In 2020, over 41 million Americans needed substance use treatment, but only about 7% received it. This means that our existing approaches are not reaching the vast majority of people in need of substance use treatment.

Fortunately, there is an evidence-based way to address this treatment gap. Including a harm reduction treatment approach as part of your clinic’s or practice’s treatment offerings can make it possible for you to reach and effectively treat clients and patients who are not ready, willing or able to get sober.

What Is Harm Reduction?

Harm reduction refers to a set of pragmatic and compassionate approaches to help people who use substances, their families and their communities reduce substance-related harm and improve quality of life.

Harm reduction treatment is a way to apply a harm reduction approach to your substance use treatment and counseling practice. Harm reduction treatment prioritizes clients’ own goals, provides safer-use strategies for people who do not have abstinence-based goals, and helps clients measure and track metrics of harm reduction as they work with you. Where harm reduction differs from other approaches is that it does not require or prioritize sobriety or use reduction. Instead, harm reduction is about meeting people where they are at and prioritizing their own goals.

Because of these differences from abstinence or sobriety-based treatment and counseling approaches, counselors and clinicians sometimes have questions about integrating harm reduction into their practice. This post provides scientific information to help differentiate between myths and facts about harm-reduction approaches in treatment.

Myth: “Medications for substance use disorder just substitute one addiction for another.”

Fact: Medications for substance use disorder can save lives and support patients’ recovery.

Medications for substance use disorder, like Suboxone and naloxone for opioid use disorder or naltrexone or gabapentin for alcohol use disorder, are FDA-approved and widely available. A large number of research studies have now shown that these medications are safe, support recovery, prevent overdose, and save lives. They also pair well with talk therapy or counseling.

Myth: “If you use harm reduction in your practice, you are enabling your clients and their substance use will increase.”

Fact: The “enabling hypothesis” is not supported by research on harm reduction treatment and counseling.

Our randomized controlled trials of harm-reduction treatment both with and without harm reduction medication indicated that this approach engages people who wouldn’t otherwise present for treatment and reduces substance use and substance-related harm. To our knowledge, there have been no studies that have supported the so-called “enabling hypothesis.”

Myth: “Abstinence-based treatment is the only way to get abstinent.”

Fact: There are various pathways to recovery.

Although abstinence is not its primary focus, research on harm-reduction treatment for alcohol use disorder has shown a 20-33% reduction in positive drug tests for alcohol within the first 4 sessions. For clients who stick around for one to two years of weekly outpatient harm reduction treatment, we estimate that about one-third of clients stop using the substance causing the most harm. Harm reduction treatment allows people to make more sustainable and holistic changes if they are not ready, willing, or able to quit when they start treatment.

How to learn more

Check out our Training Calendar for information about our upcoming events to learn how to integrate harm reduction into your clinical practice. You can also find out more about harm reduction and our research here.

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