This document summarizes and compares the strengths and weaknesses of harm reduction and abstinence-based approaches to addiction treatment. Harm reduction strengths include being geographically broad, preventing clients from feeling alone, providing health checks and paraphernalia, and having a non-judgmental approach. However, it is noted that harm reduction has weaknesses such as low success rates, clients still dying, and substitute addictions developing. Abstinence-based treatment is seen as providing a safe place without pressure, addressing underlying issues, and having a community for support. But it also has weaknesses like only advocating one approach, potential abusive practices, and a judgmental view of relapse. In the end, the document calls for services to

1. Chip Somers
Clinical Advisor, Help Me Stop

2. Rehab - dead or alive?

4. Who am I?
"Chip Somers is a liar, a charlatan, a confidence trickster and a deceiver.
If only some such donkey of a faux therapist would seek recourse in the
courts for such descriptions of him. Then we would have the
opportunity to prove that he is a man of bad character and evil
motivation."
Peter Taylor , CLEAR

7. The 30 Years War

8. The 30 Years War
ABSTINENCE
V
HARM REDUCTION

12. WAR!

15. Strengths and weaknesses of each team

16. Harm reduction - strengths
• Geographically broad
• People not alone
• Health checks
• Signposting
• Substitute prescribing
• Non- judgmental paraphernalia
• Support groups
• No pressure on clients to change
• (DTTOs)

17. Harm reduction - weaknesses
• Success rate!
• People are still dying
• Substitute addiction – is methadone ‘normal’
• Positive urines
• Contempt prior to investigation
• No hope – even on paraphernalia
• Overworked staffed – very little time
• The most chaotic get suspended – what happens then?

18. Harm reduction – weaknesses 2
• NTDMS- TOPS forms
• What % of clients who want detox/rehab actually get it?
• Triple lock doors and lockers
• No interaction with family
• 1 in 4 have CSA
• Sometimes inexperience really shows
• How dare clients be judged before they are given the chance
• Terminology
• NTA

19. £ 9 million (2010/11)
Payment by results!!
36,000 in treatment!
Stole the terminology!

20. Abstinence - rehab – AA/NA: Weaknesses
• Only way!
• Early insurance funding
• £ made people myopic about relapse
• Fudged admission criteria
• “You will die!”
• No relationships for first year
• FINE
• GOD!!

21. Abstinence - rehab – AA/NA: Weaknesses 2
• Abusive
• “We break you down to build you up”
• Attitude to relapse
• Anonymity = Secrecy
• Predatory behaviour?
• Judgmental about relapsers
• Individualised plans?
• Referral fees
• CQC

22. Abstinence - rehab – AA/NA: Strengths
• Rehab is a safe place with no pressure
• Doesn’t collude with the problem
• Includes family, past issues and Aftercare
• Success rate
• People are taken out – they move from cost to input
• Unlikely to reoffend when successful
• Detox – people experience abstinence
• Community – lowers shame and isolation

23. Abstinence - rehab – AA/NA: Strengths 2
• AA, NA etc FREE
• Available anywhere in the world
• Come and go as you please
• Practice ground for social skills
• Inspires – provides hope
• Fills up time!

24. Solutions - dreams
• Probably discover much more about genetic and brain behaviour
• More people need to come out
• That services work together
“If you treat an individual as he is, he will remain how he is. But if you
treat him as if he were what he ought to be and could be, he will
become what he ought to be and could be” (Goethe)

31. Surely it is not beyond our ability to work
together, to solve problems together and to bring
hope and life to the same group of people we all
work with.

32. #Dayhab
@HMSDayhab
www.helpmestop.org.uk
Rehab inthe real world