This topic has been discussed briefly in previous blogs but it deserves another look.
Harm reduction methods such as methadone and suboxone maintenance programs have reduced the risks of sudden death by overdose, hepatitis B and C and HIV transmission and other morbidities. Harm reduction is an addiction treatment method used in socially conscious societies. It requires a highly structured and organized health care system and is a labor-intensive process for health care workers, but there are many demonstrably beneficial results and outcomes.
Generally speaking, harm reduction methods are not utilized to treat regulated health care professionals because of the concern that a health care professional in a safety-sensitive position who fails a harm reduction approach could in turn cause harm to his or her patients. Occasionally, in some jurisdictions, a “controlled drinking” approach (under strict conditions, parameters and monitoring) is attempted when the health care professional feels strongly that she/he is able to drink “socially” and continue working in a professional capacity. However, in the vast majority of cases, regulated heath care professionals are only offered the abstinence option as a precondition to their being allowed to work.
For the general population, it is essential not to stigmatize those in a harm reduction program. Total abstinence is an ideal outcome, but not every addict can achieve that right away. Whether abstinent or in a harm reduction program, the best any of us can achieve is to be in Recovery “just for today.” None of us is ever permanently recovered or cured.
The patient in a stable harm reduction program may start the Recovery process (connection to others, self-discovery, the practice of spiritual principles) even though the ultimate ideal goal may eventually be total abstinence. In other words, one does not have to wait for total abstinence to start a spiritual Recovery within a harm reduction program. Harm reduction is often a stepping stone to a program of complete abstinence. This may not be possible for everyone however. The patient in a harm reduction program should decide for himself/herself what constitutes success.
Once any addict/alcoholic has achieved a significant period of abstinence (weeks to months), then using or drinking on an “occasional” basis can no longer be called “harm reduction.” In this context, using or drinking becomes a risk for an addicted/alcoholic person. Those addicts/alcoholics who are in good sustained abstinence are generally not prepared to take the risk of “occasional” use. Someone who uses or drinks at this stage either is not addicted (and will continue to use/drink intermittently with no consequences and no acceleration of frequency of use) or has no insight (and will accelerate his or her use/drinking until significant consequences occur).
This is not to say that a “slip” in a healthy Recovery program always results in a catastrophe; it may just be a reminder of what needs to be reformed or altered in one’s program. A “slip” may even be a stepping stone to an enhanced Recovery.
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