Professional Pessimism

A comment in a recent post exemplifies the reasons for my queasiness about many harm reduction programs and practitioners (emphasis mine):

I work with a Chicago agency engaged in needle exchange. The high rate of HIV, hepatitis and the like transmitted by dirty needles would indicate a need for more harm reduction – not less. It’s simply ridiculous to imply that providing clean needles in any way promotes drug use. Harm-reductionists soft-pedal recovery so as not to alienate active users. By engaging the user over time, harm-reductionists create opportunities for steering users to the treatment and social services they need. Certainly, they reduce the time between when a user decides he wants to quit to when he actually does something about it. There’s another reality: statistically, most addicts never do recover, regardless of what they or social agencies do. Harm-reduction addresses this reality. The harm reduced is not only for that of the user, but for society as a whole. It’s simply in everyone’s best interest to reduce the transmission of disease by dirty needles, because this also reduces transmission to the general population by sexual activity and other means. All of us in the recovery business are saddened by conditions we see. But, we also believe, where there’s life, there’s hope. Many do recover – me, for example, and just about everyone I know working in the trenches. We’ve been there. Believe me, we know what we’re doing.

Set aside from the straw man argument that, “It’s simply ridiculous to imply that providing clean needles in any way promotes drug use.”

What statistics show that most addicts never recover? Even if it’s true for the people that this worker comes in contact with, why don’t they recover? Is is because they’re incapable? Because the professional helpers they come in contact with believe that they won’t recover? Because the system would only offer them suboptimal treatment?

It’s true that some addicts will never recover. However, I’ve been doing this for 14 years and I am completely incapable of predicting who will recover and who won’t. Clients with no recovery capital recover and go back to school, start a business, reconcile with their loved ones, become wonderful neighbors, spouses, parents, and on and on. Others with everything going for them crash an burn. Because I am incapable of determining who will recover and who won’t recover, I have to treat them all as though they can recover.

For multiple problem clients, hope-engendering relationships are key to treatment engagement and recovery initiation. One cannot offer a hope-engendering relationship if one believes that most addicts won’t recover. If one can’t participate in this conspiracy of hope, that person should not work with this population.

If one is able to offer authentic and bold hope, then one would be obliged to vigorously advocate for a system that offers more than harm reduction–a system that also offers adequate recovery-oriented treatment and recovery support on demand.

One thought on “Professional Pessimism

  1. Here in the UK, where we have a plethora of needle exchange facilities, HIV, Hep C and other blood born diseases are rising year on year. We also have the highest rates of drug related deaths in Europe.It is inaccurate to describe Needle Exchanges as harm reduction for two reasons: (1) No needle has yet been invented which can reduce the harmful effects caused by the actions of the injected drug. (2) The best that can be hoped for is that clean needels prevent, or curtail, the spread of blood born disease. That is harm prevention,not ‘reduction’Further there is no safe way in which toxic, psycho active drugs can be injected. The claim that the majority of addicts do not recover is at best speculative. I suggest that anyone who holds that view spends a couple of nights a week for a year or so,attending ‘open meetings’ of 12 step fellowship groups. In doing so they will come to realise that hundreds of thousands of addicts are in recovery at no expense to the taxpayer. It may also lead to the conclusion that there are far more addicts in recovery, than there are using needle exchanges.A recent survey commissioned by the founders of INSITE, the Candadian based supervised injecting service, made the following comments:1.’Insite encourages users to seek counselling and treatment, which has resulted in anincrease in treatment engagement.’ Regrettably no statistics were offered in support of that statement.2.’Mathematical modelling shows that Insite saves about one death by drug overdose each year.’Again no statistics are offered as to how many drug deaths there are, or how many of these were insite users.3. ‘The assumptions that researchers make about HIV prevention may not be entirely validand are therefore inconclusive’. 4’There is no evidence that SISs influence rates of drug use in the community’.It is apparent that they too ‘soft pedal’the idea of recovery to the detriment of the user. A view reinforced by the next finding.5.’An average of more than 600 visits a day shows that INSITE operates near capacity.Approximately80% of the 600 daily visits are for injecting, the remaining 20% for othersupport services such as counseling’.Given that the site seems to exist in order to facilitate the injection of drugs, it is little wonder that the users have any incentive for recovery.As for preventing the spread of HIV etc, consider the following finding.6.87% are infected with Hepatitis C virus (HCV) and 17% with human immunodeficiencyvirus (HIV)It is to be noted that no indication is offered as to whethe either figure is increasing or decreasing.It is also important to remember that this report was not intended to be hostile, that it was commissioned by the advocates of supervised injecion, clean needles etc, in the hope of extending the site.In ‘soft pedaling’ recovery needle exchange facilities and Injecting sites ignore the inescapable fact that the outcome of addiction is always abstinence. It is merely a question of whether it occurs through choice which may require dedication and patience, rather than a quick fix,(no pun intended) death or insanity. Therefore, rather than worrying about ‘alienating users’, should we not be more proactive in helping them to recovery, before the ongoing use of drugs destroys their brain and spirit, to the extent that they have forever lost the ability to make that choice, and death seems to be preferable to their present condition?

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