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.
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.
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.
Comparing and contrasting the harm reduction approach and abstinence model
It is worth noting that the goals of abstinence and harm reduction are quite similar. The goal is basically to create a better and enhanced quality of life for the recipient of the service. Ideally, whenever a drug user approaches a facility for help, they get assigned to a key employee who helps them by first going through the process of assessment and then developing a care plan before subsequently introducing the drug user to certain services that the various philosophies advocate for.
The main objective of the counseling approaches like the Minnesota Model is to instigate a lifetime abstinence from opiates and other drugs as well as to improve the quality of life. This particular objective is realized by the application of the principles contained in the 12-step philosophy. The 12-step program involves frequent meetings that are attended by other recovering addicts as well as changes in behavior. The end result is to achieve a personality change as well as a change in the feeling, basic thinking as well as actions of the individuals. The change which is achieved within this framework is called the spiritual experience.
A comparison of the abstinence approach in the treatment of a person who uses heroin while HIV positive would involve encouraging the individual to cease using heroin and then help them to completely abstain from sex.
However, in the case of harm reduction approach, the same individual may be encouraged to learn how to use the drug, heroin in this case in a safe manner. The activities that may be encouraged in this particular case include the use of clean syringes and needles, clean spoons as well as other equipment. The use of methadone as a substitute to heroin as well as practicing of safe sex is also encouraged.
It is worth noting that abstinence never works for everybody and the spiritual nature of the 12-step program of a faith in some form of a higher power is not pleasing to some individuals. The hand reduction model is noted to be supported by motivational interviewing techniques and therefore makes part of the key factors.
The motivational interviewing techniques have been indicated to be intertwined with the harm reduction model since one of the main factors with the concept of motivational interviewing is to deal with ambivalence. The ambivalent need and desire to do a certain action while equally being encouraged to carry out the opposite .
In the case of the HIV positive heroin addict, the individual may be faced with a tough option of continuing to use heroin among other options. One of the suitable options may be to reduce the amount of heroin being used or to enroll for a methadone maintenance programme in an effort of stabilizing their health while using anti-retro viral drugs at a latter stage.
The concept of motivational interviewing is anchored upon five main principles.
Expression of empathy
The very first principle of express empathy is important in guiding the therapist in sharing of the understanding of the perspective of the client.
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