A woman sits on an exam table at a facility that practices the harm reduction model of addition treatment.

The Harm Reduction Model of Addiction Treatment


Sober Recovery Expert Author

A woman sits on an exam table at a facility that practices the harm reduction model of addition treatment.

When addicts can’t completely abstain from substances, clinicians may use the harm reduction treatment model of addiction. Traditionally, addiction treatment focuses on total abstinence, but proponents of this method assist to those who are in the midst of chronic addiction and can’t stay clean. This controversial approach helps addicts use safely. The idea is that the addict is going to use no matter what, but their lives may be saved, if they are given directions on how to prevent disease, infection and even overdose. These are the methods used in the Harm Reduction Model.

Syringe and Needle Exchange Programs

The needle or syringe exchange program allows heroin users to exchange their used needles for clean, sterilized ones at government-operated hospitals and clinics. This way, addicts stop sharing their needles and consequently spreading infectious diseases such as hepatitis B and HIV/AIDS. Addicts also receive information about drugs and basic health care during the exchange.

The debate continues on whether harm reduction is a viable option for those who can't stay sober, whether by choice or due to lack of recovery resources.

Drug Potency Reduction and Exchange

This potency-reduction strategy is dual focused. Opioid replacement therapy (ORT) allows addicts to exchange, under medical supervision, illegal and harmful opioids such as heroin for similar but less potent drugs like methadone. Addicts can also receive pharmaceutical heroin by prescription. To prevent overdose, Naloxone may be used to neutralize heroin effects and to prevent overdose. In addition to prescribing naloxone as a potential life-saver to addicts in danger of overdose, health professionals may teach resuscitation and first aid strategies.

Supervised Injection Sites

In Canada, Australia, and Europe, there are specialized rooms where drug users can self-inject under the watch of medical staff. This is intended to reduce the incidence of fatal overdosing. On the other end of the spectrum are those facilities that handle self-injection problems such as open needle wounds, abscesses and poor vein maintenance. They may also test for HIV and hepatitis, and they perform research to the causes and predictors of drug abuse and to plan solutions to stop it.

In America, these private facilities are not yet legal, but Seattle has openly announced its intent to open one, with New York, Boston, San Francisco, and Baltimore all moving in that direction, despite push-back by lawmakers. These lawmakers believe these private injection rooms will only further the drug epidemic, but evidence obtained from legal international facilities shows this isn’t case. Furthermore, the potential for harm reduction in the U.S. can be backed up by studies done of illegal supervised injection sites in the country.

Alcohol Intake Guidelines

Harm reductionists have an approach to safe behavior around alcohol consumption, as well. Alcoholics will be advised to refrain from drinking while driving, for instance, and to delegate their driving duties when drunk.

To control their members’ drinking levels, homeless shelters may allow drinking to take place in phases – such as one drink per hour. By doing this, shelters hope to prevent alcoholics from drinking dangerous alcoholic non-consumables, such as rubbing alcohol. Of course, all of these harm-reduction strategies require the addict to self-moderate.

Criticisms and Merits of the Harm Reduction Model

As previously mentioned, the harm-reduction model has both support and opposition.

Those against the harm-reduction model believe:

  • Supporting addictive behavior in a supposedly safe environment enables the behavior.
  • Substituting harmful drugs for less harmful ones does not lead to abstinence, since some addicts remain on ORT such as methadone for years on end, switching one addiction for another.
  • Prolonged exposure to drugs and alcohol, even within a supposedly safe environment, still takes its toll on health.
  • Prolonged substance abuse permanently alters the brain, making it impossible for chronic users to self-moderate. Studies show evidence of these alterations in children who were exposed to drugs during prenatal development, despite these children not having drug exposure once born.
  • Harm reduction sends out a message that illegal or risky practices are OK so long as they happen in a safe environment.

On the other hand, those who believe in the harm-reduction model say:

  • It reduces the sharing of needles or repeated use of dirty needles by intravenous drug users.
  • The syringe exchange reduces transmission of HIV and infectious diseases among heroin users.
  • ORT has reduced the use of dangerous drugs like heroin and steered users to less harmful drugs.
  • Entire communities benefit from lower crime levels.
  • Harm-reduction may prevent drunk driving.
  • Harm-reduction prolongs lives and looks out for groups of people who do not fit into the usual addiction treatment mold, such as homeless people.

While complete abstinence is the gold-standard of safe and effective addiction treatment, the debate continues on whether harm reduction is a viable option for those who will not stay sober, whether by choice or due to their inability to access addiction-recovery resources (i.e., homeless and impoverished addicts). In America, harm reduction therapy may be a work in progress. But with cities like Seattle opening new harm-reduction facilities, time and research will determine how the method develops in the country.

Drug and alcohol addiction is an incredibly dangerous disease. If you or someone you know struggles with addiction, see our directory of treatment centers, or call us at 800-772-8219 to discuss your options.

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