A Cultural Approach to Addictions Treatment: Harm Reduction
A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.We cannot escape the influences of the society that we live in. For example, television commercials normalize alcohol use and contribute to increased drinking among young people (Snyder, Milici, Slater, Sun & Strizhakova, 2006). Some popular music reifies the drug culture and encourages illicit drug use. People are bombarded every day by advertisements that promote pharmaceutical solutions to nearly every health problem. People demand a quick-fix to their health concerns. Busy physicians respond to these demands with prescription tablet in hand.
Addiction is certainly a cultural problem. To treat addiction at this level we must examine not only how society affects individuals, but also how addicted individuals affect society. The social costs of addiction are enormous. We all pay the price for addiction. Addiction contributes to higher healthcare costs, crime, premature deaths, destruction of property, lost productivity, and many other losses (to list of personal costs).
A harm reduction approach to addiction operates from the premise that many individuals with addiction problems may never achieve lasting abstinence. Harm reduction accepts this unfortunate fact. Therefore, it seeks to limit the harm to addicted people. At the same time, harm reduction decreases the cost of addiction to society as a whole. In some cases, a harm reduction approach serves to keep addicted persons alive long enough for recovery to begin.
A harm reduction approach to addiction stands in opposition to treatment approaches that insist upon abstinence. Many individuals faced with the proposition of complete abstinence refuse treatment of this sort. A harm reduction approach considers some positive change is better than no change at all. When we consider abstinence the only acceptable recovery outcome, positive change is limited. This is because individuals refusing abstinence will make no change at all. Harm reduction seeks to maximize positive change by reducing harm to addicted persons without insisting upon abstinence.
One example of a harm reduction approach is the advent of nicotine replacement products. Tobacco products create a vast cost to society. For individuals who cannot break the nicotine addiction, several nicotine replacement products are available. These include gum, patches, lozenges, and inhalers. These products do not totally eliminate the risks associated with nicotine use such as cardiac problems and hypertension. However, they significantly reduce the harm of nicotine addiction by eliminating the delivery of nicotine in the dangerous forms of smoking or chewing tobacco. Cigarettes and chewing tobacco contain not only nicotine but also toxic, cancer-causing agents as well.
Smoking tobacco products not only harms the individual smoker but also puts others at risk. Designated, no-smoking areas represent another type of harm reduction. Designated non-smoking areas protect non-smokers from exposure to smoke. Another type of harm reduction is tobacco regulation and anti-smoking campaigns. These are intended to reduce harm to society by reducing the number of people who become addicted to cigarettes.
A controversial harm reduction approach is heroin (methadone) maintenance programs (HMPs). The primary risks to individual heroin users is overdose and health risks associated with sharing needles (HIV, Hepatitis). The primary cost to society of heroin addiction is crime. HMPs curtail both the risk to heroin users, and the cost to society. Oral medications in controlled doses (such as methadone) reduce risks to heroin addicts, and reduce costs to society. Research shows that individuals in HMPs are more likely to remain in addiction treatment. They are also less likely to use street drugs, and less likely to have other negative consequences of addiction. Critics of heroin maintenance programs argue that HMPs are expensive and that rehabilitation reduces crime more than maintenance. Proponents point out that heroin maintenance programs are typically less expensive than prison. Research suggests that heroin maintenance programs are cost-effective due to savings in the criminal justice system (Lintzeris, 2009).
Needle exchange programs reduce harm by providing clean needles and syringes to IV (injection) drug users. Because syringes usually require a prescription, IV drug users often reuse syringes and share needles with each other. This contributes to the spread of infectious diseases such as HIV and Hepatitis C.
Similarly, safe injection sites provide sterile injection equipment in a medically supervised environment. Other names for these harm reduction facilities include supervised injection facility; safer injection facility (SIF); drug consumption facility (DCF); or medically supervised injection center. At these locations, medical personal monitor individuals who go to these safe injection sites to inject their own drugs. If a drug user develops respiratory distress or heart failure (i.e., overdose), they can receive immediate medical attention. Critics argue that safe injection sites encourage drug use. Supporters argue that they do not increase levels of drug use. In fact, safe injection sites decrease risky behavior while increasing access to addiction treatment services. These sites are located in countries around the world. At the present time, Australia, Canada, Switzerland, Germany, Spain, and the Netherlands offer some version of this harm reduction approach.
Resources
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Articles
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What is Addiction?
- Introduction to What is An Addiction
- Definition of Addiction
- Definiton of Addiction Continued
- The Addiction Definition Compared to Other Addiction Terms
- How Do I Know if I Have An Addiction?
- Why Don't They Just Stop? Addiction and the Loss of Control
- Is Alcoholism a Disease?
- Addiction Statistics: How Big of a Problem Is It?
- A Brief History of Alcoholism
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What Causes Addiction?
- Introduction to Causes of Addiction
- The Many Causes of Addiction and Bio-Psych-Social-Spiritual Model
- Biological Causes of Addiction
- Disease Model of Addiction and Recovery Implications
- Evolutionary Model of Addiction and Recovery Implications
- Psychological Causes of Addiction
- Learning Theory of Addiction and Recovery Implications:
- Social Learning Theory of Addiction and Recovery Implications
- Cognitive (Expectancy) Theory of Addiction and Recovery Implications
- Educational Model of Addiction and Recovery Implications
- Developmental Model of Addiction and Recovery Implications
- Sociological Causes of Addiction and the Temperance Model
- General Systems Theory of Addiction and Recovery Implications
- Sociocultural Model of Addiction and Recovery Implications
- Public Health Model of Addiction and Recovery Implications
- Moral and Spiritual Causes of Addiction
- Addiction and Personal Responsibility: A Fundamental Conflict
- Personal Responsibility and Locus of Control
- Controversies in the Addiction Field: Change Versus Acceptance
- Conflict between 12-Step Anonymous Groups and Science: A Historical Perspective
- Conflict between 12-Step Anonymous Groups and Science Continued
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How Do You Get Addicted?
- Introduction to How Do You Get Addicted?
- The Biology of Addiction and Recovery
- How Does Addiction Affect the Brain?
- Addiction Changes the Brain's Chemistry
- Addiction Changes the Brain's Communication Pathways
- Addiction Changes Brain Structures and Their Functioning
- Impaired Decision-making, Impulsivity, and Compulsivity: Addictions' Effect on the Cerebral Cortex
- Drug Seeking and Cravings: Addictions' Effect on the Brain's Reward System
- Habit Formation, Craving, Withdrawal, and Relapse Triggers: Addictions' Effect on the Amygdala
- Stress Regulation and Withdrawal: Addictions' Effect on the Hypothalamus
- The Good News: The Brain Also Helps to Reverse Addiction
- The Psychology of Addiction and Recovery
- Learning Theory and Addiction
- Classical Conditioning and Addiction
- Operant Conditioning and Addiction
- Social Learning Theory and Addiction
- Cognitive Theory and Addiction (Thoughts, Beliefs, Expectations)
- Cognitive Theory and Addiction Continued
- Cognitive-Behavioral Therapy: Improving Coping Skills
- Addiction and Other Psychological Disorders
- Developmental Theory and Addiction
- Recovery from Addiction: The Psychology of Motivation and Change
- Addiction: Social and Cultural Influences
- Addiction and Sociological Influences: Culture and Ethnicity
- Recovery from Addiction: Becoming Aware of Cultural Influences
- Recovery from Addiction: The Powerful Influence of Families
- Recovery from Addiction: Social Support
- The Spirituality of Addiction & Recovery
- The Spirituality of Addiction & Recovery Continued
- Incorporating Spirituality into Recovery from Addiction
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Signs and Symptoms of Addiction
- How Do You Know If You Have An Addiction?
- The Diagnostic Criteria for Substance Use Disorders (Addiction)
- The Diagnostic Criteria of Substance-Induced Disorders
- Alcohol-Related Disorders
- Caffeine-Use Disorders
- Cannabis-Related Disorders (Marijuana)
- Hallucinogen-Related Disorders
- Inhalant-Related Disorders
- Opioid-Related Disorders (Heroin, Oxycontin®, Vicodin® and other pain medications)
- Sedative-, Hypnotic-, Or Anxiolytic-Related Disorders
- Stimulant Use Disorder: Amphetamine Type (e.g., methamphetamine)
- Tobacco-Related Disorders
- Other Substance-Related Diagnosis and Unspecified Other Substance-Related Disorder
- Activity Addictions (Behavioral Addictions)
- Gambling Disorder (Addiction)
- Sexual Addiction and Pornography Addiction
- Other Activity (or Behavioral) Addictions: Internet Gaming Disorder (Addiction)
- Other Activity (or Behavioral) Addictions: Food Addiction
- Addiction and Other Psychological Disorders
- Addiction and Eating Disorders
- Addiction and Personality Disorders
- Addiction with Depression, Anxiety, and Compulsive Disorders
- Summary of the Diagnostic Process
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Treatment for Addiction
- Treatment for Addiction
- Natural Recovery: Recovery from Addiction Without Treatment
- Natural Recovery Continued
- Choosing An Effective Treatment Approach: Evidenced-Based Practices
- What Makes An Addictions Treatment Effective?
- Biological Approaches to Addiction Treatment: Medications
- The Role of Medication in Addictions Treatment
- Pharmacologic Medications for Addictions Treatment
- Pharmacologic Medications for Addictions Treatment: Part II
- Psychological Approaches to Addiction Treatment
- Motivation for Change: The Stages of Change Model
- Motivation for Change Continued
- Types of Evidenced-Based (Effective) Treatments for Addiction: Motivational Interviewing
- Relapse Prevention Therapy
- Contingency Management
- Cognitive-Behavioral Therapy
- Dialectical Behavioral Therapy
- Acceptance and Commitment Therapy
- What The Pros Know: The Practical Recovery Model
- Social Approaches Addictions Recovery
- A Cultural Approach to Addictions Treatment: Harm Reduction
- Family Approaches to Addictions Treatment: CRAFT, Intervention And Al-Anon
- The Social Support Approach to Addictions Recovery: Recovery Support Groups
- Self-Empowering Support Groups for Addiction Recovery: Smart Recovery
- Moderation Management
- Women for Sobriety
- LifeRing Secular Recovery
- Summary of Self-Empowering Support Groups
- Spiritual Approaches to Addiction Recovery
- 12-Step Support Groups: Groups That End With "Anonymous"
- 12-Step Support Groups: Part II
- 12-Step Support Groups: Part III
- Expanding Addiction Treatment Choices in the United States
- Developing a Personal Action Plan for Addiction Recovery: Part I
- Developing a Personal Action Plan for Addiction Recovery: Part II
- References
- Resources
- Frequentlly Asked Questions about Addiction
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What is Addiction?
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Questions and Answers
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Tests
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Book & Media Reviews
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Videos
- Technology Addiction
- Why People Can Become Addicted to Opioids
- The Swiss Cheese Model of Drug Addiction
- The 7 Skills for Addiction-Free Living: Alternatives to Substance Abuse
- Teen Drug Use: 2014 Monitoring The Future Survey Results
- Sex and Gender Differences of Importance to Addiction Science
- How to Tell if a Loved One is Abusing Opioids
- Why Addiction is a “Disease” and Why Is It Important
- NIDA Emerging Drugs-Methylone and Molly
- Designed to Drink? The Genetics of Alcoholism
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39 more
- Women and Addiction: Why Gender Matters
- Designed to Drink? The Genetics of Alcoholism
- Gaming disorder: questions and answers
- ADHD & Risk of Adult Drug Use
- Energy Drink Sparking More ER Visits
- Why are Drugs So Hard To Quit
- Anyone Can Become Addicted to Drugs
- Substance Use: Addiction Theories New Treatments and the Role of Doctoring in Society
- The Impact of Changing Social Behaviors on Teen Drug Use
- Teen Substance Use
- Cannabis Effects on Driving Performance
- Epidemiology of Tobacco Use
- Addiction: Learning to Forget
- Addiction: What Can I Do About It?
- Addiction: Treat It Like a Disease
- Addiction: What Is It?
- One in 4 People Prescribed Opioids Progresses to Longer-Term Prescriptions
- NIDA’s Dr. Phil Skolnick discusses intranasal naloxone
- "Eyes On" Research in Drugged Driving
- How Will Anti-Drug Vaccines Be Used? An Interview With Dr. Thomas Kosten
- Opioid Use in Pregnancy: A Community’s Approach
- Naloxone Rescue Kits
- Living Without Fear
- What You Need to Know About Internet Addiction
- Hooked, Hacked, Hijacked: Reclaim Your Brain from Addictive Living
- The Neuroscience of Internet Addiction
- Internet Addiction: Signs You Need to Shut Down
- What the Internet is Doing to Our Brains
- Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment
- The Reward Circuit: How the Brain Responds to Cocaine
- The Reward Circuit: How the Brain Responds to Methamphetamine
- The Reward Circuit: How the Brain Responds to Marijuana
- The Reward Circuit: How the Brain Responds to Natural Rewards and Drugs
- Mindfulness-Based Relapse Prevention (MBRP) for Addictions Video (vol. 1)
- Mindfulness-Based Relapse Prevention for Addictions (vol. 2)
- Prescription Opioid Misuse
- Substance Use Disorders/Addictions - Clinical Overview
- Addiction in the Elderly
- Teenagers, ADHD, and Substance Abuse
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