Experts explain how people with an addiction can still seek help even when they're not ready to quit

• Harm reduction encourages recovery from addiction without complete sobriety.
• The treatment focuses on meeting people where they are, keeping them safe in their recovery journey.

Drug addiction and alcohol addiction are dangerous — there's no denying that. A single dirty needle, for example, can lead to a life-long debilitating disease like HIV or hepatitis.

But helping people with a drug addiction is not black and white.

Of course, abstinence is the best way to prevent harm. However, what about those who can't afford medical care or just don't want to stop using drugs or alcohol?

There's still a way to help. It's an approach called harm reduction, which focuses on delivering compassionate care that does not involve pressure to quit or judgment.

"There are a lot of barriers for people who use drugs or do sex work and are living in certain situations," says Orisha Bowers, the Executive Director of the National Harm Reduction Coalition.

Syringe exchange programs, for example, are a form of harm reduction that allow people to swap used needles for clean ones, which prevents the spread of bloodborne diseases. Moreover, the safe disposal of dirty needles keeps community members safe, says Bowers.

Many harm reduction efforts focus on reducing the spread of bloodborne illnesses, preventing overdose deaths, and improving the wellbeing of people with substance use disorders.

If you or a loved one uses drugs, there are various harm reduction strategies that might be able to help you.

Read on to learn more about these techniques and how you can best implement them in your life.

Harm reduction interventions

One way to understand harm reduction is to think of it like distributing condoms in high schools, says Gonzalo Perez-Garcia, the facility director for behavioral health at TexasHealth Presbyterian Dallas.

"[We] kind of approach that with the philosophy of: Teenagers will have sex no matter how much we tell them to wait, so let's at least make sure they do so safely," he says. "Harm reduction is similar."

The strategy is still controversial in some circles, with some experts believing it promotes drug use and that its risks are not yet fully understood.

However, harm reduction is becoming more popular and accepted in many areas, including in the US, where the opioid epidemic is continuing to worsen.

Syringe exchanges, which are currently offered in 92 countries, are one of the most well-established harm reduction strategies, but there are other harm reduction interventions, too, including:

Safe consumption sites

Safe consumption sites give people who use drugs a safe place to inject, says Alëna Balasanova, an associate professor of psychiatry at the University of Nebraska Medical Center.

These programs are just getting off the ground in the US, but evidence from Vancouver, Canada – where safe injection sites have been running for years – suggests they can significantly reduce overdose deaths.

Naloxone (Narcan) distribution

Naloxone is a medication that can mitigate the effects of an overdose if administered quickly. Naloxone, also known by the brand name Narcan, isn't a permanent solution, but it can often buy enough time to get someone to a hospital, Perez-Garcia says.

It can be injected with a needle or administered via a nasal spray.

Medication-assisted treatment programs

Medication Assisted Treatment (MAT) programs combine medications with counseling and behavioral therapies to help individuals with their substance abuse. Medication Assisted Treatment faces a societal stigma, so it's especially important to approach anyone who is seeking recovery treatment of any kind with compassion. There are different programs for different medications — here are some of the most common:

• Methadone programs: Methadone is an opioid agonist which means it reduces the desire to abuse other opioids like heroin. In these programs, patients take methadone daily at a methadone clinic, and are able to take home the medication for small periods of time once they are stable and do not show evidence of abusing methadone or other substances.
• Suboxone programs: Suboxone is a combination of buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist. It stops opioid cravings while simultaneously blocking the euphoric effects of other opioids and needs to be taken 1 to 3 times per day.
• Vivitrol programs: Vivitrol, known generically as naltrexone, is an opioid antagonist that blocks the effects of opioids. Vivitrol is an extended release formulation that can be administered intravenously once per month by a physician. Vivitrol can also be used for alcohol dependence as it helps block the effects from drinking.
• Fentanyl testing kits:

Fentanyl is a potent opioid that is sometimes added to other drugs, contaminating the supply. The problem with this is that it can lead to accidental overdoses. Fentanyl is 50 times stronger than heroin, and a lethal dose can look like a few grains of salt.

So to help prevent overdose, some cities and nightclubs distribute fentanyl testing kits, that way people who use drugs can test their supply for fentanyl, Perez-Garcia says.

"The idea is, just because they're using drugs doesn't mean they don't deserve to be kept safe from fentanyl contamination," he says.

• Designated driving programs:

Users of all kinds of substances can benefit from harm reduction programs, including those who drink alcohol.

Designated driving programs – which can include informal setups amongst family and friends, or businesses like sober taxis or sober scooters – are a great example of harm reduction in practice.

By designating someone at the beginning of the night to stay sober, they limit the risk that someone will drive drunk while still allowing people to consume alcohol if they want to.

• Moderation Management programs:

Moderation Management programs are an alternative counseling approach to abstinence based programs that help people moderate their alcohol use. The approach typically starts with an extended period of complete abstinence — if the person is ready to be abstinent — followed by slowly reintroducing the substance to the individual. Moderation Management programs may not be successful for those with more severe substance abuse issues.

Harm reduction is not one-size-fits-all

Not everyone who uses drugs will be best served by the same strategies: there's no cookie-cutter approach, Balasanova says. Practitioners have to take each person's unique wants and desires into account.

Practitioners might interview new patients asking them about their goals to help determine if harm reduction is a viable option. It's important to talk about their wishes instead of assuming you know what they want, Balasanova says.

It's also important to note that while harm reduction need not aim for abstinence, it can lead to sobriety down the road.

For instance, evidence shows people who use syringe exchange programs have significantly higher recovery rates than people who don't, Balasanova says.

The core principles of harm reduction

According to a 2017 study published in the Harm Reduction Journal, which was based on interviews with harm reduction practitioners and patients, there are six main principles of harm reduction.

1. Humanism

People who use drugs are often stereotyped and dismissed, Bowers says, but harm reduction uses a person-centered approach that focuses on the human, not the illness. In other words, compassion is key.

2. Pragmatism

Pragmatism means practitioners should realize that perfect sobriety often isn't possible. Instead of insisting on complete abstinence, healthcare professionals should strive towards supporting patients and improving their drug use.

3. Individualism

Because every person who uses drugs is different, everyone should have personalized treatment plans that best fit their individual wants and needs.

4. Autonomy

Patients in harm reduction programs should be empowered to make their own decisions, rather than having their choices made for them. "They need to have say-so in their own life," Bowers says.

5. Incrementalism

Change doesn't happen overnight, which is why harm reduction prioritizes making small changes one-by-one. Over time, these small steps can add up to huge transformations.

6. Accountability without termination

It's important to make sure patients feel responsible for their drug use, which is why practitioners want patients to take accountability for relapses. However, that doesn't mean practitioners should stop care or reduce treatment after a slip-up: harm reduction interventions should be available to anyone at any time.

How to support someone using harm reduction principles

A key tenet of harm reduction is its flexibility, meaning exact interventions will vary from patient to patient. Only you and your loved ones know what is best for you.

But if you're looking for ideas, here are a few key ways you might be able to implement harm reduction techniques in your own life.

Buy naloxone

Keeping naloxone in your house or on your person means you're prepared in the event of an overdose, Perez-Garcia says.

If you have a loved one who regularly uses drugs, consider buying naloxone to keep on hand. The drug is sold over the counter at most large pharmacy chains and may be covered by your insurance.

You may also be able to get naloxone through free naloxone distribution sites or even sent to you by mail, depending on where you live. Naloxone is very easy to administer by using simple instructions or taking a free naloxone training.

Set up a designated driving plan

Though we tend to associate designated drivers with alcohol, these programs can be useful for anyone who consumes mind-altering substances, Balasanova says.

Talk to your loved one about how they plan to get around when they're under the influence, and offer yourself up as a designated driver if appropriate.

Help research official resources in the area

Not all states offer the same harm reduction programs. For instance, safe syringe exchanges aren't available in every area, Balasanova says.

One way you can help your loved one is by researching what harm reduction programs are readily available near them, so they have information on hand if they decide to get help, Bowers says.

Important: Not everyone may want your help. In these cases, Bowers says to still offer your help so they know it's there if they change their mind. The key is "letting the person know you want to support them and you want to respect the ways in which they want you to support them," Bowers says.

Insider's takeaway

Harm reduction is a strategy to reduce the damage done by substance use without necessarily reducing drug use overall. Harm reduction programs can include syringe exchanges, free naloxone distribution, medication assisted treatments, or safe injection sites.

"The biggest misconception is that this is encouraging drug use or discouraging sobriety, and that's absolutely not the case," Perez-Garcia says. "It's just acknowledging that even though someone's addicted to the substance doesn't mean they're a bad person, doesn't mean they're not worthy of help, of safe risk prevention."

"Bottom line is," he adds, "there's multiple ways to approach harm reduction to make sure people are as safe as they can be."

Correction: January 12, 2023 — An earlier version of this story misstated the purpose of Moderation Management Programs. Moderation Management Programs predominantly focus on alcohol use recovery, and a 30-day abstinence period is not required, as previously stated.