should accept and provide services to support incremental change, but it must not damn them with low expectations, it must not be satisfied with reducing risk for harm, and must offer hope and support for full recovery.
I have to confess, I have no little trouble fathoming how on earth we have ended up here, once again engaged in the obsessive navel gazing that is the debate about whether the focus of treatment should be abstinence or maintenance?
Its just not a question that I can identify with, because people experiencing drug treatment need the opportunity to choose the interventions that work best for them. This might change through someone’s drug using career, with needle exchange, drop in, prescribing, inpatient and community detox and residential or community rehabilitation services coming into play at different points for different people. Sometimes, as we know, people will not move through these interventions in any convenient linear mapable way, but may well drift in and out of treatment over a protracted period of time
Of course as long as they stay for at least 13 weeks we’re all absolutely cool about it.
So is the aim abstinence? Yes. Is it maintenance? Yes. Do we need Harm Reduction? Yes. Is prevention important? Yes.
There is no right or wrong answer and really there should be no debate about this. There is no “one size fits all” solution to the problems people who use drug face. I have as little time for people who say everyone needs a script as I do for those who say everyone needs to go to a fellowship group.