Harm Reduction or Bust
- May 5
- 5 min read
For nearly 14 years, I've helped individuals navigate the complex landscape of addiction in order to achieve recovery. Nicknamed "The Casual Counselor", my approach is unconventional but undeniably effective.
Total abstinence or failure! That’s what 9 out of 10 traditional programs, specialists, and addiction treatment experts will tell us. However, while the accidental overdose crisis reaches epic proportions, at least 100,000+ Americans dying annually. It is incumbent that we shift the paradigm of treatment toward more compassionate, evidence-based strategies.
Broadly defined as “harm reduction”
It is finally, increasingly being recognized as the most effective treatment modality because it is, and we’re at a breaking point. We have been since the scourge of fentanyl and its analogues, and other horrifying contaminants poisoning the “illicit” street drug supply. That said, the sea change has been slow. Too slow.
As an avowed harm reductionist in practice, I’ve been watching and waiting for the tide to truly turn so that we can seriously start helping our clients heal. Sadly, that antiquated traditional approach to drug and alcohol treatment in the industry persists in pushing back.
I love the work I do, helping people and families reshape and relearn and rebuild themselves. Learning to live and maintain healthy stability in ordinary life is amazing. But I hate the freaking industry.
The core philosophy of harm reduction is to hell with the “zero tolerance” model. I’m all for abstinence. Abstinence is harm reduction, too. The ultimate safety net, objectively. But for many individuals, abstinence is not the desired goal, and even if it is, it can be a hard task to achieve.
Us treaters? When I was a student, being trained in the dance of this work, it was driven home hard. We uphold radical autonomy with our clients’ preferences, and we always meet them where they are, all the time, every time. Full stop. Non negotiable.
Harm reduction honors this approach to recovery, that of a spectrum of treatment that is anything but rigid and punitive. This includes:
Helping individuals reduce the quantities and or frequency of what they’re using.
Providing safety tools like fentanyl test strips, sterile syringes, supervised consumption sites, wound care kits, and direct contact outreach to help substance users mitigate the risk of overdose and infection.
Removing the requirement of immediate abstinence to access recovery housing and mental healthcare services.
By focusing on any positive change, we can help establish a sense of self confidence in clients who have been repeatedly marginalized by “stay sober or hit the highway” treatment programs.
To help people better understand, a comparison. Kicking someone out of drug treatment for using drugs is like kicking someone out of a cardiac unit for having a heart attack.
That’s why they are in treatment to begin with
Hello? The goal of harm reduction is to preserve people’s lives and to prevent disease. Based on those metrics, harm reduction efforts are among the most successful in modern medicine by a wide margin. Seems like a no brainer if the goal is to truly help people not die, eh?
The distribution of naloxone, Narcan, an overdose reversal nasal spray, has become the cornerstone of overdose prevention. I have personally administered Narcan four times in my 14 year career. Those four individuals remain alive and breathing today. Fentanyl poisoning was the prelude to respiratory arrest and their faces turning blue.
In the year 2024, nearly 2 million naloxone kits were dispensed in the country, significantly contributing to the first notable decline in overdose deaths in years. Further, newer tools like access to drug testing kits provide users the ability to identify whether or not their pills and powders are poisoned.
IV drug use has historically driven the epidemic of big drug danger and the spread of infectious disease. Beyond the risk of overdose, when a user starts injecting drugs, it’s typically that lifestyle of needles that creates such mayhem. Harm reduction programs, specifically syringe service programs, SSPs, have only helped:
Hepatitis C, HCV. Infections rose 124 percent between 2013 and 2020 due to unsafe injection. SSPs provide sterile equipment that helps prevent this.
HIV. One in fifteen new HIV cases is acquired through unsafe IV drug use. Communities with SSPs have significantly lower rates of new and accidental infection.
This is all backed by science, data, peer reviewed research, etc, by the way. Yet the mainstream treatment industry as a business doesn’t want to acknowledge it. It’s not immediately helpful to their bottom line.
I say, “And?”
If you go into the field of human services to become obscenely wealthy, to build an empire, shame on you. Find a different venue. One in which the stakes aren’t life and death.
My first college course, the first night, the director of the licensing program said to us, “If there is anyone in this classroom who is motivated to do this work to become rich, you can gather your belongings and leave. We’re not in the business to get rich. We’re in the business of helping people.”
Joe, absolute badass
Ironically, with respect to government spending, the total economic hit of the opioid epidemic in the U.S. was estimated at 2.7 trillion dollars in 2023, relative to healthcare costs.
Harm reduction services, in addition to keeping people alive, also provide a substantial return on financial investment to our country’s economy. Maybe not for the private companies in the treatment industry, but for our actual society of humans.
In some jurisdictions, every 1 dollar spent on harm reduction delivers 10 dollars in societal benefits. I’m no mathematician, but that seems like a pretty healthy return on an investment.
Reduced ER visits. Prevention of infections, abscesses, and endocarditis because users can inject themselves using sterile supplies. They 100 percent will inject themselves with whatever option is available, so. Fewer 9 1 1 calls. Decreased crime. Job creation. The list goes on and on.
The conventional “sober or failure” crowd will tell you that harm reduction “enables,” or even encourages drug use. I’ve got breaking news. Americans use drugs. We always have, and we always will, in spite of prohibiting or discouraging. But guess what. Harm reduction actually, and sometimes accidentally, nudges users in the direction of the hardline abstinence only model. Funny, that.
Harm reduction oriented programs are significantly more likely to help people toward detox or long term care than those that are not. It’s because harm reduction upholds the appropriate model of autonomy and respect and belief and rapport between treater and client in order to build real trust and goodwill.
Simple arithmetic. When you treat a human with dignity rather than shame for using, they are more likely to seek help when they are ready. They know love. Feeling seen, heard, known, encouraged, and cared for by the so called “experts,” and often for the first time ever, enables self belief.
Harm reduction or bust
Want a healthier society? Re evaluate what you think you know about the spectrum of recovery. But more importantly, re evaluate what type of rapport might inspire a person to live a healthier life. That ol’ golden rule, trying to think about what it might be like to walk a mile in their shoes. What most inspires people? Is it hope? Is it fear?
Read more from Joshua Bennett-Johnson
Joshua Bennett-Johnson, Licensed Counselor & Owner of JBJ Counseling
After working for 7 years in an amazing clinic, I launched into private practice in 2018. I love my job. I can say that without reservation. Watching people rebuild their lives is something that is worth more than any dollar amount.
