Private Pain and Public Performance

^{The Fall of Icarus by Jacob Peeter Gowy}

I recently read a moving and, sadly, familiar story.

It’s about a person with addiction who finds recovery and pours himself into advocacy. He seeks an audience and influence, finds an opportunity in harm reduction, distance grows between him and the foundations of his recovery, he relapses, he dies.

Tributes have flowed since his death — from politicians, journalists, charities — each reaffirming the noble story: that Krykant battled for the marginalised, that he broke through political silence, that he cared. And all of that is true. But it is not the whole truth. These stories erase the part that matters most: the human cost of turning private pain into public performance, and the way a man who wanted to save lives slowly lost his own as his addiction became awkward for his gang of civic cheerleaders.

There are lessons here for everyone. For campaigners, a reminder of the dangers of building movements around individuals still in crisis. For journalists, a call to interrogate narratives rather than merely regurgitate them. For charities and funders, a warning against mistaking visibility for stability. And, for all of us, an invitation to tell more honest stories — about addiction, about recovery, and about the fine line between advocacy and exploitation.

McGarvey, D. (2025, June 18). The dark truth about Peter Krykant. UnHerd. https://unherd.com/2025/06/the-dark-truth-about-peter-krykant/?us

Ironically, one of the things that fueled advocacy was reading obituary after obituary of tragically young people who “died suddenly” with no reference to the cause of death. This has been changing, stigma reduction efforts have probably played an important role. Now, we found ourselves reading obituaries and social media posts about advocates who died suddenly with no comment about the cause of death.

While the harm reduction element brings unique elements that may destabilize recovery (exposure to drugs and drug use, social networks with neutral or pro-drug beliefs, philosophies that deconstruct addiction, etc.), there are plenty of stories without the harm reduction part of the story.

It points to a few messages highlighted on this blog and elsewhere:

Those messages are relevant to these patterns, whether harm reduction is part of the story or not.

However, the potential risks associated with the harm reduction part of some of these stories got me reflecting on Recovery-Oriented Harm Reduction and how lessons from these stories might be integrated. Below is a summary of the model with additions highlighted.

What is recovery-oriented harm reduction?

Recovery-oriented harm reduction (ROHR) seeks to address the historical failings of both abstinence-oriented treatment and harm reduction services. ROHR views recovery as the ideal outcome for any person with addiction and uses 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 treatment provider.

Addiction is an illness. The defining characteristic of the disease of addiction is impaired control related to substance use.

Drug use in addiction is not freely chosen. Because the disease of addiction affects the ability to choose, drug use by people with addiction should not be viewed as a lifestyle choice or manifestation of free will to be protected. It is not an expression of personal liberty; it is a symptom of an illness and indicates compromised personal agency.

Not all drug use is addiction. There is a broad spectrum of alcohol and other drug use. Addiction is at the extreme of the problematic end of that spectrum. We should not presume that the principles that apply to the problem of addiction apply to other AOD use.

ROHR is committed to improving the well-being of all people with addiction. ROHR services are not contingent on recovery status, current AOD use, motivation, or goals. Further, their dignity, respect, and concern for their rights are essential and not contingent on any of these factors.

ROHR does not neglect addiction within its workforce. Recognizing addiction as an illness and the commitment to the well-being of all people with addiction, ROHR acknowledges that working in harm reduction may pose risks to recovering people within its workforce and seeks to mitigate those risks. When relapse occurs, ROHR is neither neutral nor passive and seeks opportunities to facilitate stabilization and recovery.

An emphasis on client choice—no coercion. While addiction indicates impaired choice-making regarding AOD use, ROHR providers do not engage in coercive tactics to engage clients in services. Service engagement should be voluntary. Where other systems (legal, professional, child protection, etc.) use coercive pressure, service providers should be cautious that they do not participate in the disenfranchisement or stigmatization of people with addiction.

For those with addiction, full recovery is the ideal outcome. People with addiction, the systems that work with them, and the people around them often begin to lower expectations for recovery. In some cases, this arises in the context of inadequate resources. In others, it stems from working in systems that never offer an opportunity to witness recovery. Whatever the reason, maintaining a vision of full recovery as the ideal outcome is critical. Just as we would for any other treatable chronic illness.

The concept of recovery can be inclusive — it can include partial, serial, etc. While this series argues for a distinction between recovery and harm reduction, Bill White has described paths that can be considered precursors (precovery) to full recovery.

Recovery is possible for any person with addiction. ROHR refuses cultural, institutional, or professional pressures to treat any sub-population as incapable of recovery. ROHR recognizes the humbling experiential wisdom that many recovering people once had an abysmal clinical prognosis.

All services should communicate hope for recovery. ROHR recognizes that hope-based interventions are essential for enhancing motivation to recover and for developing community-based recovery capital. Practitioners can maintain a nonjudgmental and warm approach with active AOD use while also conveying hope for recovery. All ROHR services should inventory the signals they send to individuals and the community. As Scott Kellogg says, “at some point you need to help build a life after you’ve saved one.”

Incremental and radical change should be supported and affirmed. As the concepts of gradualism and precovery indicate, recovery often begins with small incremental steps. These steps should not be dismissed or judged as inadequate. They should be supported and possibly even celebrated and they should never be treated as an endpoint. Likewise, radical change should not be dismissed as unrealistic or unsustainable pathology.

ROHR looks beyond the individual and public health when attempting to reduce harm. ROHR wrestles with whether public health is being protected at the expense of people with addiction, whether harm is being sustained to families and communities, and whether an intervention has implications for recovery landscapes.

ROHR should aggressively address counter-transference. ROHR recognizes a history of providers universalizing their (positive or negative) recovery experiences while others enjoy vicarious nonconformity or transgression through clients. It is also sensitive to the ways relapse can influence attitudes toward communities of recovery and recovery pathways. These tendencies should be openly discussed and addressed during training and ongoing supervision.

ROHR refuses to be a counterforce to recovery. ROHR seeks to be a bridge to recovery, lowering thresholds to recovery rather than positioning itself as a counterforce to recovery. Recognizing that addiction/recovery has become a front in culture wars, ROHR seeks to address barriers while also being sensitive to the barriers that can be created in this context. When ROHR seeks to challenge the status quo, it is especially wary of critiques that deploy straw men, recognizing that this rhetoric is harmful to recovering communities and, therefore, to their clients’ chances of achieving stable recovery.

ROHR sees harm reduction as a means to an end. ROHR views harm reduction as strategies, interventions, and ideas aimed at reducing harm. As such, it is wary of harm reduction as a philosophy that frames harm reduction as an end for addiction. Back to Scott Kellogg’s point, “at some point you need to help build a life after you’ve saved one.” The end we seek is recovery, or restoration, or flourishing. Seeing harm reduction as a philosophy or ideology risks viewing it as “the thing” rather than “the thing that gets us to the thing.”