Harm Reduction approach to Addiction Remission

   Although total abstinence from an addiction is the ultimate goal and addictive thinking no longer governs the neural plasticity of the brain, the ARMOR Program recognizes the many stages (or phases) the human process goes through, while transitioning from active addiction to sustained remission. For purposes here, we will look at an addiction to opiates, more specifically an addiction to the intravenous use of heroin, in order to provide examples of a harm reduction approach.

·         In severe cases, the addicted individual has completely substituted heroin for all other life sustaining behaviors like: eating, drinking sufficient fluids, addressing hygiene, sleep, etc. If you give this person $20.00 for food, they will simply use it to purchase heroin. These individuals are approaching death. A harm reduction strategy may be to give this person $20.00 after they’ve eaten a healthy meal. These types of cases are usually homeless (literally living under a bridge), couch surfing, or living in a homeless shelter. Often their family and loved ones have completely disenfranchised them from their lives, because of behaviors associated with heroin use (i.e. stealing, lying, and manipulating).

·         In less severe cases, the individual may still be living at home and holding down a job. This doesn’t negate the risk of overdosing, as addicts tend to push their use to lethal limits, regardless of lifestyle situations. A "harm reduction" approach may be to provide clean syringes and an education in areas like: how diseases are spread by sharing needles, how using the same syringe multiple times increases risk for fatal bacterial infections (i.e. endocarditis), and the role tolerance plays in the risk of overdosing. The idea is to keep those suffering from an addiction to opiates engaged, not to completely disenfranchise them because they are actively addicted.

   Currently there exists a type of thinking, by some, that encourages a tough-love concept which disenfranchises opiate addicts from loved ones and their homes. This is truly sad, as heroin addicts are human beings deserving of love and support, just like any other ill person. This is not to imply that it is alright to enable addicts; there’s a fine line between loving and supporting an addict and enabling an addict. Opiate addiction is a fatal but treatable chronic relapsing cognitive illness. Love is capable of competing with an addiction to heroin. Where negative consequences fail to modify behaviors, love succeeds.  

Often programs designed to help an addict will terminate services (possibly due to insurance protocol) when a lapse or relapse occurs. This can leave the addict feeling abandoned and rejected, which is not consistent with a harm-reduction approach to treatment. If anything, a lapse indicates a need for more intensified treatment.

The "Harm Reduction Coalition"  www.harmreduction.org  provides several harm reduction concepts, which are consistent with ARMOR Program protocol:

·  Accepts, for better and or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.

·  Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.

·  Establishes quality of individual and community life and well-being–not necessarily cessation of all drug use–as the criteria for successful interventions and policies.

·  Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.

·  Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.

·  Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.

·  Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.

·  Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.