More on HR

Last week I missed an op-ed weighinh in against HR. The writer closes with this thought:

Many organizations offer the rationalization that drug use is part of our lives and will not go away. That is probably true, as it is true that most people who use recreational drugs or drink will not become addicted.

But there are those who are addicted and whose lives are in trouble. For them, continued use can and will ultimately prove to be disastrous.

It is a courageous act for an individual to face their problems and attempt to make the changes necessary to break free of their addiction. It’s not an easy transition to make.

We, as a society, should do everything possible to assist them on their road to recovery. Everything, except create the illusion that only going half way down that road is all it takes.

Today, another writer offers a less certain opinion:

…I have come to realize, slowly and painfully, that complete abstinence may be out of reach for some. The all-or-nothing approach of abstinence advocates neglects the needs of many substance users who may fall somewhere in between.

This is obviously true–some people with addiction, even those who recieve treatment, will die of their addiction. The problem is that we don’t know who will recovery and who will not. After 14 years in this field, I am unable to predict those who will recover and those who will not. Further, my instincts are repeatedly proven wrong. This being the case, the only solution is to treat all addicts as though they can recover. This is not an argument against HR, rather it’s an argument in favor of making recovery-oriented services available to all who want them. It is also important that systems recognize that many who do not want recovery-oriented services may be making this decision due to an absence of hope, and it is the system’s responsibility impart hope and encourage clients to seriously consider all of the best treatments available. (Just as we would do with a cancer patient facing difficult treatment with uncertain outcomes.)

The writer does maintain a conclusion that I can agree with:

All said, I am still not sure where I stand on harm reduction. I know that abstinence is the ideal.

I appreciate someone talking about their struggle with the matter. I’ve steadily grown more wary of people expressing what Anne Lamont referred to as “excessive certitude”.

One thought on “More on HR

  1. I agree with your assessment. Having worked in both harm reduction and in abstinence focussed (recovery) treatment, that for many, harm reduction is a half-way house. In the UK, most of our treatment population is floating on a lake of methadone, and nobody is calling the boats in. The lack of hope is not only in the addicts, it’s also in many of the professionals working in the field, some of whom have never seen a client recover. As you said yesterday, if we don’t have hopeful services with plenty of success on view (and there are places where this happens; I know!) then we (both professionals and clients) remain in a culture of dependency and addiction instead of a culture of recovery. I love these blogs; always a thrill to read.Dr DaveMy own experience as an addiction doctor is that it is not wise to predict who will recover and who won’t. There are some parameters which can be advantageous and even one or two tools to help, but in the end, it is often about influences and forces I have little understanding of. Your perfect logic is the only logic that stands up. All who want to try should have the opportunity.


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