Updated: Mar 1, 2020
By: Logan Cohen, Professional Therapist & Online Life Coach
It seems like everybody is talking about substance abuse or addiction treatment these days. Since the government of the United States realized they must respond to the crippling opiate epidemic they allowed the pharmaceutical industry to fuel, there has been a renewed attempt to help People struggling with substance misuse and addiction to find effective solutions.
The fact of the matter is that the field of Addiction Treatment is one that has been entrenched in old (albeit a few effective) ways of doing things.
This older and occasionally outdated approach to addiction treatment is generally known as an “abstinence-based” approach – whereby a complete avoidance of the substance of choice is required.
You can do some research online RIGHT NOW to confirm this – go to Google and search “Addiction Treatment near me” – you will find that 90% of those addiction treatment approaches require complete abstinence from the use of substances.
The governing body for overseeing the study and implementation of evidence-based approaches for mental health conditions is called SAMHSA – which stands for Substance Abuse & Mental Health Services of America. A harm reduction approach to combating addiction has been recommended by governing bodies such as SAMHSA and even the CDC in the face of public health concerns - however the older, more established, and outdated way of looking at addiction treatment continues to remain in practice predominantly today.
So – what is harm reduction?
A harm reduction approach to public health and addiction treatment was initially used with high-risk populations - hence the name “harm reduction” - when it seemed like basic safety could only be assured if providers didn’t strongly recommend intensive courses of treatment.
As you probably already know, there is a tendency for Human Beings to push back against these types of attempts to control our personal freedoms.
Instead, addiction treatment providers who were practicing a harm reduction approach predominantly experimented with offering safer ways to access and use drugs - then where possible, addiction treatment practitioners would also help People consider when THEY are ready to use a bit less, or minimize risk some other way - wherever possible and safe. What addiction treatment practitioners found over time is that clients were actually getting better than initially expected – and staying better.
This harm reduction approach actually worked better than any others with this population.
What these addiction treatment practitioners also found is that when these methods of harm reduction were also practiced with lower risk populations of People dealing with substance misuse or addiction, this harm reduction approach was also effective! When addiction treatment practitioners began to share their results about the effectiveness of a harm reduction approach – between word of mouth among addiction treatment practitioners, through academic journals, and at addiction treatment conferences - the academic community at large finally began to take notice in the 1990s.
So why is a harm reduction approach not more widely practiced?? With all of the amazing virtues of the United States, it is also a vast body of land and People managed by bureaucratic processes – which take TIME for change. On the surface, there is still a tendency to pay homage to a “traditional” way of going about our business – whether the "business" is about American economy, healthcare, or social change.
A harm reduction approach goes against TWO old and established traditions in the United States around addiction treatment:
#1 Reason A Harm Reduction Approach is Not Yet Popular In The USA for Addiction Treatment - They are illegal
The United States has a Law and Order approach to legal corrections, which relies on punishment of Citizens who break crimes.
Don’t get me wrong – I love this country and I think we get a lot of things right and in fact, our legal system was one of those virtues for a long time. When it came to innovation in the legal system, the United States was really “ahead of the times”. We had a huge social and governmental experiment that culminated in 1776 whereby we essentially created modern democracy and within this government body. The “judicial system” makes up one-third of that decision-making process.
And when it came to how American citizens were to be “tried in a court of law”, this was a whole new system! The United States deemed it appropriate to be considered, “innocent until proven guilty by a jury of peers” and that was some real cutting-edge action after being accustomed to rich guys in wigs saying “off with their head” without even having a chance to speak. When compared to the relative lack of transparent justice that was occurring everywhere else in the World at the time, this was pretty innovative and even became the “golden seal” of reason and fairness as democracies and republics popped up in other areas of the World.
While this historical context is a source of well-deserved pride and identity for many Americans, the fact of the matter is that our current legal system no longer serves the function of Balance in our society that it used to. In fact, the whole American System seems to be pretty off Balance these days and the legal system appears to have become all but a pawn for a small group of economic & political elite.
Whether we want to look at the modern wave of our justice system criminalizing the behavior associated with addiction OR the last wave of prohibition in the early 20th century – both of these legal and social experiments have been abysmal failures in the eyes of social and political reform. Each time the American government has tried to criminalize the use of substances, it only ends in increased violence and a decrease in trust for our government.
This flawed approach does nothing for public health concerns created by the disease of addiction itself. If People want or need to use substances, then they WILL do so. There is no amount of punishment with prison time that will disrupt the disease of addiction and even worse – once someone struggling with addiction does end up in jail, how is that supposed to make them stop??
There are just as many drugs available in jail as outside of jail, but inside of jail – there can be very little else to live for when you struggle with addiction.
Recovery from the disease of addiction and its underlying emotional, cognitive, and behavioral concerns requires real treatment. Adequate treatment for addiction does not have to involve punishment, judgment of wrong-doing, finger pointing, or losing the ability to make choices about what works in your own Life. In fact, an effective approach to addiction treatment should involve affirmation of the client’s desire to change and ongoing support, while helping the client regain control of their own Balanced Life choices for themselves – not the other way around.
#2 Reason A Harm Reduction Approach is Not Yet Popular In The USA for Addiction Treatment - Religious Fundamentalism
The social and cultural expectations of the United States are founded on moral judgments derived from Anglo-Saxon Protestant religious denominations who immigrated from Western Europe freely in search of freedom from religious persecution.
These social and cultural expectations form the "rules of engagement" between and among People in a given area of the world, ethnic group, or Country. The specific religious groups that tended to comprise the specific Protestant religious affiliation of most founding American immigrants (NOT slaves) had/have a hyper-focus on the upsides of “productivity”. Think back to John Calvin's “Protest work ethic” – a tendency to believe that anything which stifled productivity was inherently “evil” and “sinful”.
This socio-cultural understanding of People during that time period who happened to struggle with the disease of addiction is that they suffered from an affliction of the spirit and soul. Many of these religious groups viewed (and some more traditional ones still do today) the cornerstone features of addiction – compulsive use, loss of inhibition around pleasure seeking behaviors, and the apparent "laziness" of those in the throes of addiction – as obvious indicators that mind-altering substances and resulting addiction is literally “of the devil” and the use of mind-altering substances is inherently “sinful” or wrong.
I have even been to some Alcoholics Anonymous and Al-Anon groups (also traditionally founded on "Christian values") who will all but say those very shaming words, and especially in more traditionally religious geographic regions of the United States.
Whether or not career politicians, old institutional bureaucrats, or addiction treatment practitioners who are just behind the times feel personally comfortable with a harm reduction approach, this approach to addiction treatment makes a lot of sense for many People who are ready to make a change in their Lives RIGHT NOW, but just don't like the idea of mandated abstinence from substance use altogether.
If you want to learn more about how a harm reduction approach to addiction treatment works and what you can do from the comfort and privacy of Home to start making some of those changes today – feel free to check out our another article on 5 Ways A Harm Reduction Approach to Addiction Treatment Works.
My name is Logan Cohen and I am a Professional Therapist & Life Coach with over 10 years in the field of Counseling Psychology. I am a Clinical Supervisor for the American Association of Marriage & Family Therapy, as well as the founder of New Leaf Counseling Group, LLC in Charlotte, NC. After spending tens of thousands of clinical hours with my own clients, starting a successful group practice, as well as a beautiful Family, I “picked my head up from the grindstone” to check in on childhood Friends & Loved Ones.
I painfully discovered that more than a few of my childhood Friends passed away at a young age from preventable health conditions and decided that as a Man, Husband, Father, and Friend, I could no longer stand by as People suffered in silence and self-destructed rather than ask for help. It doesn’t have to be like that and the holistic healing methods offered by the Balanced Man Plan is designed to help People “get unstuck” and break free from old patterns that are the barriers between Self & quality of Life.
The Balanced Man Plan is a therapeutic digital experience delivered through Self-Guided Coaching Plans created by a Male Therapist with the common barriers & strengths of Men in mind. The Balanced Man Plan has the goal of introducing a natural Balance back to Life so it is sustainable for the optimal Health & Well-Being of Self and Loved Ones - and ALL from the privacy and comfort of Home. If you have enjoyed what you see so far, check out our Self Guided Coaching Plans!