The term “harm reduction” occurred to me again the other day.
The term harm reduction is often used when speaking of addiction of which I often speak.
I suggest that it is a loaded phrase.
It is pejorative. And why is that? It is pejorative because it treats the whole enterprise of addiction as something other than what it is. Hidden in the phrase is an assumption that addictions are somehow different from any other medical problem.
They are not. Further harm reduction separates out opiate addiction from other drug addictions. That is it usually refers to opiate use. In part, this makes some sense because for most addictions we do not have concrete steps we can take to reduce harm in other addictions as we do with opiates. With opiates, we have buprenorphine and methadone, and a few other medications that are specific for opiates and we can do things such as provide clean needles and naloxone.
Of course, the phrase is not meant to be pejorative at all but to convey exactly what it says, reduce harm.
All medicine is based on the ethic of “do no harm”. All medicine is aimed at reducing harm. Specifically saying that these modalities for opiates are “harm reduction” is redundant and implies that we could choose not to do them.
The problme is ignormance. The alternative is supposed to be abstinent. Just stop taking the drug.
We should not let that type of thinking dictate treatment or influence it in any way. We should not because addiction is a disease-based process that is multifactorial being genetic, epigenetic, social-economic, psychological, and behavioral.
Education has to do a better job of getting the message across that it is not just a matter of willpower. But of course, that always brings up a conundrum in education and that is who teaches the teachers if they don’t know in the first place?
The argument of willpower is driven by those in various factions. One faction says that taking drugs is evil. Therefore the way to cure it is to pray and use your will to stop.
Others go further and just believe that it would be good that addicts should just die. And I’m not exaggerating as there there are plenty people of people that feel this way.
And then there are the well-motivated and well-intentioned recovery movement people. Many of these are modeled on Alcoholics Anonymous or AA or NA, Narcotics Anonymous. Many opiate addicts go to AA. It is fairly standard for those groups to admonish people not to take any addiction medicine. They tell the person that they are not “clean”.
I have dealt with plenty of addicts that would go to the meetings and just not tell the group that they were taking Suboxone, buprenorphine, or methadone.
My opinion is that AA groups work not because of the steps but because of the social interaction, the connection, and the mutual interest in each other, that is why it is helpful.
Much of the nation has an opiate phobia. Phobias tend to stop the thinking process and have people simply run away from what is scaring them. Thinking stops.
It leads to such irrational thinking as I’ve heard people in town halls saying about the use of Naloxone(the antidote for an opiate overdose) that “well doesn’t that just encourage them to use again?' You have to think about that statement. Well, you don’t have to think about it much. If they don’t get the naloxone they die. So you cannot use again and you cannot stop using and get better because you are dead.
The logic would be no different if you said you should stop your blood pressure medicine because it is just a crutch. If you lost 30 pounds and walked 2 miles a day your blood pressure would be fine. This may or may not be true but in the meantime, if you didn’t take your blood pressure medicine your chances of dying of a heart attack or a stroke would not change until you achieve your physical goals. In the meantime obviously, you could have a heart attack or a stroke and die.
But beyond that, there are many reasons for having high blood pressure some of which are genetic, epigenetic, psychosocial, and psychological just like addiction. And unfortunately, once you have hypertension, for the most part, you can rarely control it just with lifestyle changes. So too opiate addiction.
My experience is that NA is the 12 step fellowship where you find a significant amount of semi-organized opposition to MAT among sponsors. Sponsors in AA are much more likely to treat this as an outside issue. As a therapist, and a recovering person myself, I am ambivalent. Our first obligation is to keep people alive and on that score it seems that MAT is definitely a real help. I am concerned however, about long-term use. It seems lots of people settle into a lifestyle that is so much less than what a good recovery program has to offer. Suboxone supplemented by lots of weed and possibly cocaine too. Do you have any idea how common this is? Finally, I might agree with you that the value of 12 steps is primarily social, but I don’t think it’s the meetings. I think the most meaningful activity, and social activity, is doing the step work and sharing it with another human being. That’s where the real magic is.
It's a double edge sword, but iv been researching and found Dr.Robert Beck..he had made magnetic electrical zapers,etc..which electrical current pulses to the brain stop withdrawal and having the will to not want it..the drummer from the band WHO ,went on rhe same electrical pulses and was able to stop using .actually dr.beck said all elements from pur body can be hesled.