As San Francisco opens a safe injection site, it’s time to accept harm reduction as a crucial part of addiction treatment.
My roommate in a popular Concord detox facility was three days in, and she’d had enough. She was withdrawing from heroin, me from benzos—I hadn’t yet found a bottom with opiates. She bolted, as addicts like us are so good at doing. I’ve had sponsees in recovery homes bolt in the night. Anyone in long-term recovery knows this. We see people come into treatment, or meetings, or reach out for help. And then we see them go back out.
My roommate left the detox at the roughest time, admitting to me she was headed back to drug use. This was a perfect opportunity for an addiction treatment facility to offer harm reduction solutions and strategies. Actually, the perfect time may have been not three days in, but before her detox process even started. Harm reduction strategies were never offered to us, however.
Why is there a split between harm reduction and the rest of addiction treatment?
When talking about addiction treatment, we consider relapse prevention. But we rarely focus on risk prevention once the relapse has begun. Addiction treatment centers often talk about the hell of using, which addicts know well. But if many of us recover in sprints and starts—and we do—harm reduction should be built into that recovery process. This would minimize our risk as we find a path to recovery that works for us.
As San Francisco opens the country’s first injection site, and debates about other injection sites across the country continue, we need to realize that treating people actively using drugs like human beings will raise their self esteem to a point where they may be able to consider treatment an option. When we treat those currently using and those in recovery as two wildly separate groups that never meet—the recovered and the unwilling to recover—we’re doing everyone a disservice. If we make the divide between using and sobriety smaller, active users may be more willing to step into recovery and try it on. If we redefine recovery with more open and accepting arms, it may go from an impossibility to a reachable goal.
Educating people about addiction is a part of recovery.
It’s scary to think about relapse. But at the same time, we know that addiction is a chronic disease, and that relapse can be a part of recovery. Massachusetts Governor Charlie Baker said that safe injection sites, a crucial element of harm reduction during the opioid epidemic, are not “a path to treatment.” If educating people about the risks and precautions related to their chronic disease isn’t a path to treatment, then what is?
A Boston Globe editorial noted that, “Being alive, after all, is itself a path to treatment.” But let’s push it further. We currently force people to shoot up Russian roulette-like cocktails in the streets. Let’s not merely keep them alive. Let’s give them some dignity, privacy, and safety.
A powerful deterrent from relapse can be thinking about the catastrophic occurrences that happen when you drink or use. For me, remembering that I have no recollection of what happens in a drink or drug blackout is a powerful deterrent from ever wanting to drink or use drugs again. But other things also keep me sober today. Recognizing why I have thoughts about drinking or using and what specifically causes those thoughts to come up helps me stay sober. So does thinking about what I can do to care for myself in a way that reduces my risk of relapse. I don’t keep myself scared straight today. And in a moment of anger or hopelessness, would fear keep me from relapse, anyways? Of course not. It’s healthy coping tools that keep me sober.
This is why in the Workit program, we meet people where they are. We let our members make their own recovery goals: moderate or quit, work on one substance or quit everything. We offer members online lessons about harm reduction, as well as giving up for good. And we don’t see these as contradictory pieces of information. We see them all as educational fuel that feeds each member’s journey where they want to go, in the way that works best for them.
