Harm Reduction is a pragmatic and strategic approach to reduce the harmful effects of substance use that has emerged in recent years that recognizes that people with substance use disorders present for care at different stages in their road to recovery and that successful intervention in substance abuse treatment can be applied even with people who haven’t stopped their use altogether.
The premise of harm reduction includes the following concepts.
- There is a continuum of substance use from complete abstinence to severe abuse.
- Some ways of using substances are not as unsafe as others.
- Successful intervention does not just mean abstaining from all drugs and alcohol but rather can be measured by an improvement in a person’s wellbeing and reduction in risk of severe consequences from drug use.
- Lastly, a harm reduction approach is non-judgmental and gives the patient more of a voice and greater responsibility in their recovery process.
Even if a person is not ready to stop using substances completely, there can be therapeutic benefit in encouraging and supporting a reduction in use to mitigate the risks and harmful consequences of heavy drug or alcohol use.
- A person who is drinking moderately on a daily basis, versus heavily on a daily basis, has a lower risk of medical and legal complications from their ongoing alcohol use.
- A person who is taking methadone or Suboxone (naltrexone and buprenorphine) is less likely to have medical complications than a person who continues to use IV heroin.
In line with the application of a Harm Reduction approach in the care of substance involved patients, the use of Medication Assisted Treatments (MAT) can be a highly effective treatment tool in reducing morbidity and mortality. Two examples of MAT interventions are:
1) the substitution of safer alternative medication regimens as alternates for street drugs for opioid dependent individuals
2) the use of medications such as naltrexone and acamprosate (Campral) to help reduce cravings for alcohol. While still substance use involved, patients using MAT successfully can manage their conditions with lower risk and with greater potential for ongoing recovery, including eventual abstinence for some, over the long term.
Related to the MAT approach, there is also increased recognition that substance use disorders are often associated with co-morbid psychiatric conditions, so that current day practice now no longer mandates waiting until a person is completely abstinent from substances before assessing and treating co-morbid psychiatric conditions. Now we have a better understanding that a person’s mental health state can be a risk factor for ongoing substance use or relapse back into substance use. Therefore there is good evidence that treating co-morbid mental health conditions, even if one does not know “what came first” can help a person achieve sobriety or at the very least reduce their substance use.
It is our hope that this introduction to the principle of harm reduction and associated medication interventions is helpful as you continue to work with people who are dealing with substance abuse concerns. Please refer to previous e-weekly articles on alcohol use disorders and opioid use disorders for more specific information about medications that are part of the harm reduction model.