Where’s your evidence?

PeaPod has a great post challenging evidence-based practices as a basis for harm reduction

Now I’m pretty convinced by the wealth of evidence on methadone prescribing. It saves lives. But I’m always asking compared to what? No treatment? Of course. Stand alone detox? I shudder at the thought. But has anyone designed a study comparing standard methadone prescribing as we generally do it on these shores (“script and go”) with treatment in a recovery oriented integrated treatment system?

By that I mean that an individual gets treatment of sufficient intensity (dose) and duration, using evidenced psychosocial interventions, with attention being paid to housing, education, and employability? Such systems will have a solid concept of the protective power of assertive referral to recovery communities including mutual aid and will provide aftercare and peer-support systems.

Of course, it would help if we weren’t fighting for the same scraps. Personally, I’m convinced that, if comprehensive and high quality harm reduction and recovery-oriented services were readily available, addicts would migrate toward the recovery-oriented service system. Of course, it would be even better if we had both and the harm reduction services engaged addicts and sought to move them into recovery-oriented services. Wait! That would be recovery-oriented harm reduction!

I’ve been thinking about a model of recovery-oriented harm reduction that would address the historic failings of abstinence-oriented and harm reduction services. The idea is that it would provide recovery (for addicts only) as an organizing and unifying construct for treatment and harm reduction services. Admittedly, these judgments of the historic failings are my own and represent the perspective of a Midwestern U.S. recovery-oriented provider:

  • an emphasis on client choice–no coercion
  • all drug use is not addiction
  • addiction is an illness characterized by loss of control
  • for those with addiction, full recovery is the ideal outcome
  • the concept of recovery is inclusive — can include partial, serial, etc.
  • recovery is possible for any addict
  • all services should communicate hope for recovery–recognizing that hope-based interventions are essential for enhancing motivation to recover
  • incremental and radical change should be supported and affirmed
  • while incremental changes are validated and supported, they are not to be treated as an end-point
  • such a system would aggressively deal with countertransference–some people may impose their own recovery path on clients, others might enjoy vicarious nonconformity through clients

Today, I’d go further and add that it has to recognize drug use by addicts as oppressive and harmful to the addict.