Revisiting recovery-oriented harm reduction (part 1)

meet them where they are at

The opioid crisis, for good reason, has elevated the role and visibility of harm reduction over the last decade. This seems like a good time to revisit a concept I’ve discussed here several times over the years—recovery-oriented harm reduction.

In 2003, we wrote an article about harm reduction that articulated 6 values that guide our approach to services.

  1. Drug use by addicts is inherently bad and oppressive.
  2. Every addict must be treated with the belief that recovery is possible for him or her, and interventions must place supreme value on recovery from addiction.
  3. Any intervention must attempt to assess “aggregate harm” done to the addict, other interested persons and the community.
  4. Any intervention targeting addicts must communicate hope to both the individual and the community.
  5. Does the program reinforce the culture of addiction or the culture of recovery?
  6. Stewardship of community resources must be integral to this dialogue.

We encouraged other providers to identify their values and hoped that this might lead to more productive dialogue and collaboration.

In 2006, I suggested that this article was really a call for “recovery oriented harm reduction.”

In 2008, I proposed an outline of recovery-oriented harm reduction:

Recovery is all about freedom. The freedom to live one’s life in the way one chooses without being a slave to addiction or being controlled by treatment or criminal justice systems.

. . .

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 counter-transference – some people may impose their own recovery path on clients, others might enjoy vicarious nonconformity through clients

By this time, harm reduction was already moving toward the mainstream. (Maybe it would be more accurate to say that the mainstream was already moving toward harm reduction?) However, the opioid crisis and, more specifically, the overdose crisis has accelerated the process. A result has been not just a mainstreaming of harm reduction, but an effort to redefine recovery from a process involving “sobriety” to a process of improved wellness, effectively placing harm reduction inside that definition of recovery.

More on that tomorrow.

Other posts in this series

5 thoughts on “Revisiting recovery-oriented harm reduction (part 1)

  1. Love most of your ideas Jason but a sticking point for me is the idea that recovery is inclusive. If we can’t define what recovery is how doe we help people achieve it, evaluate program outcomes or get third parties to pay for it?


    1. Are you talking about partial, serial, etc?

      I’m thinking that those could be specifiers that help navigate an all-or-nothing problem with recovery. Kind of like the early/sustained and partial/full specifiers in the DSM.

      I support the Betty Ford definition. Does that clarify things?


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