As clinicians we are constantly struggling for improved models of treatment, and new paradigms to hopefully enhance a more effective treatment. At times it appears we move quickly to implement, before all the information is in. Pharmaceutical Companies frequently get hit hard for this, and try to rush to market or rush to publication. Usually, and sadly it is about the monetary gain, not the efficacy of the intervention or the patient.
Harm reduction philosophy in addiction treatment focuses on the concept, of reducing harm by reducing frequency and/or changing to less severe or less serious recreational drugs. There are numerous flaws with this paradigm, and some benefit. It is this author’s opinion the risk of this modality far outweighs the benefit. There are situations with alcoholics, were they might be able to reduce their intake. In order for this to occur, one cannot have a firm belief of the disease model. There are teenagers, and adolescents abusing cocaine, heroin, and pharmaceuticals that would jump at the chance to reduce down to cannabis. What message are we giving to abusers as clinicians? We cannot treat you effectively, this is difficult, so we will meet you half way on the bridge, and this will reduce harm in the short term. I realize it is not that simple or trite, however there are addicts that view this model as an out.
There is more and more evidence piling up to support a genetic predisposition to alcoholism, how does that fit into a harm reduction treatment plan? It does not. Clinicians, who adhere to the addiction cycle, also will have difficulty instilling this treatment modality. Counselors, who believe strongly in the harm reduction modality, believe this can also be used in sex addiction and gambling. To review the cycle of addiction, we need to assess the patterns.
1. Desire for substance, or vice. (including children with pedophilia)
2. Behavior is implemented, drinking, gambling, or abuse of child.
3. Satiation, followed by phase of guilt.
5. Need to re-offend or abuse the substance.
How does the harm reduction model work for other addiction, sex addiction, gambling, and pedophilia? It was as recent as 1990, when sexually abusing a child, if divorced less than six months or in severe marital discord was NOT labeled pedophilia. This was the DSM-III criteria. Diagnoses change, treatment modalities come and go, some are appropriate and others grossly inappropriate. There are many philosophies of treatment. Caution, implementation of a treatment, with some success does not make it necessarily ethical or accurate. Extensive research with larger populations needs to be implemented. Strict criteria, specifying on whom it should be implemented on and who would be at risk is imperative, before the harm reduction modality is consistently used.