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Abstinence vs. Harm Reduction in Addiction Recovery

It’s an age-old question: which is better – harm reduction or abstinence-based recovery? Each have their own set of benefits, yet have completely different approaches to recovery.  We explore both below.

Historically, addiction treatment has centered upon an abstinence-based model, one which asserts that abstinence is essential in order to recover from addiction.   One of the most popular forms of “abstinence only” recovery treatment is Alcoholics Anonymous (AA), a Step-based, peer recovery program that has more than 2 million members worldwide in over 100,000 locally supported groups. Based on a set of “Principles” outlined in the Big Book of AA, the program is spiritual in nature and calls on its members to turn their lives over to a higher power, as well as complete 12 guidelines – or Steps – to help them overcome alcoholism.

For some people, the AA program has not resonated, mainly due to its spiritual component.  After all, not all people are comfortable with the idea of praying or focusing on spirituality.  Others have found its framework too rigid, especially where the complete abstinence requirement is concerned.  They feel the stigma of labelling oneself as an alcoholic or addict keeps many people from seeking treatment in the first place.  As a result of these concerns, programs that aim to reduce the harm caused by addiction without encouraging abstinence have been developed.

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use and addiction.  It incorporates a spectrum of strategies – from safer use, to managed use to abstinence – to meet drug users “where they’re at,” addressing conditions of use along with the use itself.  Because harm reduction requires that policies designed to serve drug users reflect specific individual and community needs, there is no universal formula for implementing it.



eBut while supporters of the harm reduction approach believe it promotes early self-recognition of risky drinking and drugging behavior – thus allowing users to moderate their use before becoming completely addicted – opponents believe it simply enables addicts to continue drinking.  These naysayers also point to low success rates and an unwillingness for those individuals to seek treatment since they don’t want to completely cease using.

As you can see, both approaches to treatment have their perceived pros and cons; yet there is no “right” choice.  After all, addiction is a personal disease, and recovery can be supported in a number of ways.  Therefore, it is important to find what works for you, and then stick with it.


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