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There is no evidence from anywhere in the world that harm reduction measures encourage drug use. Denying addicts humane assistance multiplies their miseries without bringing them one inch closer to recovery. There is also no contradiction between harm reduction and abstinence. The two objectives are incompatible only if we imagine that we can set the agenda for someone else’s life regardless of what he or she may choose. We cannot. Short of extreme coercion there is absolutely nothing anyone can do to induce another to give up addiction, except to provide the island of relief where contemplation and self-respect can, perhaps, take root.
Those ready to choose abstinence should receive every possible support — much more support than we currently provide. But what of those who don’t choose that path? The impossibility of changing other people is not restricted to addictions. Try as we may to motivate another person to be different or to do this or not to do that, our attempts founder on a basic human trait: the drive for autonomy. “And one may choose what is contrary to one’s own interests and sometimes one positively ought,” wrote Fyodor Dostoevsky in Notes from the Underground. “What man wants is simply independent choice, whatever that independence may cost and wherever it may lead.”
The issue is not whether the addict would be better off without his habit — of course he would — but whether we are going to abandon him if he is unable to give it up. Are we willing to care for human beings who suffer because of their own persistent behaviours, mindful that these behaviours stem from early life misfortunes they had no hand in creating? The harm reduction approach accepts that some people — many people — are too deeply enmeshed in substance dependence for any realistic “cure” under present circumstances.
There is, for now, too much pain in their lives and too few internal and external resources available to them. In practising harm reduction we do not give up on abstinence — on the contrary, we may hope to encourage that possibility by helping people feel better, bringing them into therapeutic relationships with caregivers, offering them a sense of trust, removing judgment from our interactions with them and giving them a sense of acceptance. At the same time, we do not hold out abstinence as the Holy Grail and we do not make our valuation of addicts as worthwhile human beings dependent on their making choices that please us. Harm reduction is as much an attitude and way of being as it is a set of policies and methods.
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