‘The Role of Harm Reduction in Recovery-oriented Systems of Care: The Philadelphia Experience’

images‘While harm reduction can be viewed as an end in itself with a focus on mitigating harm to individuals, families and the community as a whole, harm reduction strategies can also be viewed collectively as a platform or point of access for promoting long-term health, and, for those with severe alcohol and other drug problems, long-term personal and family recovery.

If our goal is to promote health and reclaim lives, then we must understand the direct and sometimes circuitous paths through which individuals and families achieve and sustain such health. We must meet each individual and family with fresh eyes in every encounter with a belief that each encounter is an opportunity for movement, no matter how small, towards health and wholeness.’ Arthur C. Evans, Jr., 2013

‘Bridging the harm reduction and traditional addiction treatment and recovery worlds “requires openness to the possibility that our worldview and the cherished concepts we use to describe it may need to become subtler, more fine-grained, amended or even discarded; and, that approaches which don’t work for one person can, equally, be life-saving for others, when all the time our own beliefs, experiences, perhaps even our entire biography, shouts out that this can’t be so.” Neil Hunt, 2012

I can highly recommend this paper by Arthur C. Evans, Jr., PhD, William L. White, MA, and Roland Lamb, MA. It’s 36 pages long, so you’re going to have to put your feet up. Here’s the Conclusion for starters:

‘Harm reduction and abstinence approaches for the management and resolution of AOD problems have often been presented as binary choices within what have often been vitriolic debates within the AOD problems arena.

At a policy level, there has similarly been a tendency for governments to focus on one or the other of these strategies while marginalizing the alternative. What we have attempted to explore in this article is how such approaches might be more effectively integrated to achieve greater balance at both social policy and service practice levels.

Spurred on by a philosophy that holds long-term recovery as the ultimate goal for all individuals with AOD problems, considerable efforts have been exerted by the City of Philadelphia to achieve integration of AATR and HR approaches.

However, many questions remain about the desirability, mechanics, and outcomes of such integration. What is clear is that the chasm between HR and AATR principles and practices is being bridged with hybrid approaches that integrate public health and clinical perspectives. Such integration may well constitute the future for the management of the most severe, complex, and chronic AOD problems.

Public health and medical models of intervention into AOD problems can each result in a depersonalization of the very people they are intended to serve. Resilience and recovery perspectives may offer a way to humanize both approaches while retaining their most valuable elements.

Hybrid models that blend elements of HR and AATR may be particularly well-suited for individuals and families who have been difficult to reach, engage, treat, and reintegrate into mainstream community life through traditional service programs.

There is a question we continue to confront locally, nationally, and internationally. That question is whether existing social institutions competing for cultural and financial ownership of AOD problems can transcend their ideological divisions to forge new collaborative, integrated models of intervention that address the whole spectrum of AOD problems. The fate of these institutions and the health of nations may well rest on the outcome of this question.’