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.