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Harm Reduction

If you know someone with an addiction, it’s likely that you wish the person would understand the dangers and choose to stop abusing substances right away. In short, you might think of addiction in strictly black-and-white terms, with addiction on one side and sobriety on the other. It’s a common belief among people who are addicted and people who have never been addicted to anything in their lives. Some addiction experts, however, think of addiction in shades of grey. To these experts, addictions can sometimes be managed, and harms of addiction softened. At the end of this process, the person might choose to accept a fuller treatment for an addiction. In the interim, perhaps some of the more serious consequences of addiction can be avoided. It’s a concept known as harm reduction, and the addict you love might benefit from following some of those principles.

*A User’s Story

“I knew I should stop using altogether, but each time I tried to do that, I just fell right back on my old habits. I think I hadn’t really made a firm decision to quit using for good. I signed up for a needle-exchange program, because my girlfriend begged me to do it, and I kept going back over and over. They never pushed me to quit, but I kept seeing the flyers and thinking about what I was doing. Over time, I just made the decision to get help, and they made sure I got into the right program. I don’t think I could have done it without their help.” – Kirk

Understanding Harm

All addictions bring about serious consequences. Some of these situations cannot really be softened, no matter what anyone chooses to do about it. For example, no program can help an addict spend fewer dollars on the addiction. Only by refusing to buy the substances can that effect come about. But there are some other forms of harm that are associated with drug and alcohol abuse, and perhaps those situations can be avoided.

For example, people who abuse alcohol or drugs often choose to get behind the wheel of a car and drive while intoxicated. According to the Centers for Disease Control and Prevention (CDC), 32 percent of all traffic-related deaths in the United States are due to alcohol-impaired driving. Drugs are involved in about 18 percent of driver deaths, according to the CDC. Policies that remove the driving rights of people who drive while intoxicated serve as harm-reduction strategies. These policies often don’t force people into rehabilitation programs. They may choose to enter, but they also may not. But by removing their ability to drive, the policies serve to reduce the number of deaths that intoxicated driving can cause.

As this example makes clear, harm-reduction strategies are designed to help keep people from making horrible, life-threatening mistakes while they struggle with their addictions. The best policies pair restrictions with information about recovery. Perhaps, one day, the person will choose to take advantage of these programs and stop using for good. But if not, at least some of the major problems circling addiction will be avoided.

*Fundamentals of Harm Reduction

While harm reduction can take many different forms, most harm-reduction programs attempt to:

  • Be pragmatic about drug abuse, realizing that some people may never choose to overcome their addictions
  • Resist the urge to judge someone for addiction
  • Focus exclusively on removing and reducing harm
  • Balance cost and benefits
  • Give immediate needs priority over long-term goals

Source: Canadian Centre on Substance Abuse

Special Risks for Drug Injectors

People who abuse drugs via needle are at increased risk for blood-borne diseases. A study in the journal Epidemiology and Infection makes this link quite clear. Of injecting drug users studied, about 82 percent had blood antibodies for hepatitis C and about 61 percent had antibodies for hepatitis B. Some of these people may have received their infections via tattoos, but many received them via sharing needles with one another. It’s a common practice among drug users, as needles are increasingly difficult to find. Instead of insisting upon clean needles for all of their injectable drugs, they attempt to wash needles between uses. Some don’t even wash the needles they use. A small speck of blood could hold an entire colony of infection, and that infection can quickly take hold when the user injects drugs with that tainted needle.

In addition, some injectable drugs are contaminated with materials that don’t dissolve in water. Heroin addicts may experience this when their dealers “cut” their drugs with powders, in order to make their drug supplies last longer. Prescription drug abusers who crush and inject their pills may experience this problem frequently, as many substances contained in pills are designed to move through the digestive tract, not through the bloodstream. These insoluble materials, when injected, can create tiny pockets of infection in the heart or lungs. They can even travel to the brain and cause strokes.

In order to lower these risks, some communities offer needle-sharing programs that can allow users to turn in their dirty needles for clean needles. Several studies have indicated that these programs can be helpful in lowering the risk of infection in people who abuse drugs. For example, according to a study published in The Lancet communities with needle-sharing programs saw their rates of HIV infection drop by 5.8 percent, but communities without them had a rise of infection of 5.9 percent. Watching someone you love go to a center to trade needles might make you upset, as it reminds you that the person you love is still using, but it might be helpful to remember that these clean needles could keep your loved one safe.

It’s harder to address concerns about insoluble drugs. After all, these drugs are illegal and therefore not regulated by any sort of outside agency for purity or quality. However, some needles contain filters that can remove insoluble materials like this. The needle exchange program your loved one uses may provide these needles to ensure that injection-related problems don’t occur. Some addicts learn how to move from injecting drugs to using other methods that are somewhat safer and aren’t associated with such serious risks. Other addicts learn to taper from very dangerous drugs to other drugs that aren’t associated with so many health risk factors. All of these methods could be put under the umbrella of harm reduction.

*Resistance Explained

In order to understand why harm reduction is important, it might be best to understand why people won’t get the help they need. According to a study published in the American Journal of Drug and Alcohol Abuse, about 18 percent of those studied had no interest in drug or alcohol abuse services. They felt enrollment was too difficult, or they were too involved with their addictions to enroll. One day, these people might change their minds and get the needed help. But if they choose not to do so, they may truly benefit from harm-reduction strategies.

Moving Forward

Preventing a catastrophe from occurring is not the same as stating that an addiction is somehow inevitable and can’t be treated. If your loved one is participating in a needle-exchange program or looking for a specific method of taking drugs that is somewhat safer than some other method, that doesn’t mean that the use is acceptable and will continue indefinitely. Consider this: Many needle exchange programs provide information to addicts about services they can use to stop abusing drugs for good. The information is often provided in a subtle, open way. The addicts can choose to ignore it, or they can choose to follow up. Many of them choose to do the latter. For example, according to a study in the British Journal of Addiction, a needle exchange program provided 510 referrals to its clients, and 59.7 percent of them were to drug agencies. These clients likely thought they were only getting clean needles. In reality, they may have gotten a subtle cue that allowed them to begin fighting their addictions.

While it might always be up to the addict to choose sobriety, there are some things that you can do to help support the harm-reduction strategies the person is taking, and perhaps encourage the person to take the next step in treatment. Try:

  • Encouraging progress, no matter how small, in managing addiction. Focus on the good things, not the mistakes the person makes.
  • Leaving materials about rehabilitation in plain sight, in case the person chooses to read them and move forward with rehabilitation.
  • Learning all you can about addiction. This might help you to understand why quitting might be hard, and why it might take time.
  • Taking care of yourself first. Watching someone else deal with an addiction, day in and day out, can be stressful. Make sure you’re getting your own counseling help to deal with the stress.

*The Bottom Line

There’s no question that drug addiction is a serious and prevalent problem. The statistics are hard to ignore. For example, according to news reports, more people die of drugs than motor vehicle accidents in the United States. With statistics like this available, addiction can never be considered benign, and treatment for addiction remains the best and most surefire way to ensure that nothing tragic like this happens. But following harm-reduction strategies may be a good interim step, until the person is really ready to get help for addiction.