Harm reduction is one of the most misunderstood concepts in recovery, whether that is mental health recovery or recovery from substance abuse.  The term “harm reduction” can be taken quite literally.  It refers to efforts to reduce the harm a person is suffering from a behavior, behaviors, or lifestyle that is harmful to them. The goal is to reduce the harm those behaviors or that lifestyle is causing them. 

Because it is so basic, the potential for successful harm reduction strategies is almost endless. The most recognized harm reduction strategy for IV drug users is needle exchange programs. Even so, these are controversial. We are accustomed to the concept that one must become sober with an abstinence-only approach, and that this is the only true way to remove oneself from harm’s way. However this approach takes a tremendous amount of effort, motivation, and timing. (This is not to say abstinence programs like the 12 steps aren’t helpful, but they are often regarded in a vacuum.) The harm reduction philosophy acknowledges that there are steps that can be taken to increase the level of safety in a person’s life until they are ready to abstain from behaviors that are not serving them. Dirty needles can cause infection and disease which can eventually lead to death. Providing clean needles to keep people safer from these consequences allows them time to move forward with the mental and emotional work it takes to get to a place where sobriety is an option. 

However, needle exchanges are not the only form of harm reduction, and people with Substance Use Disorder are not the only population that can benefit. That is why Peer Solutions of Georgia promises that our processes are founded on the harm reduction model. Quite frankly, not everyone will become sober, not everyone will go from rags to riches, and we are not (knowingly) preparing the next United States President. What we are doing, is everything we can to facilitate in improvement in the quality of life of people who are overwhelmed and under resourced. People who are weary, people who, despite their best efforts, cannot seem to reduce the harm without their community rallying around them. 

This may look like sitting with them on a computer and helping them find a provider. This may be listening as they say things out loud that are painful and frightening while being heard instead of being analyzed or judged. 

It may even look like calling a facility on their behalf to arrange treatment so that they can enter an abstinence program to get clean and sober from substance abuse. 

What it doesn’t look like is providing assistance with tasks a person is capable of completing on their own. It isn’t providing resources directly rather than facilitating problem solving and solution implementation to the best of their ability. 

That is enabling. 

Enabling cripples a person rather than assists them. Think of self-sufficiency as a muscle. If it isn’t used, it will atrophy, becoming too weak to perform. Without performing, it becomes weaker and weaker. If a person has been in a vulnerable position for long enough, you may encounter them with this muscle too atrophied to perform on its own. In those cases we can take the place of a physical therapist, assisting that muscle, allowing the tone to return while slowly withdrawing assistance as it grows stronger. Eventually the muscle, or the person’s agency over that aspect of their life, will return, and we can step back and watch them excel. Is it ever appropriate to assist? Oh, yes. There are many reasons a person’s ability to perform life skills can be depleted to a debilitating extent. But they cannot grow past that without  some amount of ‘benign neglect.’

There is a balance between harm reduction and enabling, and the difference can be razor thin. When we commit to assisting someone, it is up to us to fulfill that promise by keeping that balance for as long as necessary. Done right and with luck, that difference will widen as they get healthier. 

When a person is in a cycle they have not been able to break even when opportunities present themselves, sometimes a nudge is all they need.