Abstinence vs. Harm Reduction Drug Treatment: Which Is Best?

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AA. NA. CA. These are all familiar acronyms that reflect the various 12-step, abstinence-based treatments that are designed to help an individual maintain sobriety. These self-supported fellowships are the original abstinence-based intervention, dating back to 1935. Since then, a significant evidence-base has developed around the 12-step treatment philosophy showing that it can be effective in helping reduce substance use (Kaskutas et al., 2009).

Furthermore, hundreds, if not thousands, of Intensive Outpatient and Residential treatment programs have been developed that also espouse an abstinence-based, zero-tolerance approach, meaning that no use of any substance is allowed. Random urine drug screens, group treatment programs, and care coordination all help individuals in these programs. And as a result, many have been able to find and maintain sobriety.

However, there is another treatment philosophy that has historically been at odds with these abstinence-based approaches. Enter harm reduction.

Harm reduction treatments were designed to “meet people where they are” and with the philosophy that there is no “one size fits all.” It shifts the focus away from the problematic use itself and more about the harmful consequences of the behavior.

Harm reduction programs are important when considering treatment options for substance use disorders. It has been suggested that individuals who do not want to completely abstain, but who want to moderate their use, do not seek treatment because treatment centers have a front-end requirement for abstinence to receive services (Marlatt et al., 1993). Although abstinence may be the ultimate goal for the clinician and the family and maybe on some level the patient, harm reduction programs involve a compassionate, pragmatic philosophy designed to reduce the harmful consequences of using.

Thus, between the abstinence-based and harm reduction treatment programs, we can create a larger menu of treatment options. By doing that, the hope is we can ultimately move towards a normalization of treatment, decreased stigmatization, and increased access to care.

So what should you do?

1. Consult with a psychologist: You should consult with a mental health professional in your area to see what makes the most sense for your particular circumstance. A psychologist can help talk you through the various treatment options in terms of both abstinence vs. harm reduction but also the level of care (e.g. outpatient, intensive outpatient, residential) that might best be suited to you given your particular situation. From there, a treatment plan can be developed to help give you a better sense of steps involved in the process of recovery.

Although there is a multitude of factors that go into the recommendations I make and I cannot make a blanket statement about what I would say, it is often helpful to get a little bit of time clean from substances to experience what that is like. I don’t mean three days of sobriety or even a week, but an extended period of six months, as it takes time for your brain and body to recover and to begin to produce the neurotransmitters that were typically provided by your substance of choice.

With that said, I do not make the same recommendation to everybody and it is important to think about your specific goals.

2. Think about your goals and your willingness to move toward them: It is important to think about your specific goals. Is your goal to quit drinking or using? Or is your goal to make it to work on time and not get fired? Is it both? Your goals will likely dictate the treatment plan.

Ask yourself how important is it for you to make a change and how confident you feel in your ability to make the change. Why is it important to you? What will it take to help you feel more confident? These are all critical questions to ask yourself as you begin the process.

3. Do your research: I always encourage patients to be their own advocate and do their own research to see what the various treatment options are nearby. Think about your own personal pros and cons of doing outpatient versus residential care. Have you been able to cut down successfully as an outpatient? What worked last time? What didn’t work last time? You can use SAMHSA.gov to find a treatment program that is right for you.

4. Consult with a psychiatrist: Note that harm reduction interventions can also come in the form of pharmacological interventions. There are many pharmaceuticals that can help reduce the urge to use, and therefore reduce use overall. You should talk with a psychiatrist to see what makes the most sense for you.

Harm Reduction Essential Reads

Addiction Psychotherapy and Harm Reduction Go Hand In Hand

Is Vaping Harm Reduction?

With all that said, there is a lot of nuance to each of these pieces, but use some of these questions and ideas as a starting point on your journey. Please continue to Google, research, and find programs and resources in your community. And know that there is no single, “best” treatment. It’s about finding what is best for your needs.

Check Psychology Today’s directory of therapists for a mental health professional near you.