Amber Hollingsworth (speaker) explains the difference between harm reduction and abstinence-based addiction treatments. She describes harm reduction as damage-control strategies (e.g., medication-assisted treatment) that reduce overdose and legal risk but may not resolve underlying issues, and abstinence-based programs as complete cessation from mood- or mind-altering substances, which she favors for later-stage addiction. She advises matching treatment to the user’s stage (earlier stages → harm reduction; later/failed-management stages → abstinence) and points viewers to related videos on stages of addiction and change.
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You know, there are about as many viewpoints on addiction as there are religions. And in this video we're going to zoom in and talk specifically about the differences between abstinence based programs and harm reduction programs. And you'll learn which program is suited for your particular issue. You know, this is really a hot topic out there in the addiction world and people tend to have real strong views on this issue. A lot of times they're strongly and firmly in one camp or the other camp. Myself personally, I have. I'm probably about 75% over in the abstinence based program camp and maybe 25% of me is over in the harm reduction camp. It's not so much that I'm against harm reduction, it's more that I think that that particular type program fits certain types of situations and abstinence based programs fit other types of situations. So let's talk about the differences. The first thing you need to understand is what harm reduction program is. Basically, it's like doing damage control on a bad situation. So we all know that there's a severe addiction crisis going on these days and everybody's doing everything to try to figure out how to the problem. Harm reduction program comes at it from a standpoint of let's do what we can. Maybe we can't fix this person, but at least we can damage control the situation. Some examples of harm reduction programs would be like medication assisted treatment. And if you haven't already seen them, I've got a lot of videos on medication assisted treatment. But basically what it is is it's usually for people that are addicted to heroin or pain pills. And so what happens is instead of trying to get the completely off pain pills or heroin, the person will go to a program and get put on another form of opiate in order to maintain the problem, to keep it from growing and getting bigger. It reduces the risk of overdose, definitely. It significantly reduces the legal problems that someone might get into. You know, it reduces things like theft and family conflict and a lot of that other stuff. So it definitely is helpful in some circumstances. What it doesn't do necessarily is give you what we call the promises of recovery. It doesn't necessarily get you happy, joyous and free. Because you see, most of the time when people have developed an addiction, it's because they're using a substance to fix some sort of internal problem. And yeah, you can switch out what substance you're using to fix that problem, but the problem's still there unless you're addressing it. And as long as you're Using another chemical to fix it, chances are you're probably not addressing it. So in that regards, harm reduction isn't a bad thing. It's definitely several steps in the right direction, but it doesn't necessarily go the whole distance. Abstinence based programs, on the other hand, mean that the person isn't considered in recovery unless they are off all mood and mind altering substances. No weed, no alcohol, no nothing else, completely clean and sober. That's an abstinence based program. And many people feel like you've got to get those chemicals out of the way to have any chance whatsoever at getting underneath to those underlying issues and starting to fix them. Now you can do that in lots of ways. You can do that through therapy, you can do that through church based programs. You can do that through 12 step, you can do that through smart recovery. There's tons of ways to get there. But the point is it's an abstinence based program. The reason why I'm 75% over in that camp is because in my professional experience, trying to teach someone to manage their drug or alcohol use just isn't that successful with most of the clients, patients, families that walk through our doors. Because by the time you've got in to come see Amber, my guess is you've already tried to manage it, control it, cut it back, switch substances. You've tried everything already before you ever got in to see me and it didn't work. Maybe you got one problem under control and then another problem popped up. You know what it's like? It's like, you know that game like Whack a Mole, you know, at like the arcade where you have like the hammer and the little mole pops up and you hit it and another one pops up and you hit that one and another one, you hit that one. And so pretty commonly in the early stages, what people want to do is they want to cut it back or they want to stop using cocaine, but they still want to drink and smoke marijuana, or they want to stop using vodka, but they want to drink beer or any of these other what I call bargaining type behaviors. Can I keep substances in my life somehow in some form, but keep it manageable? If you are in those later stages of addiction, like late stage three and stage four, you're probably chances are gonna need an abstinence based program. And I know that's bad news and some people might disagree, but hey, that's just my professional experience. I've seen people try it bazillion other ways and what I find is it just doesn't work until they get on the abstinence based program model. Because until someone gets completely sober from drugs and alcohol, that addiction just keeps sneaking back in there some way, somehow it just pops up in this form or that form or the other form because you're not really dealing with the underneath issue. And if you want it to go away, you've got to deal with that. Now that doesn't mean that harm reduction programs never work. Like for example, sometimes when we see like a teenager, maybe that's coming in at the early stages of substance abuse issues, not fully dependent, not in stage four or anything like that, but in those maybe like experimentation stages or maybe even heavier use stages. But we know that they have some kind of control over it. Damage control or harm reduction might be the best way to go in that kind of situation. Because it's not necessarily that the person has lost complete control of their ability to manage substances, but if they don't do something soon, they're probably going to get there. So in that kind of situation with a teenager or young adult, I might come at it from a harm reduction standpoint. But I gotta be honest, when someone comes in to see me fully addicted or fully alcohol dependent, I'm usually gonna encourage them towards the abstinence model. Now that doesn't mean I'm intolerant of the other thing. In fact, I'm all about it because almost everyone I see has to try all of those things before they get to the point that they're really like, dang, I guess I gotta give this stuff up altogether. It takes a lot to get there. I like to say you don't get to powerless until you're completely exhausted and you thoroughly went through every single idea that you can possibly come up with on how to manage it. You know, like I worked with this guy one time and he said he literally had his substances based on the weather. So like on sunny days he did like cocaine and on rainy days he like smoked weed or something. I mean, people try every different kind of thing to manage it. And for the most part, the clients that get into my office haven't been very successful because if they had, they wouldn't be in my office. Another example of when a harm reduction program might be the best fit is when someone just truly isn't ready to give it up altogether. And in that kind of situation, you definitely want to reduce the negative things that can happen and most definitely want to reduce the safety risk associated with the drug or alcohol use. A lot of times if you'll just Allow people to work through that. They will come around to get all the way to the other side and they'll come to terms with themselves whether or not they need to be completely abstinent or whether they can manage the drug or alcohol use. Most of my clients end up figuring out for themselves that it is easier to be completely sober than it is to cut it back or moderate it. I mean, cutting it back or moderating is just annoying. That's using just enough to aggravate yourself. So, to summarize my thoughts on the situation, harm reduction is best used in circumstances where the person is in the earlier stages of substance use or the person is not ready to totally give it up just yet. And abstinence based programs are typically most appropriate when the individual has already tried managing it. They've tried the harm reduction, they've tried all that and been unsuccessful. And they come to terms with the fact that it's easier to not do anything than it is to reduce it or manage it. Now, if you haven't already seen my videos on the stages of addiction, you really need to watch those, because that's going to help you understand when each of these methods might come into play for yourself or for your loved one. And after you watch those videos, I might suggest that you watch my videos on the stages of change. So first it's the stages of addiction, and then it's the stages of change. Or you could call it the stages of recovery. Understanding the stage is vitally important to understanding what kind of treatment option is going to work best. If you or a loved one has a drug or alcohol problem and you don't want to waste a lot of time and money doing all the wrong things, Save yourself the heartache. Subscribe to this channel and I'll make sure you're always five steps ahead of addiction.
