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Harm reduction vs. abstinence - are they really opposites?

In the world of addiction treatment and recovery, the term "harm reduction" is often used as shorthand to refer to moderating the use of a substance. However, the definition of harm reduction is actually much more broad. Harm reduction could mean anything that leads to less suffering for you and for those around you.


Some examples of harm reduction strategies include:

  • Checking in with a trusted friend before and after a night out

  • Using fentanyl test strips to test your drugs before using

  • Carrying Narcan

  • Taking a cab home after using as opposed to driving while intoxicated or walking through a dangerous area

  • Eating a meal before drinking

  • Using a medication like Naltrexone to limit cravings

Harm reduction and abstinence are often framed as opposite approaches to addiction, but they are not. In fact, for many people, abstinence is the best harm reduction strategy. This is because for them, prolonged and/or heavy substance use has changed their bodies and brains to the point where moderation simply isn’t possible. Many find that once they begin using, they lose control and are compelled to use more and more of the substance. This can lead to severe physical, emotional, and social consequences.


If you’re curious whether moderation is a realistic harm reduction strategy for you, my advice would be to try it out! Give yourself some rules to follow--for example, “I will only drink 2 glasses of wine on Saturday night” or “I will only smoke weed on Sundays” and see if you can stick to them. If you find that you are consistently breaking your own rules, that might be a sign that moderation isn’t working and you need to consider abstinence, at least for a period of time.


Substance use is really complicated, and it’s normal to feel ambivalent or overwhelmed about making a change to your substance use habits. If you think therapy might help you work through some of this, feel free to reach out to me and set up a free 20 minute consultation!


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