From Harm Reduction to Total Abstinence – Chula Goonewardene takes a balanced view on ‘warring factions’
The last nine years have been a juggling act for me, in trying to balance the seeming polarities of the voluntary-sector treatment approach of harm reduction, where I have been working for nine years, with the 12-Step fellowship philosophy of total abstinence, where I have found recovery. When I came into the treatment field in a professional capacity, I was surprised to find these two approaches were warring factions and unfortunately, from my observations, some of this remains today and continues to obstruct our ability to effectively support clients into long-term recovery.
I have witnessed the same arguments and the same debates, over and over again, but in my opinion, it is never quite as clear-cut or one-sided as some people seem to feel. Why, I often ask myself, are we still unable to work in harmony? I have heard stories of voluntary-sector Managers removing 12 Step meetings-lists from service receptions, and even discouraging Practitioners from including fellowship attendance in Care Plans. I have also heard professionals (who are in 12-Step recovery) proclaiming that immediate total abstinence is the only way to an acceptable recovery, and casting judgement to only compound the shame that can accompany a struggle to maintain abstinence.
Some might say that the split I see is because of the rampant, codependent enabling of harm reductionists, others would blame the evangelical and rigid close-mindedness of 12-steppers, and both aspects probably play their part when the fanatics take hold, but isn’t it time we moved passed these perceived differences and narrowed the divide to focus on recovery for all? Surely we are working to the same goal; to support people into better lives (in their own eyes) than they are currently living.
Personally, I have found and maintain my recovery through 12-Step principles and practice, but what allowed me to reach this discovery was undoubtedly harm reduction. Being on a methadone script for four years, one could say that my addiction was prolonged, creating a longer journey to my rock-bottom, as I used heroin ‘on top’ throughout, but one could also say that without it there would have been nothing to prevent a venture into: IV use, homelessness, crime and prison, all things I managed to avoid. Both points of view I believe to be true, and I’m aware that appears to be a contradiction, however, this is my case-in-point; if we work together, one can lead to the other for those who are able to sustain long-term abstinent recovery, resulting in positive outcomes for all concerned.
When I first started working in the voluntary sector, two years into my total abstinence, I firmly believed it was the only way, that all the chaotic, addicted clients that I worked with needed to get clean and stay clean, by going to meetings and working a 12-Step programme, I saw no exception to this rule. I then had the privilege of working with some of the most severely traumatised people I have ever met in my life, and saw, as we encouraged them to decrease their substance misuse, a life-time of terror come rising to the surface. It shocked me.
Obviously I had seen and heard a great deal on my journey so far, but these folk were the extreme of the extreme, the most deeply entrenched in their addictive defence-mechanisms, protecting their fractured souls from the red-hot pain of their pasts. I questioned whether it was right, safe, or healthy to uncover what they had worked so hard to hide, and if they did open the box, could they survive it? I wonder if our recently deceased celebrities were ever given that consideration, or were the expectations of our society all they could hear. We all know that repeated relapse can create sinking esteem, if people are not adequately supported through the process, and if there is nobody there, in our darkest hour, the decisional line between the bottle or the blade can evaporate.
Don’t get me wrong, I believe that all those who are addicted have the potential to find long-term recovery, but shouldn’t the most defining element of that recovery be an improvement of their emotional well-being…to their understanding? Who are we to prescribe this for another, we can only measure our own happiness, and support others to find theirs, giving them all the education available, so that each individual is able to make informed choices for their future. By adopting this approach we can embrace both sides of the argument, acknowledging that harm reduction is where we need to start, in order to prepare the desperate and motivated for the long, arduous journey ahead, and hold the contemplative ambivalent, safely simmering, until the discrepancies resolve. For this to have value, however, I believe we must be focused towards total abstinence for those motivated souls, and pathways from treatment into fellowship should be seamlessly supported and strongly encouraged, with therapy of some kind running parallel, to work through any emerging trauma. The under-lying issues of the addicted individual can be few, or they can be many, how do we know? The answer is…we don’t! We can only guide people to take the next step on their journey and this is true at every stage in the cycle of change that we find ourselves in, as a professional meeting a client who is asking (or sometimes being coerced to ask) for our help.
What I have learnt for myself is that even though I have been abstinent for 11 years, one day at a time, my work in personal therapy continues to teach me more and more as the years go by. Not only that, it also reveals to me that there is plenty left to be uncovered and it appears that my internal recovery is going to be a life-long experience, with no end in sight, no clear targets to aim for, and certainly no quick-fixes. This can be a tough truth to digest, especially for those who commission statutory services and demand that clients find long-term recovery via twelve weeks of key-working, a few groups and an IT qualification. Learning how to accept the discomfort of being in such a process can be half the battle when it comes to daily maintenance, and this is where the 12-Step fellowships being a world-wide, free of charge, and consistently available means of support, can make all the difference to client outcomes being a temporary tick in a box, or a truly life-changing success..
The argument that 12-Step is not for everyone, or the notion that harm reduction prolongs active addiction, may contain grains of truth for certain parties, but neither are really the issue when we adopt a wider perspective. The reality we need to address is the plight of the still suffering, the shortcomings of our treatment systems, that fail to meet their needs, and the wealth of experience and understanding that we have at our disposal, on both sides of the fence, which together can bring some remedy to an already difficult situation, by working to the best of our ability and aspiring to the highest of ideals.
Chula Goonewardene MBACP