Navigating the Waters: Harm Reduction versus Enabling
Harm Reduction & Enablement - Telling the Difference |
As I write this article, it feels like I should heed a warning to myself “You're off the edge of the map, mate. Here there be deep waters and monsters!" You’ll read why I’m thinking that in the next paragraph. Despite the complexities, we’re going to take a shot at working through what both these terms mean. Let's state up front, that they are NOT the same.
Shutting Down The Conversation
Recently, there has been a concerning trend where people who oppose harm reduction attempt to shut down discussions by employing a powerful and emotionally charged statement: "You're enabling them." The term "enabling" carries a negative connotation and is widely perceived as inherently bad by society. When harm reduction is linked to enabling, it serves as a tactic to not only halt ongoing conversations but also to evoke a strong emotional response.
Comparing harm reduction to enabling is an attempt to stigmatize and delegitimize the approach. It plays on the commonly held belief that enabling or supporting behaviours that perpetuate a problem, is morally wrong. By associating harm reduction with this negative term, opponents of harm reduction aim to create a sense of guilt or shame among those advocating for a compassionate and pragmatic approach to substance disorder issues.
This tactic serves to shut down discussion, especially when the phrase begins with “YOU”. It makes supporters of harm reduction feel personally implicated in what is presented as a morally reprehensible act. The emotional weight behind the term "enabling" is intended to provoke a visceral reaction, steering the conversation away from evidence-based discussions on the value of harm reduction. In doing so, it obstructs the opportunity for open, constructive conversations about the nuanced nature of substance use disorders and the multifaceted strategies needed to address them.
It's crucial for those supporting harm reduction to recognize this tactic, separate it from the evidence supporting harm reduction's effectiveness, and maintain a focus on promoting understanding and collaboration in addressing all the aspects of substance disorders. By staying informed and resilient in the face of such tactics, advocates can continue to contribute meaningfully to conversations that prioritize the well-being of people and communities
Harm Reduction: A Compassionate Approach
In the world of choices and consequences, harm reduction and enabling often find themselves intertwined in discussions about helping others: These concepts may seem similar on the surface, however, when we delve down and take a closer look we can reveal crucial differences that can shape the outcomes of support and intervention. Let's embark on a short journey to understand the distinction between harm reduction and enabling and why it's vital to recognize their unique roles.
Harm reduction is like a compass guiding individuals and communities towards safer choices. It's a philosophy that acknowledges the reality of risky behaviours and seeks to minimize the potential negative consequences rather than the unrealistic idea of eliminating that behaviour. Think of it as equipping someone who can’t swim with a life jacket rather than insisting they stay out of the water. Or it’s like going outside on a rainy day. Putting on a raincoat and hat so we will keep dry. Or taking a drive in your car. Putting on a seatbelt can save your life. You get the idea. Humans do all kinds of behaviours that can be risky, including using unregulated substances. Telling people to not do drugs is at best naïve, and does not recognize the reality of the situation.
In practical terms, harm reduction strategies focus on minimizing the adverse effects of behaviours without condemning or stigmatizing the individual involved. For instance, in the context of substance use, harm reduction may involve providing drug testing or clean needles to reduce the risk of infections or offering education on safer consumption practices.
Frankly, harm reduction is one of the few working strategies we have until we find and implement solutions to the causes of the poisoned drug catastrophe.
The key idea is to meet people where they are, understanding that change is a gradual process. Harm reduction respects autonomy and recognizes that individuals have the agency to make choices, aiming to make those choices as safe as possible. Harm reduction programs are also the entryway into all kinds of programs that can start people on their recovery journey.
Enabling: The Unintended Pitfall
Enabling, on the other hand, is like a well-intentioned bridge that inadvertently leads towards deeper waters. Unlike harm reduction, enabling involves supporting behaviours that may become harmful or counterproductive in the long run. It often stems from a desire to help or protect someone, but it can unintentionally reinforce destructive behaviours and patterns.
Enabling can be evident in various ways, such as providing financial assistance without addressing the root cause of financial instability, covering up mistakes or consequences to shield someone from accountability, or even justifying unhealthy behaviours. While the intention may be to alleviate immediate distress, enabling tends to perpetuate a cycle of dependency and hinder personal growth.
Each family has to define what harm reduction and enabling means to them - often the term "they have to reach rock bottom" is used by well-meaning extended family or friends. Rock bottom in today's substance disorder world can often mean death. Staying connected is also a harm-reduction strategy. That means one family may provide a roof over their loved one's head, knowing they are actively using substances. Another family because of factors like younger children in the house or behaviours of the family member who is using substances may choose less connection.
Here are some general examples:
- Giving
money to buy drugs.
- Making excuses for missed responsibilities.
- Lending
a car or phone for drug-related activities.
- Bailing
them out of jail or paying fines.
- Ignoring
or denying drug use.
- Letting
them skip work or school without consequences.
- Paying
bills or debts caused by drug use.
- Not
setting boundaries for co-existing in the home. (boundaries are defined by each family - For example, the person using substances in your home could very well for the most part, live by the household guidelines - eg home by a certain time, no parties to all hours. On the other hand, they may be selling drugs from you front door, running a meth lab in your basement or having wild drug parties to all hours of night. Most people can live with the former, but not the later.)
Here are some from a social or government level:
- Inadequate
funding for drug treatment programs.
- Criminalization
of drug addiction instead of treating it as a public health issue.
- Lack
of access to affordable and timely recovery options.
- Insufficient
education and prevention efforts in schools and communities.
- Failure
to address underlying social and economic issues that contribute to
addiction.
- Not
addressing stigma and discrimination against individuals struggling with
addiction. This can prevent them from seeking help.
Recognizing the
Differences
To understand the distinction between harm reduction and
enabling, it's important to recognize their underlying principles and goals.
- Intent
vs. Outcome:
- Harm
Reduction: The intention is to keep people alive or reduce the
negative consequences of certain behaviours like preventing bloodborne diseases
while respecting individual autonomy.
- Enabling:
The intention is to alleviate immediate distress but may inadvertently
support or perpetuate harmful behaviours in the long run.
- Empowerment
vs. Dependency:
- Harm
Reduction: Aims to empower people by providing tools and resources to
make safer choices.
- Enabling:
Can create a co-dependency dynamic, hindering personal responsibility and
growth.
- Long-Term
Impact:
- Harm
Reduction: Focuses on minimizing harm while recognizing that change
is a gradual process.
- Enabling:
Risks reinforcing destructive patterns and delaying the resolution of
underlying issues.
Wrapping Up
In the complex landscape of support and intervention, understanding
the difference between harm reduction and enabling is important. Harm reduction
is a compassionate and practical approach that seeks to minimize the negative
consequences of certain behaviours without judgment. It respects autonomy and
recognizes the gradual nature of change. Its primary and most important goal is
to keep people alive until they are in a position to choose healthier options.
On the other hand, enabling, despite its well-intentioned origins, can
inadvertently foster dependency and hinder personal growth. It's essential to
be mindful of the unintended consequences that enabling can bring and strive
for a balance that promotes positive change.
As we navigate the waters of compassion and assistance, let's keep the compass
of harm reduction close at hand, guiding us toward safer shores while
respecting the unique journey of each individual.
Resources:
Science-Based References on Harm Reduction for Drugs with Valid Links:
Global:
- World
Health Organization (WHO):
- Harm
Reduction: https://www.emro.who.int/asd/health-topics/drug-related-harm-reduction.html
- Global
State of Harm Reduction 2020: https://www.hri.global/files/2021/03/04/Global_State_HRI_2020_BOOK_FA_Web.pdf
- United
Nations Office on Drugs and Crime (UNODC):
- International
Guidelines on Drug Use Prevention: https://www.unodc.org/unodc/en/prevention/prevention-standards.html
- World
Drug Report 2023: https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html
North America:
- National
Institute on Drug Abuse (NIDA):
- Harm
Reduction: https://www.samhsa.gov/find-help/harm-reduction
- Principles
of Effective Addiction Treatment: https://nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf
- Substance
Abuse and Mental Health Services Administration (SAMHSA):
- Harm
Reduction: https://www.samhsa.gov/find-help/harm-reduction
- Model
Programs: https://www.samhsa.gov/
- Canadian
Centre on Substance Use and Addiction (CCSA):
- Harm
Reduction: https://www.ccsa.ca/harm-reduction-whats-name
Specific Strategies:
- Needle
and Syringe Programs:
- DesJarlais,
D.C., et al. (2015). Harm reduction: Effectiveness, cost-effectiveness,
and acceptability. Behavioral and Brain Sciences, 38(2), e55. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928290/
- Strathdee,
S.A., & Vlahov, D. (2010). Needle and syringe exchange programs and
HIV/AIDS prevention among injection drug users: A review of the evidence.
The Lancet Infectious Diseases, 10(3), 260-274. https://www.cdc.gov/hiv/risk/drugs/index.html
- Medication-Assisted
Treatment (MAT):
- Mattick,
R.P., et al. (2017). Methadone maintenance treatment for opioid use
disorder: A review of clinical effectiveness and cost-effectiveness.
Addiction, 112(7), 1156-1169. https://www.tandfonline.com/doi/full/10.1080/1533256X.2020.1793065
- Dong,
B., et al. (2020). Buprenorphine for opioid use disorder: A review of
clinical effectiveness and cost-effectiveness. Drug and Alcohol
Dependence, 206, 107860. https://www.sciencedirect.com/science/article/abs/pii/S0376871620300442
- Overdose
Prevention Sites (OPS)/Supervised Injection Facilities (SIFs):
- Fischer,
E.B., et al. (2020). Supervised injection facilities and overdose
prevention: A systematic review of reviews. International Journal of Drug
Policy, 83, 102919. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787158/
- Wood,
E., et al. (2014). Effectiveness of medically supervised injecting
facilities in reducing HIV and other blood-borne infections: A
comprehensive review. Lancet Infectious Diseases, 14(7), 577-590. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960132-3/fulltext
Additional Resources:
- Harm
Reduction Coalition: https://harmreduction.org/
- National
Harm Reduction Coalition: https://harmreduction.org/
- The
Center for Harm Reduction at the University of Washington: https://psychiatry.uw.edu/research/division-of-addictions/
Fantastic article. This will act as an amazing educational tool for all who dive in! Well done!
ReplyDeleteWonderful article!! There are a few issues that I what take exception with around safety, under the heading of enabling. We can talk about it - Leslie McBain
DeleteGreat article how ever there are some of these organizations that are a front to help in the fight on addiction but who many of us know clearly are on this list for financial gain and nothing more ..
ReplyDeleteWhat I would have liked to have read more of is that harm reduction is not meant to promote or go against abstinence. It is not meant to force change towards any mandatory behaviour. This is what the backlash is about. People believe that forcing change is the answer to the catastrophe when it clearly fails on so many levels. Forced or expected abstinence is just another level of criminalization. Harm reduction as you say is the only current strategy that is having any impact. It just isn’t forcing abstinence. It was never meant to. Ben Goerner.
ReplyDelete