Are there any residential addiction programs that use a harm-reduction approach?

 Thank you for posting this I don’t know of any myself but it would be interesting to hear, as most of the facilities I deal with, although they respect the need for harm reduction, don’t provide it in-patient.

I’m presuming that is because most addiction specialists see harm reduction for the most part as a way to learn that moderation does not work, and it’s best use is in saving lives in the present moment. 

The time/cost of moving through harm reduction in-patient would be huge and hard to integrate with others who have progressed beyond any belief of moderation. 

This may be of interest.  From what I understand this is a residential program offering a harm reduction model.

https://sm.cmha.ca/programs-se...ome-hrh-day-program/

Hi, Please check out the Oaks in Ottawa for alcohol dependent, previously homeless clients who get regular pours of alcohol under health supervision by Inner City Health: https://www.sghottawa.com/the-oaks/. 

In Hamilton https://wesley.ca/services/hou...d-special-care-unit/

Tapering off program in Elliot Lake http://sjghel.ca/index.php/ser...ams/tapering-program 

The purpose of Residential Addiction Treatment is to provide time for intensive therapy in an safe abstinent environment, in order to deal with trauma and attachment issues, and to to correct maladjusted coping strategies (substance use and behavioural disorders) which are symptomatic . Concurrent (mental health) issues often complicate treatment. The programming usually consists of a holistic bio-psycho-socio-spiritual model of therapy utilizing techniques of MI, CBT, psycho-educational and spiritual approaches. Clients for this intensive therapy need to be farther along in the stages of change than the pre-contemplative , or harm reduction phase. The work is done in the Contemplative-Action phases, and the goal of a Residential treatment program should be to provide the client the opportunity of achieving the Maintenance phase of recovery. !2 Step based treatment programs incorporate all the above, with an emphasis on the spiritual aspect, and preparation for a lifetime of critical aftercare.

Abstinent Recovery requires CHANGE- Motivation ,Commitment, Critical self reflection, and Hope- for a better quality of life than harm reduction can EVER provide... IMHO

[@mention:308523583285396643] I'd like to add to your question by asking "Are we willing to define recovery in terms of 'here's the evidence for how this person's life has improved', without including our personal values in the definition?"

Like, can 'objective recovery' be viewed independently of the value-laden concepts of Abstinence and Harm-Reduction?

Unequivocally, YES. is my answer. I just re-read your study. I have 45 years of lived addiction experience. 20 years in various stages of recovery. I have just completed a post graduate ADMH program. I have almost 2 1/2 years of abstinent recovery to date, more than double I have ever achieved before (just some background). My thoughts/Experience:

1) If the opposite of Addiction = Connection, Then lifetime aftercare is essential to ongoing recovery (which is the cornerstone of 12 step programs). Peer support is required for connection , as is therapy for trauma/attachment issues which may preclude socialization. The most common statement I hear from my peers is,         "I never felt a part of.."  With acquired periods of abstinence, a relapse diminishes to a lapse- it is a learning curve.

2) Abstinence allows a person to have a life with limitless potential, harm reduction can not do the same. Commitment to abstinence is very difficult, especially in early recovery where the focus everywhere is on harm reduction. These goals are inherently mutually exclusive , and thus the ability to maintain abstinence is undermined systemically by this harm reduction focus.

3) A Holistic, Bio-Psycho-Social-Spiritual approach to recovery is essential. I have personally found the spiritual aspect a key in promoting an overall positive outlook with the other components as building blocks.

4) Recovery is a Lifetime Commitment. Aftercare, including wellness self-care and peer support, maintain Connection, which is vital to abstinent recovery. This is provided by easily accessible 12 step programs.

SDH - You have correctly highlighted as a huge factor in recovery - Environmental Financial, and Relationship issues play a very large part in  possible recovery cycle, and can very often work to disrupt/disengage clients.

I work at at facility that provides short-term residential treatment for youth, men and women and we identify that we operate from a harm-reduction philosophy.  While clients do need to remain sober while attending the residential programs, they work on the substance use goals in consultation with their clinician that are right for them, from abstinence to reducing use, for when treatment is over.  From my perspective working here for over 10 years, the harm reduction approach is useful for getting individuals engaged in the recovery process and committing to treatment- this is especially important for youth- as opposed to saying "Well, here it is, you will never touch another substance again after this is over!" which could scare off a lot of people.  Although clients need to remain abstinent while in the program, they are told that their post-treatment goals are for them to determine with their clinician, based on the variety of information they acquire in treatment, versus them getting only abstinence-based messages.  In my experience, some clients have been successful with reducing their use after treatment while still achieving their goals, while others have found that to be too difficult and change their goals to abstinence.  One of the key messages with harm-reduction is the element of choice, which is hugely important in recovery.  Recovery is individual and should be defined individually and around a variety of areas, not simply in terms of whether someone is abstinent or not.

That is the best harm reduction approach... kudos to you and your agency.

May I ask where you work [@mention:367941993888149413]?

The Jean Tweed Centre Cumberland house integrated the principles and strategies of harm reduction are woven into the material, content and approach of the program. For instance, we work with the group/each woman to explore her real goals with respect to each of her substances after she leaves the program. We support her in developing plans for when she leaves the program that respond to her goals (which are often about either about reducing or using more safely). In addition Jean Tweed has been a long standing ORT and women using methadone and suboxone etc. 

Todd Kaufman posted:

 Thank you for posting this I don’t know of any myself but it would be interesting to hear, as most of the facilities I deal with, although they respect the need for harm reduction, don’t provide it in-patient.

I’m presuming that is because most addiction specialists see harm reduction for the most part as a way to learn that moderation does not work, and it’s best use is in saving lives in the present moment. 

The time/cost of moving through harm reduction in-patient would be huge and hard to integrate with others who have progressed beyond any belief of moderation. 

I’m not positive but I heard that Sudbury has a harm reduction approach in regards to homeless and alcohol consumption. 

Theres registered staff who do assessments and pour the drinks for clients and if they’re too drunk then they’re not given a drink. It’s to keep them from using other things like rubbing alcohol to get the “buzz” they’re craving