In support of abstinence: harm reduction ultimately fails to improve the quality of life for people with addictions.

Many visitors to Caron Treatment Centers' main campus in Pennsylvania remark about a sign in the admissions area that says "If you want to drink--that's your business! If you want to stop drinking that's our business!" This is the driving principle upon which Dick and Catherine Caron founded Chit Chat Farms (today known as Caron Treatment Centers) 50 years ago. Today, we continue to uphold the values of our founders to do the right thing by providing hope for people affected by the disease of chemical dependency. As the president and CEO of Caron, I have the privilege of seeing how a successful recovery can impact a patient and his/her family. Through sobriety, patients and their families realize dreams that were once inconceivable.

At Caron, we do understand that harm reduction has its place in modern society--that needle exchanges or opiate maintenance regimes may help prevent the spread of diseases such as hepatitis C and HIV. However, we also know that for the true addict, moderation-based treatments are not a solution. Society is too eager to accept harm reduction as an alternative approach to healthcare for a chronic illness. In reality, we should strive to create a better system in which all people have a true opportunity to receive treatment for the disease of addiction and begin a new and sober life.

There are three key elements of harm reduction that I believe are highly problematic. First, research shows abstinence-based programs are much more supportive and successful for long-term recovery than harm reduction initiatives because they provide patients with skills to start a new life and also treat the family system. In fact, a person on methadone might have some counseling, but he is more likely to get the drugs he needs from a clinic and leave. True, he may no longer be actively abusing heroin. However, he probably has not learned about the biologic, medical, social, and psychological factors that contribute to his addiction. He probably also hasn't developed a foundation or support system to live a healthier life or worked with family members to start their own healing process. Thus, methadone alone isn't enough to fully address heroin addiction and is not a long-term solution.

Second, harm reduction defies the "people, places, and things" rule of recovery. For example, someone going to a needle exchange or opiate maintenance clinic often will be in the same environment where he/she is accustomed to acting out with his/her drug(s) of choice. Additionally, there are anecdotal reports that methadone clinics can be havens for drug dealers looking to prey on vulnerable people. Abstinent people in recovery who attend 12-Step programs such as Alcoholics Anonymous or live in halfway houses have more options to protect themselves from these unhealthy influences.

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My final, and perhaps the most critical, reason why we should strive for abstinence is the sheer difference in a person's quality of life. One Caron alumnus, Tom R., had been on methadone maintenance as part of a harm reduction plan but is now free of using heroin and methadone. "I was hoping methadone would be the 'magic pill' I was looking for," says Tom. "While it might have prevented me from dying of a heroin overdose, I was still my same addict self and caught up in my same addict lifestyle." While Tom had stopped using heroin, he had not altered any of his behavior. He still was allowing a drug (i.e., methadone) to remain a focal point in his life.

Tom continued to take methadone daily until he realized he didn't want to just "get by" anymore. Now that he's sober, he tells a different story. "I feel emotions now I forgot I could have," Tom says. "Sometimes it's difficult to feel pain and not turn to a drug for relief. But I think sobriety is worth fighting for."

A common definition of insanity is doing the same things over and over again and expecting different results. True recovery and sobriety are found in practicing the 12 Steps and living an abstinence-based life one day at a time. Harm reduction reduces harm for a period of time--abstinence reduces it for a lifetime.

Photo by Tim Tannous on behalf of Caron Treatment Centers.

ABOUT THE AUTHOR

Doug Tieman is President and CEO of Caron Treatment Centers, based in Wernersville, Pennsylvania.