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Drug users worthy of both harm reduction and recovery

  • Folkhälsa
sep
2016
7

- We need a progressive alliance between harm reduction and recovery in the treatment of drug dependence, professor Alex Stevens from the University of Kent, stated at the Nordic Alcohol and Drug Researchers’ Assembly (NADRA) which was held in Helsinki in August 2016.

Harm reduction includes providing information on safer use, opiate substitution treatment, needle and syringe exchange programmes, Naloxone to reverse opiate overdose and heroin-assisted treatment. Recovery, on the other hand, focuses on a life without drugs. The harm reduction approach has faced mounting oppositions from advocates of recovery.

- Harm reduction, being such a controversial issue, has to prove itself on an evidence-based level even harder. The fact is, harm reduction does save more money than it costs, Stevens says.

Research shows an increased engagement and retention of problematic drug users in health services and reductions in HIV and other infections, criminal offending and drug-related deaths.

- If harm reduction prolongs drug use, it is by prolonging the lives of drug users, Stevens points out.

The unintended consequences of harm reduction includes diversion of opiate substitution treatment drugs to other users, demotivating some drug users to change and not meeting drug users’ own desires to end drug use.

In terms of abstinent recovery, studies show that most people who enter drug treatment want to end their drug use completely and the public opinion is more supportive of recovery than harm reduction.

- Some argue that resources should be shifted from medically assisted maintenance treatment to abstinence-oriented services. There are dangers in shifting resources in this way. Specifically due to increased death rates among opiate users who are not in medically assisted treatment.

Stevens uses the concept of moral foundations to show that there are conflicting moral positions between those who advocate for harm reduction and recovery. Supporters of harm reduction tend to be ‘liberals’ who believe in individual freedom. Proponents of abstinent recovery are more likely to be ‘conservatives’ who value the moral foundations of authority and loyalty. According to Stevens there is, however, inherent compatibility between the aims of harm reduction and recovery. Both express care for the prevention of harm to fellow human beings; a moral foundation that is shared by both liberals and conservatives.

- Both should focus on the rights of drug users to define their own best outcomes and to receive the medical, housing, employment and peer support services they need in order to achieve them.

- Advocates of recovery would have to accept continued drug use as part of recovery for some drug users, while advocates of harm reduction would have to accept abstinence as a worthwhile goal, Stevens concludes.

Alex Stevens' presentation at NADRA 2016 (pdf, opens in a new window)

Alex Stevens, NADRA 2016

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