Reviews and Critiques

Treatment and harm reduction professionals need to make peace

Bruce Alexander. The Canadian Nurse. Apr 2009. Vol. 105, Iss. 4; pg. 40, 1 pgs

Abstract (Summary)

One of the deepest feuds dividing the field of addiction is between those practitioners who treat drug addiction by supporting people who are striving to abstain and those who reduce harm by providing clean needles and methadone to confirmed drug addicts. These two groups can infuriate each other. Treatment practitioners may equate harm reduction with enabling addicts to continue a self-destructive habit. Harm reduction practitioners may think that treatment proponents aren't willing to acknowledge that many addicted people the before they "hit bottom" and rebound into effective interventions.

Jump to indexing (document details) Copyright Canadian Nurses Association Apr 2009

Many nurses and members of other helping professions are alarmed by the addictive misery that they see and are committed to doing something about it. It is a great loss when these compassionate, dedicated professionals do not respect and support each other.

One of the deepest feuds dividing the field of addiction is between those practitioners who treat drug addiction by supporting people who are striving to abstain and those who reduce harm by providing clean needles and methadone to confirmed drug addicts. These two groups can infuriate each other. Treatment practitioners may equate harm reduction with enabling addicts to continue a self-destructive habit. Harm reduction practitioners may think that treatment proponents aren't willing to acknowledge that many addicted people the before they "hit bottom" and rebound into effective interventions.

This unfortunate conflict goes back at least a century. Isn't it time to end it?

The logical basis for a lasting peace is the fact that even though both treatment and harm reduction have yielded successes and saved lives, neither comes close to being a complete answer. Regardless of what side they are on, the professionals, with all their dedication and talent, are destined to watch many of their clients go to prison or the and to recognize that their programs' successes will be fewer than their failures.

Resolving the wasteful feud also entails that we realize that neither of these essential approaches can be blamed for the rising flood of addiction in the modern world. Modernity itself fragments society and tears people away from supportive social matrices that are essential to human wholeness and resilience. People who are dislocated from essential social supports experience anguish and desperation. They do whatever they can to re-establish a sense of belonging, identity and meaning. When they do not succeed, addiction - to drugs or any of a thousand other habits - all too often provides a substitute social world and some measure of solace. Addiction never solves the problem of social dislocation and fragmentation, but it can provide enough relief that desperate people will cling to it with reckless abandon.

I do not mean to suggest that neurochemistry and genes have nothing to do with addiction. Rather, I wish we could expand our attention to the larger problem, not just the corner of it that has to do with drugs and alcohol. When an entire society is drowning in addiction - to gambling, sex, dysfunctional relationships, computer games, pornography, work, shopping, credit, exercise, ideological fanaticism and much more - we must think beyond supposedly addictive substances and individual genetics. We must look for social factors that make some societies more vulnerable to addiction than others and that, historically, have transformed cultures that were almost addiction free into populations that are engulfed by addictive misery.

Analyzing the entire range of addictions in the modern world is of course a huge undertaking. It has become my life work, and I don't think it can be adequately discussed in this short article. However, there is space enough here to plead for peace. Many worthy endeavours, involving treatment, harm reduction, prevention, law enforcement and a great variety of spiritual interventions, are underway. Each has the potential to help some addicted people. None will bring the problem of addiction under control, either alone or in combination.

Addiction will finally be understood and overcome as part of a larger revolution in social values. No one can prophesy when that will occur, although some of us dare to believe it might be soon. In the meantime, peaceful and supportive relationships between the dedicated practitioners of our diverse disciplines will enable us all to help as much as we can.