Getting clean and harm reduction: adversarial or complementary issues for injection drug users

Abstract

Many contemporary HIV prevention interventions targeting injection drug users (IDUs) have been implemented using Harm Reduction as a theoretical framework. Among drug-using individuals, however, the abstinence-based "getting clean" models espoused by Narcotics Anonymous and other widely adopted approaches to drug treatment are often more readily accepted. This paper describes an ethnographic examination of the ideological dichotomy between Harm Reduction and abstinence-based "getting clean" treatment model which emerged during the piloting phase of an HIV prevention intervention in Baltimore City, Maryland, USA. This paper describes how the conflict was identified and what changes were made to the intervention to help resolve the participants' dichotomous thinking concerning their substance abuse issues.

Harm Reduction and Tensions in Trust and Distrust in a Mental Health Service: A Qualitative Approach

“…Distrust was more abundant than trust in participants’ reports, revealing the fragility of trust and the focus on abstinence within this setting, despite the harm reduction approach that has been established in mental health policies. These findings are consistent with the ideology of “fixing” the user, a curative approach also called the “getting clean” model of care, through which participants see abstinence as the main goal rather than “the end result of a process, as it is viewed from the Harm Reduction perspective” ([35], p. 6). In this context, stigma is often present and it is hard for all involved to manage such a complex chronic illness that is not easily “fixable” [2, 36, 37].…”

Harm reduction in hospitals: is it time?

“…While an abstinence-based approach to drug use generally requires that complete cessation from all non-prescribed drugs is a pre-requisite for effective addiction treatment [ 15 ], harm reduction emphasizes that efforts to improve health and social outcomes should begin with 'where a person is at' in terms of their drug use [ 16 ]. Strategies need to be maximized, both in terms of types of services offered and where they operate.…”

“…Low threshold services, including needle exchange programmes (NEPs), have minimal requirements for involvement and put IDU in contact with a continuum of care even when they may not be ready to engage in abstinence-based treatment [ 18 ]. Harm reduction involves a continuous spectrum of strategies, from the promotion of safer and managed drug use to complete abstinence [ 15 ]. Harm reduction advocates and guidelines [ 19 ] suggest that strategies to reduce the high risk of disease transmission should be culturally relevant and implemented within multiple contexts, including health care facilities such as hospitals [ 18 ].…”

Hypertrophic and Atrophic Scars

“…Following detoxification, various inpatient and outpatient rehabilitation strategies have been described. These can be roughly classified into two broad categories: abstinence oriented ("getting clean") and agonist maintenance (harm reduction) (14). Narcotics Anonymous (www.na.org) offers a 12-step program that provides group support and education for patients in recovery.…”