Harm reduction and abstinence approaches in opiate addiction treatment

Harm Reduction

Abstinence

Motivational interviewing

Development of discrepancy

Rolling with resistance

Support self-efficacy

Avoidance of argument

In this paper we lay bear the differences that exist between harm reduction approach and the abstinence model of managing drug (opiate) addiction. We do this by a thorough analysis of the processes involved in each approach and then a systematic review of their applications. A comparison as well as contrasting of the approaches is then carried out. A recommendation on how to best apply the two techniques for optimal outcome is then provided.

The treatment of drug addiction has been indicated to be a tough journey that requires several intervention techniques. Two main interventions have been proposed and even applied in efforts to assist drug addiction patients. The two techniques, harm reduction and the abstinence have been indicated and argued to be two different roads which lead to the same destination (Mckeganey,2005). The World Health Organization indicated that both techniques can be integrated into an effective program for treating drug abusers with WHO (2006,p.13) suggesting that harm reduction is an integral step in the journey towards abstinence.

Harm reduction

Peterson et al. (2006) argued that while the abstinence-based intervention approach to opiate use generally demands a total cessation from the use of all non-prescribed drugs as a prerequisite for a successful addiction treatment, the harm reduction technique places an emphasis on the improvement of health as well as social outcomes and begins with the addicts position in regard to drug usage (Lenton,1998).

Both strategies need to be optimized in regards to service delivery as well as their operations. The abstinence-based programs are noted by Rachlis et al. (2009,p.2) to be ideally high-threshold in regard to the eligibility criteria as well as the extent of 'readiness' necessary for individuals to enroll (Peterson et al.,2006; Lenton,1998).

The low threshold services such as the needle exchange programmes (NEPs) are noted to have very minimal requirements in regard to involvement. They also place the IDU in direct contact with a series of care at a time when the patients may not be eligible to engaged in programmes that are abstinence-based (Marlatt,1996).

The harm reduction techniques involves a series of strategies that range from the promotion of safe as well as managed drug use to complete abstinence (Peterson et al.,2006). The proponents of harm reduction as well as its guidelines indicate that the strategies aim at reducing the rather high risks of transmission of diseases and should therefore be treated as culturally appropriate and then subsequently implemented in healthcare settings such as hospitals (Marlatt,1996). Existing evidence indeed suggests that drug use is active in hospitals and this is associated with abandoning AMA (Hurley and Jolly,1997).

In regard to the specific strategies, the methadone maintenance treatment (MMT) is closely associated with a general reduction in the necessity of hospitalization and has been shown to lead to a general improvement in the level of access to healthcare.

The needle exchange programmes (NEPs) aims at the reduction of the level of disease transmission through the reduction of the syringe sharing rate as well as the length and number of time that the used syringes stay in circulation (Dolan et al.,2004). The introduction of Supervised Injecting Facilities (SIFs) have been noted to successfully lead to a general reduction in the risk of contracting HIV as well as other harms amongst the IDUs. In the initial phases of implementing Supervised Injecting Facilities (SIFs) in the U.S., IDU were given access to sterile syringes, referral to addiction treatment, emergency care as well as primary care services (Kerr et al.,2005).The use of Supervised Injecting Facilities (SIFs) has been associated with a general increase in the level of safer injecting practices (Wood et al.,2005a;2006), a rapid entry into the various detox programs (Wood et al.,2006) as well as a general increase in the level of acceptance of addiction treatment (Wood at al,2005b).

Ideally, the concept of harm reduction denotes the use of policies as well as programmes that are aimed at the reduction of the harm that is closely associated with the use of drugs.The main feature of the harm reduction technique is their focus on the ultimate protection from and prevention of various drug-related harm as opposed to the complete prevention of drug use. Newcombe (1992) reiterated the argument that the concept of harm reduction makes a distinction of harm at various different levels' individual, societal and community as well as different types; social, economic and health.

Abstinence

The abstinence approach is based on the 12-step program for use by the alcoholic anonymous movement. The 12 step program comprises of a group of men and women who regularly meet in order to provide support to each other in an effort of achieving as well as maintaining abstinence. The groups within AA are run by the members themselves and no professional counselor is involved. The spiritual foundation of AA is not affiliated with any particular religion as indicated in the work of Murray (1994).

It has been indicate that several drug addicts end up avoiding mainstream treatment as a consequence of not having long-term abstinence in their long-term goals (Rotgers,1996). The harm reduction approach therefore becomes the natural choice for such individuals because its cost-effectiveness and low-threshold level.

The harm reduction approach is very important in the lives of such individuals since they manage to get help in areas that the traditional programs fail. In the U.S. For instance, several people are several individuals who are aware of the number of substance dependent people who 'fail' in the course of their treatment.

This failure is a sign of the inability of the individuals to abstain and is usually attributed to the unwillingness of the individuals to fully engage in the Alcoholic Anonymous or Narcotic Anonymous as well as any other program that is based in the 12-step programme.

Development of discrepancy

This second step is important in helping the client to truly appreciate the value of a change by helping them to explore the discrepancy that exists between how the clients envision their lives to be against their current situation and quality of life.

This from the counseling perspective indicates that one would encourage the recovering addict to consider the true benefits of continuing to consume heroin while infected with HIV against the consequences as well as impact that this would have on their health if they continue taking the heroin while infected with HIV. The benefits of embracing alternatives to the situation as wells as the impact that it would have on their health are also explored.

Rolling with resistance

This step is important in helping the therapist to understand the reluctance of the client to embrace change as a natural process rather than a pathological one. One might expect that the user of heroin who at the same time has been diagnosed with HIV would be very scared as well as reluctant to seek alternatives. What would be really important is for the individual to readily embrace change in their behavior. At this point the confrontational0-denial trap must be avoided at all costs.

Support self-efficacy

This step is important in guiding the therapist on how to explicitly embrace the autonomy of the client. This should be maintained even if the client refuses to change. The step is important in helping the client advance towards change with success and confidence.

Avoidance of argument

This step is important in ensuring that the counselor and the client avoid direct confrontation.

The main aim of motivational interviewing is to establish a good rapport, create change conversation as well as establish a form of a commitment language for the various clients as outlined by Miller & Rollnick (2002)

The main goals of motivational interviewing are to establish rapport, elicit change talk, and establish commitment language from the client. (Miller & Rollnick, 2002).The concept of motivational interviewing is based on Carl Rogers; humanistic theories on the capabilities of people in exercising free choice as well as instigating change process via self-actualization.

The therapeutic correlation that exists between the motivational interviewers and the Rogerian is a form of a democratic relationship/partnership. The role of the counselor is purely directive and is aimed at eliciting a self-motivational statement as well as change in behavior from the drug addict in addition to the creation of discrepancy so as to enhance the motivation needed for appositive change as pointed out by Miller and Rollnick (2002).

Discussions

Harm reduction can be regarded as an umbrella term that refers to the interventions aimed at the reduction of the rather problematic effects of behavior as outlined by Marlatt (1998). Critics of the approach claim that the harm reduction choice enables as well as excuses the engagement in poor choices. Even though abstinence may be the ultimate goal of drub abuse management, harm reduction practitioners aim at meeting the client wherever they may be in regard to their level of motivation as well as ability to change. The goals of the practitioner are need to be secondary to the wants of the client (Logan and Marlatt,2010).

Logan and Marlatt (2010,p.202) pointed out that one major difference that exists between the abstinence-based programs and the harm reduction ones is their definition of the therapeutic process.

Conclusion

The abstinence method of treating opiate addiction is very efficient but is often not practical. The harm reduction techniques as well as motivational interviewing can end up empowering more clients due to their practicability. The two methods can therefore be seen as entirely different in their working but the end result is often the same. In fact they complement each other. A suitable approach would be an integrated one that involves both approaches.