Abstinence and Harm Reduction Approaches are not Opposites

National Addictions Awareness Week Series

A message from Dr. Nel Wieman, Senior Medical Officer, and Paul Perry, MN, First Nations Addictions Care Partnership Manager, FNHA Office of the Chief Medical Officer (OCMO)

Recovering from drug addiction can be thought of as a return to a state of health, mind, spirit and strength. While the end goal of recovery is to reduce or quit substance use in order to achieve an optimal quality of life or a low-risk lifestyle, we need to be compassionate and non-judgmental towards people who struggle with addictions and are not yet ready for this step. In these cases, the short-term goal on the spectrum of recovery is keeping people safe – and alive. In public health circles, this is known as a harm-reduction approach, so named because it aims to minimize the harms and potential danger – including overdose – to people who use substances.

Harm reduction and abstinence approaches are not opposites

Harm reduction is a huge topic that is often misunderstood and surrounded with controversy. It is our view that abstinence and harm reduction are not opposites; rather, abstinence is at one end on the spectrum of harm-reduction approaches, with the same core goal of minimizing harm from substance use. While the evidence shows that harm reduction is often the first step towards a better quality of life, not everyone agrees and myths abound. One myth is that providing harm-reduction supplies encourages people to use more. However, providing clean supplies does not encourage people to use. It does:

• Reduce the health risks of getting infections like Hepatitis C and HIV

•  Prevent skin infections like cellulitis and skin abscesses, and

• Help prevent serious heart infections and other heart problems.

Providing tamper-proof containers for used supplies supports communities in becoming safer places, and demonstrates respect and concern for people who use substances. Check out our video series to hear more about this.

What should we do – or not do – to help people living with addiction?

Many sisters, brothers, cousins, mothers, fathers, aunties and uncles have left our communities too soon as a result of addiction. Their loved ones are asking what they can do and what else can be done to help. The good news is that there are a number of different treatment options to choose from (described further on in this message), all developed with the understanding that people are different – and that what will work for one will not necessarily work for another.

For more information about understanding addiction and helping loved ones who live with addiction, read messages from Dr. Evan Adams, FNHA Chief Medical Officer, and Dr. Shannon McDonald, FNHA Deputy Chief Medical Officer.

But why don’t people who want to stop just stop? And why do people relapse?

Trauma is one of the most common reasons people struggle with addiction. Colonization – which included separating Indigenous people from their children, lands, and livelihoods, and confining them to remote reserves – has left a legacy of intergenerational trauma that is compounded by the traumas Indigenous people continue to experience. Many Indigenous people feel powerless, lost, scared and hurt. Some turn to substances as a way of coping with or masking their pain. Given this, it is important to understand that substance use is a health and wellness issue, and not a moral issue, and that substance use and recovery are journeys as complex and as unique as the people who walk them. As we noted earlier, recovery is on a spectrum. Addiction is also on a spectrum, and relapse, by definition, is a part of that, meaning relapse is often part of a person’s recovery story. Not everyone who stops using substances relapses, but many do.

So what options are out there to support people living with addiction?

There are many different types of drug rehabilitation services available offering a wide variety of services depending on your needs and where you are in your journey -- from supervised consumption sites to medications to out-patient clinics to residential treatment centres.

Supervised consumption sites are part of a long-term, comprehensive approach to the harms associated with substance use. Here, people who use have access to clean supplies and health care providers who can offer any additional supports or make referrals to other services available in the community.

Opioid Agonist Therapy (OAT) is an effective treatment for addiction to opioid drugs. The therapy involves taking medications that work to prevent withdrawal and reduce cravings for opioid drugs. People are then freer to focus on things other than finding and using substances, like getting involved with their communities and working on improving their health and wellness. To find places that offer OAT, click on this link.

Detox centres are about freeing people from toxic substances like drugs and alcohol in the short-term after one stops using. Most have a period of “drying out” which usually lasts five to 10 days and gives the person an opportunity to make a clear choice about whether to go to a treatment centre or to engage with available out-patient programs and services.

First Nations treatment centres offer people a safe place to heal, learn and reflect about substance use in a culturally safe way. Some are funded through the National Native Alcohol and Drug Abuse Program (NNADAP) and offer services to a wide range of people and families including cultural and clinical interventions that support First Nations in BC. There are other treatment centres in the province and across Canada. Sometimes people can’t go away or stay in treatment facilities because of family, work or other commitments. In these cases, day treatment may be an option.

Day treatment programs are intensive out-patient services that help people understand their addictions and help support pathways to healing and improving a person’s quality of life. These services are more intense than standard out-patient services but less intense than residential treatment centres.

Again, unconditional love is the bottom line for helping people living with addiction

If you have people in your life who need help, please talk to them about the many options available to them and keep an open mind and heart. And remember, as Grand Chief Doug Kelly said in a heartfelt message on addiction, “Sometimes the healthy choice is too harsh, and the best we can do is to minimize harm. We can save a person’s life by being flexible and not being judgmental. We have to draw strength from a well of unconditional love before we make decisions.”