Rock Bottom – How You Can Avoid Going There
Many people involved with treatment and recovery for substance use disorder used to believe that for someone to be ready to accept help, they first need to hit rock bottom — the point where they could sink no lower into the depths of their addiction.
Unfortunately, the opioid epidemic and the proliferation of dangerous synthetic opioids like fentanyl meant that for too many people, rock bottom was only found in the morgue. As the risks of dying from an overdose increased, more treatment centers advocated for a harm reduction model to treatment. This approach, which focuses on reducing the severe consequences of substance use, is designed to save lives.
What is a harm reduction model?
A harm reduction model rejects an all-or-nothing approach to sobriety. This approach is meant to meet people where they’re at, and to engage them with wellness and safety programs even if they’re not yet ready to get sober before they hit rock bottom.
The National Harm Reduction Coalition operates on eight principals. They’re summarized as:
- Accepting that drug use will happen
- Acknowledging that some ways of using drugs are safer than others
- Focusing on quality of life, rather than total abstinence, as a marker of success
- Calling for services for people who use drugs
- Involving people who use drugs in the development of policy around drug use
- Seeking to empower people with information
- Recognizing the role that systems of racism, classism and more play in drug use
- Accepting the real, tragic consequences that drug use can have
It’s important to recognize that there’s not just one approach to harm reduction for people with substance use disorder. At its core, harm reduction is focused on keeping people safe, even when they’re not ready to abstain from drugs and alcohol and haven’t hit rock bottom. Needle exchanges and naloxone distribution are examples of harm reduction programs.
How does harm reduction affect treatment?
Treatment for drug or alcohol abuse is often focused on sobriety. However, underpinning that objective is the desire to keep people safe and alive. With that in mind, it’s easy to see how harm reduction principals can be incorporated into treatment.
Many people resist getting treatment for their substance use disorder because they aren’t ready to give up drugs or alcohol completely. Taking a harm reduction approach — without focusing on absolute abstinence as the only way to improve one’s life — can make people more willing to engage with treatment.
The benefits and drawbacks of harm reduction.
Harm reduction strategies are all aimed at keeping people alive. With stronger drugs available more widely, we can no longer wait for people to hit rock bottom before offering a hand — we need to help them avoid a deadly consequence of their addiction.
Total abstinence and sobriety are the best way to keep from the negative consequences of addiction. However, other steps can be taken to protect people before they’re totally sober.
A harm-reduction approach to treatment provides information and resources to people in a non-judgmental way. The person enrolled in treatment might focus on learning how to cope with stressors in a healthier way. They might get treatment for underlying mental health conditions, or counseling for past traumas that are contributing to their substance abuse. They could connect with doctors and community resources that are able to help support sobriety.
In this way, a harm reduction approach empowers people, even those who are still using. It helps to give them the tools and resources that they need to make lasting change in their lives. Knowing that they have that support can make it less frightening to say yes to treatment.
Some people might, at first glance, see the harm-reduction approach as enabling. However, it’s not about encouraging a person’s substance use. Instead, the approach builds them up in order to encourage them to make changes. It also acknowledges the reality that too often, substance use disorder can be deadly. By raising rock bottom and helping someone even before they’re entirely sober, you very well could save a life.