Supporting people also means accompanying them, for as long as necessary, when they are not ready to stop using substances
Harm reduction programmes aim to minimise the adverse consequences that the use of legal or illegal substances can have on people’s health and on society – Photo by charlesdeluvio on Unsplash
Addictions and types of use
Addiction refers to the inability to control a practice intended to provide pleasure or to suppress a feeling of discomfort, and to give up this practice despite its sometimes considerable negative consequences. This definition applies not only to the pathological use of alcohol and other drugs, but also to certain non-substance addictive behaviours, such as pathological gambling.
However, this type of pathological dependence does not reflect the diversity of substance use experiences. Regardless of the substance or whether it is legal or illegal, some types of use carry little risk and do not lead to dependence: for example, we all know people who drink alcohol moderately and socially. Other types of use are not only highly addictive, but also particularly dangerous to health, even if they are regular and ordinary: smoking is the most obvious example.
Most people use drugs in a controlled or time-limited way, without endangering their health, social relationships or work.
Others find it increasingly difficult to control their drug use, which has a negative impact on their health and daily life. Addiction services are dedicated to addressing the needs of people with problematic drug use or harmful practices.
Problem use and associated risks
Problem substance use is often associated with mental health problems such as anxiety, depression and post-traumatic stress disorder, as well as economic, social and/or legal difficulties. These difficulties are not necessarily a consequence of drug use, and may even be the cause. However, there is often a tendency to see drug use as the cause of all these problems.
This erroneous analysis, combined with the many prejudices against drug users, can contribute to inappropriate care strategies and even worsen the situation for individuals.
It is important to remember that people who use problematic substances, or who live with addiction, are citizens in their own right, not weak, immoral and uncritical people.
Imposing, as is still done in some countries, forced institutionalisation, compulsory detoxification or medical treatment without consent is not only ineffective, it is a violation of human rights.
Services tailord to each people’s needs
Dianova believes that providers of support and care services specialised in substance use disorders and other addictions should focus on:
- Recognising and taking into account the diversity and complexity of individual addiction experiences;
- The need to adopt a non-judgemental, non-stigmatising and non-discriminatory attitude in their dealings with those affected and their families, and to strive to respond as best as possible to the needs and expectations of each individual;
- The duty to respect and promote human rights, including confidentiality, privacy and access to the best possible health care in the light of advances in knowledge and practice;
- The provision of individual, comprehensive and integrated care and support services, focusing on the improvement of people’s quality of life and the development of their well-being and autonomy, including aspects related to addictive disorders (prevention, treatment, harm reduction) and social aspects (housing, employment, integration, etc.);
- The need to involve people in all aspects of service provision, including its design, implementation and evaluation.
The harm reduction approach
The harm reduction approach is based on reducing the negative consequences associated with substance use rather than eliminating substance use behaviour. It aims both to help drug users regain a satisfactory quality of life and to protect the community as a whole.
The harm reduction approach is both humane and pragmatic. Humane because it is based on people’s needs and expectations. Pragmatic, because it is also based on their capacities and capabilities. The harm reduction approach is based on the following principles:
- Tolerance of stigmatised or perceived negative behaviours,
- Realism of interventions in terms of people’s expectations,
- The cost/benefit ratio of interventions,
- Gradual harm reduction until abstinence from the substance is achieved (not necessarily an achievable goal),
- Supporting beneficiaries in their efforts to integrate, become autonomous or defend their rights.
- The establishment of a trust-based relationship with the beneficiaries and the possibility of reaching out to them in their environment,
- A care offer adapted to the physical and psychological condition of the beneficiaries and the fact of having limited requirements in terms of integration in the care process (low-threshold approach).
The harm reduction approach has proven to be particularly effective for:
- Preventing sexually transmitted and intravenous infections (STIs)
- Improving people’s health and living conditions
- associated crime and its consequences
The harm reduction approach enables a trust-based relationship to be established with treatment-resistant clients
Depending on the country, harm reduction practices may include:
- Opioid prescription (heroin, morphine)
- Provision of drug paraphernalia (syringes, water ampoules, etc.)
- Substitution treatment for opioid dependence
- Awareness-raising on safer methods of drug use
- Referrals to social or health services
- Outreach work, etc.
Sutstitution treatments
The principle of opiate substitution treatment is to give the user a drug with similar pharmacological activity to the substance they are using (e.g. heroin, morphine, fentanyl or codeine). These include methadone, buprenorphine and suboxone. The latter are not risk-free either, as they are also addictive substances.
Substitution treatment is the result of harm reduction policies aimed at drug users, which involve a series of responses aimed at supporting and treating people who use opiates while reducing the consequences of use for the individual and for society.
Los medicamentos de sustitución permiten: evitar cualquier efecto físico de abstinencia; dejar de consumir heroína u otros opiáceos; proporcionar apoyo médico y psicosocial
Substitution medicines allow: avoidance of any physical withdrawal effects; cessation of heroin or other opioid use; provision of medical and psychosocial support.
