What Does Harm Reduction Look Like for Alcohol Addiction?

Addiction Recovery Publishing Alcohol Addiction June 5, 2024

What Does Harm Reduction Look Like for Alcohol Addiction?

The ancient Chinese philosopher Lao Tzu said, “The journey of a thousand miles begins with one step.” This maxim is especially pertinent when it comes to recovery. The first step is often the hardest, but it is also the most crucial. Also, after that step, there must be choices. When it comes to alcohol addiction, many people choose abstinence. However, there are those too who choose harm reduction, and ultimately, only the individual knows what path is the right one for them.

There Is No One Way to Recover

Recovery comes in all shapes and sizes. Some people will recover on their own. Yet, others will require some form of outside intervention. Some people will require a detox. Yet, others will be able to go directly into an intensive outpatient program (IOP). Some people will choose complete abstinence. Yet, others will choose a path of harm reduction.

Everyone’s recovery journey is different, and there is no one way to recover. If there is a recovery center that is touting a single way to recover, they should be taken with a significant grain of salt. 

However, it is also important to stay flexible when it comes to recovery and treatment plans. For example, many people have relapse as part of their recovery story. This is not unusual. In fact, many people don’t realize just how common relapse currently is in the U.S.

According to the academic journal Current Psychiatry Reports, “It has long been known that addictive disorders are chronic and relapsing in nature. Recent estimates from clinical treatment studies suggest that more than two-thirds of individuals relapse within weeks to months of initiating treatment.” Also, ”For 1-year outcomes across alcohol, nicotine, weight, and illicit drug abuse, studies show that more than 85% of individuals relapse and return to drug use within 1 year of treatment.” While relapse may be a part of one’s recovery story, it does not need to be the final chapter.

The key is to be willing to adjust and adapt as the recovery journey moves forward. If a certain program is not working, then there is always something else that may be tried. For certain people, harm reduction is one of those options.

Better Understanding Harm Reduction for Substance Use Disorder

The reality is that harm reduction is more common for people struggling with substance use disorder (SUD). Also, SUD that primarily has to do with opioids.

Harm reduction for certain people with SUD can be very helpful. According to the National Institute on Drug Abuse (NIDA), “Decades of research have shown that some harm reduction strategies provide significant individual and public health benefits, including preventing deaths from overdoses and preventing transmission of infectious diseases among people who use drugs and the larger community. Others reduce emergency department visits and costly healthcare services, while in some cases offering people who use drugs opportunities to connect to substance use treatment and other healthcare services in settings relatively free of stigma.”

This last point about stigma is crucial because stigma can stop people from seeking addiction help altogether. According to NIDA, “Although substance use disorders are chronic and treatable medical conditions, studies show people with these disorders still face discrimination and stigma (a set of negative attitudes and stereotypes) that can impact their health and well-being in numerous ways. This stigma also affects people who use drugs who do not have a substance use disorder.” Yet, “There are safe, effective, and lifesaving tools available to help people struggling with substance use. However, stigma often factors into the reasons why people who need help do not seek care.” Stigma can also exist for people trying to utilize harm reduction for alcohol addiction.

Better Understanding Harm Reduction for Alcohol Use Disorder

The whole idea behind harm reduction is reducing the consequences that come with using or drinking. When it comes to drinking, it has long been thought that abstinence was the only path toward recovery. However, for some people, abstinence has not been effective. Harm reduction is being discussed more and more among recovery communities. 

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), “For many years, complete abstinence from alcohol consumption was viewed as the most effective way to recover from alcohol use disorder (AUD) and was a primary outcome of AUD treatment. A large body of evidence, however, suggests that treatment and recovery strategies that reduce heavy alcohol consumption and alcohol-related consequences without complete abstinence can be effective for mitigating the harms associated with alcohol misuse for many individuals. Today, although abstinence is the safest course for certain subgroups, harm reduction strategies that are non-abstinence based have become an important part of the discussion around AUD treatment and the recovery process.” Harm reduction is an option.

The reason harm reduction is being discussed more and more is that people who choose not to abstain from alcohol are still seeking a solution to their alcohol addiction. But what exactly do those harm reduction solutions look like?

What Does Harm Reduction Look Like for Alcohol Addiction?

The ultimate goal of harm reduction is the safety of the individual and those around them. According to the peer-reviewed journal Alcohol Health and Research World, “Harm-reduction approaches to alcohol are neutral regarding the long-term goals of intervention, which may or may not include abstention. The concept’s defining feature is its attempt to minimize the negative consequences of alcohol consumption in situations where people will be drinking.” Also, “The fact that drinking will occur is accepted, implying neither approval nor disapproval, and the drinker is held responsible for his or her actions.”

“Acceptance” is a big part of the message of harm reduction. Often, in recovery, when people are pushed in a direction that they don’t wish to go, they will push back harder in the other direction. For alcohol addiction, this means drinking more dangerously.

So, a harm reduction program utilizes compassion and the elimination of judgment. One example of harm reduction for alcohol addiction is the use of non-alcoholic beverages. For some people, these beverages (such as “near beer” and mocktails) will satiate the craving that they have for alcohol (as they do contain trace amounts of alcohol in them). There are also “controlled drinking” programs for people who choose to take the path of harm reduction.

Making the Choice Between Abstinence and “Controlled Drinking”

It should be noted that the “standard” recovery model remains abstinence, and for many people, this is the best option to keep them in long-term recovery. However, there are also people who utilize controlled drinking for their recovery.

According to the peer-reviewed journal Addiction, “The proportion of untreated patients with alcohol use disorder (AUD) exceeds that of any other mental health disorder, and treatment alternatives are needed… Available evidence does not support abstinence as the only approach in the treatment of alcohol use disorder. Controlled drinking, particularly if supported by specific psychotherapy, appears to be a viable option where an abstinence-oriented approach is not applicable.” This last aspect is critical – “controlled drinking” works best when it is utilized with other means, methods, and modalities.

Harm Reduction and Other Treatment Modalities

The key to healing at the cellular level is to heal physically, mentally, emotionally, and spiritually, and, for some, this is possible while utilizing harm reduction. However, if harm reduction is used, individuals should also use treatment methods from different schools of thought. This includes scientific thinking with psychotherapies like cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT). Also, it should pull from the holistic realm with practices like yoga and meditation. It also includes more radical “outside of the box” thinking with modalities like ketamine therapy.

Harm Reduction and Ketamine Therapy

Ketamine therapy is currently experiencing a resurgence after many years of social stigma. A big reason for this resurgence is that the efficacy of ketamine therapy is becoming more and more apparent.

Promising studies regarding alcohol addiction and ketamine have been reported in the peer-reviewed journal Cureus. The journal states, “Collectively, these studies reveal that ketamine treatment may lower the probability of alcohol use, reduce heavy drinking days, and increase the proportion of post-infusion abstinent days. These findings are a step in the right direction for the management of alcohol use disorder, a complex condition that currently presents challenges for successful treatment with FDA-approved first-line agents. However, as previously stated, large-scale clinical trials are vital for assessing optimal dosing strategies, identifiable biomarkers related to clinical efficacy, and long-term risks with repeated use.”

So, there is work to be done, but thus far, the results have been promising. Ketamine therapy has also been shown to be effective at treating depression, which many people with alcohol addiction also struggle with. 

According to the British Journal of Psychiatry, “Subsequent work in addiction also administered ketamine in the context of psychodynamic group therapy, and follow-up assessments of these groups suggested this intensive therapy program was key to the effectiveness of ketamine in the treatment of alcohol use disorder. More recently, adjunct cognitive-behavioral therapy following ketamine infusions was found to prolong the therapeutic effects of ketamine for depression.” Also, “The increasingly prominent KAP (ketamine assisted psychotherapy] model strongly emphasizes the role of both therapeutic support and set and setting in accentuating and extending the longevity of ketamine effects.” Now, harm reduction can also benefit from experiential therapies like nature immersion therapy.

Harm Reduction and Nature Immersion Therapy

Part of harm reduction should always be introducing healthy activities into one’s life. Engaging with nature can constitute one of these healthy activities. Also, engaging with nature has been shown to elevate mood.

According to the National Park Service, “5 minutes walking in nature improves mood, self-esteem, and relaxation. Frequent exposure to nature reduces anxiety and depression while promoting a sense of well-being and fulfillment. Physical activity in a green space can reduce stress and lower cortisol levels by 15%.” Also, these are not the only benefits.

According to the International Journal of Environmental Research and Public Health, “Besides physical health improvements, nature exposure can bring about positive influence upon psychological constructs such as boredom, friendliness, well-being, and liveliness. However, across more than one hundred studies on nature/wildlife exposure, stress mitigation has been shown to be one of the most consistent and important psychological benefits.” Also, “Besides improvements to physical and psychological well-being, exposure to natural environments has been shown to bring about positive impacts on cognitive functioning.” Another great activity to replace heavy alcohol use is surfing.

Harm Reduction and Surf Therapy

When it comes to harm reduction, the key is to make better choices in one’s life. Surfing can be one of those exceptional choices. Also, surfing could not be more ideal than on the Hamkua Coast of Hawaii’s Big Island, which is where we at Exclusive Hawaii Rehab are located. We are mere minute journeys away from some of the best surf breaks in the world, which is why we are so blessed to be able to offer surf therapy as part of our treatment programs.

Surf therapy’s benefits are vast and varied. According to the International Journal of Environmental Research and Public Health, “Carefully planned water activities tailored to the needs of the individual can contribute to correct psychosocial and cognitive development. The International Surf Therapy Organization summarizes the benefits of adequately indicated surf therapy as follows: improved physical health and mobility; improved mental health, including reduction of specific symptoms, such as posttraumatic stress and depression; improved well-being (strengthening of trust and confidence, encouragement of independence, resilience and protective coping strategies) and improved social skills.” Meditation, both on the surfboard and on land, can also be very helpful for harm reduction.

Harm Reduction and Meditation

16th-century clergyman and philosopher Saint Francis de Sales said, “Half an hour’s meditation each day is essential, except when you are busy. Then a full hour is needed.” While this may be a bit tongue-in-cheek, there is a lot of wisdom in it. Yes, meditation can help you navigate those tough times when nothing else seems to work.

Meditation is all about quieting the mind and finding a sense of inner peace. It has been practiced for thousands of years, and while it originally started as a strictly religious or spiritual practice, it has since moved into the realm of recovery. Meditation can be very helpful for harm reduction because it helps the individual find a sense of peace and serenity with their recovery choices. It also helps calm situations down if an individual ends up relapsing past their intended alcohol use.

Like surf therapy, meditation has countless benefits. According to the International Quarterly Journal in Ayurveda (AYU), “Research has confirmed a myriad of health benefits associated with the practice of meditation. These include stress reduction, decreased anxiety, decreased depression, reduction in pain (both physical and psychological), improved memory, and increased efficiency. Physiological benefits include reduced blood pressure, heart rate, lactate, cortisol, and epinephrine; decreased metabolism, breathing pattern, oxygen utilization, and carbon dioxide elimination; and increased melatonin, dehydroepiandrosterone sulfate (DHEA-S), skin resistance, and relative blood flow to the brain.” Combined with other therapies, mediation is ideal for harm reduction.

The Importance of Individualized Addiction Care at Exclusive Hawaii Rehab

Again, to iterate, here at Exclusive Hawaii Rehab, we know that there is no one right way to recover. It is all about the personal journey.

The iconic author John Steinbeck wrote, “A journey is a person in itself; no two are alike. And all plans, safeguards, policing, and coercion are fruitless. We find that after years of struggle that we do not take a trip; a trip takes us.” For some, that trip is going to involve harm reduction.

Recovery is about the journey, never the destination. That journey always starts with one step, and there is no better place to take that step than right here at Exclusive Hawaii Rehab.

Not everyone’s addiction recovery journey is going to look the same. That is why we here at Exclusive Hawaii Rehab offer harm reduction options for those seeking a different track of addiction recovery. While this is more common for those struggling with substance use disorder (SUD), it is also possible for those trying to recover from alcohol addiction. If you feel like you or a loved one is struggling with issues of addiction, mental illness, or co-occurring disorders, we can help get you on the right road to long-term recovery right away. For more information about harm reduction and other ways to recover, please reach out to Exclusive Hawaii Rehab today at (808) 775-0200.