Not long ago the recovery community and the harm reduction community were often at odds. The two groups clashed over ideological differences such as whether abstinence is the only definition of recovery from addiction or whether people have to hit “rock bottom” in order to turn their lives around.
But in recent years, the groups have shown signs of collaboration. From big cities like Philadelphia to rural North Carolina and sunny California, the recovery and harm reduction communities are starting to realize that there is more that unites them than divides them. It hasn’t been an easy journey. Just ask Devin Reaves, who served as the Executive Director of Life of Purpose, an abstinence-based substance use treatment center in New Jersey, before switching over to head the Pennsylvania Harm Reduction Coalition in 2018.
“You’ve got [the recovery community] saying that people who need help will come to us when they are ready and the [harm reduction community] saying we need to meet people where they are at,” he explains. “Those two ideologies are diametrically opposed.”
Harm reduction programs help people who use drugs improve their lives without abstinence as a caveat. They also incorporate public health solutions to reduce death and disease associated with drug use. Reaves’ own journey towards recovery and harm reduction started in the summer of 2007. After surviving an overdose, he enrolled in a 12 step abstinence-based program, where he explains, “we were told that 12 steps was the only way to recover and that anything else was fake or half measure.”
Then in the summer of 2012, Reaves began to question what he had been taught about harm reduction. “That summer a lot of my friends dropped dead from overdose,” says Reaves. “I learned about naloxone [a medicine used to reverse an overdose], but no one had it at the time. I started to advocate for making it more available. People were saying that naloxone enables people to use more drugs, but I pushed back and said I can’t help someone recover if they’re dead.”
Reaves isn’t the only person who embraced harm reduction because a critical component of harm reduction programs, naloxone, saves lives. The need to address a scourge of opioid-related deaths also drew Donald McDonald, Executive Director of Addiction Professionals of North Carolina, to harm reduction. McDonald had developed a problematic drinking habit at 18 years old, but he was 37 before his recovery became long-term. He too found recovery through an abstinence-based program and was later introduced to harm reduction.
“My first reaction [to harm reduction] was tolerance,” he says. “That didn’t change until years later when I was working at The Healing Place of Wake County and the opioid epidemic started really kicking in. I was turning people away who didn’t subscribe to my [abstinence-only] philosophy and later finding them in the obituary. I knew we had to do something different.”
Tolerance as an initial reaction to harm reduction is common in the recovery community. Brooke Feldman, a social justice activist in Philadelphia who recently started her own training and consulting company, Sparking Solutions LLC, recalls that even when she worked at a recovery community center that embraced harm reduction methods, she still considered harm reduction as merely a pathway to the real goal of abstinence.
“I still had the expectation that the person should eventually stop using all substances,” she says. “As a child of the 80s, I grew up with ‘just say no’ and ‘this is your brain on drugs’ commercials. I was taught that addiction is a choice when my mother struggled with addiction.”
Feldman’s own drug use had escalated when she was 12 years old after she learned that her mother died of a drug overdose. “I entered into recovery at 24,” she says. “My first visceral reaction to harm reduction was that it went against everything I had been taught during my many treatment episodes and involvement in the recovery community. The change in my thinking came from a willingness to set aside all I had been taught in order to see other perspectives and look at things more critically.”
“The recovery community is a subculture,” explains McDonald. “We have certain norms and beliefs that are passed on and expressions we say that we might not even fully understand. I think there is a cultural component that leads to intolerance for harm reduction. There is also a fear-based component because many people can’t use [drugs or alcohol] in moderation and they are afraid of messaging that says that’s okay.”
McDonald says that he has noticed in recent years that more people in the recovery community are changing their minds about harm reduction. “I’ve seen people move from intolerance to tolerance, from tolerance to acceptance, and from acceptance to advocacy,” he says. “It’s happening because the two groups are communicating with one another.”
It can be difficult for someone raised in a particular mindset to see things differently, but in general, when people take a hard look at harm reduction and the evidence and philosophy behind it, they often embrace it as a different, but equally viable path towards wellness. Communication and collaboration between the harm reduction and recovery communities can help facilitate this change.
“There is heavy influence [in the treatment and recovery communities] to see drug use as the problem instead of as a coping strategy for larger or deeper problems,” says Feldman. “But lately people have started to see things differently. It’s not that the stigma of substance use has evaporated, but there is more of a willingness to embrace harm reduction tools because the two groups have started working together.”
“I think [people in recovery and people in harm reduction] need to go to each other’s conferences and get to know each other,” says Reaves. “We agree on 70% of the stuff but we are so busy arguing over our differences, sometimes we don’t get any work done.”
“There will always be key philosophical differences, and that’s okay, but there are many points of convergence that will help the two movements come together,” says Feldman. “For instance, I hope to see more collaborative work around the criminal justice aspect of drug policy, because that is one area where the recovery community and harm reduction can see eye to eye. Punishing people for substance use doesn’t help anybody.”
Change is slow, but the alliance between the recovery community and harm reductionists is evidence that people with stark ideological differences can work together to solve a common problem. This partnership might even inspire other non-traditional allies to build bridges and help each other across.