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Substance Abuse Recovery When Abstinence Is Not Yet Possible: A Discussion Of The Harm Reduction Model

Updated: Apr 8

Many of our philosophies set us apart at Red Door Life Rehab, Detox & Substance Abuse Recovery Center in Los Angeles, California. For example, you can read about our innovative, unique 12 Dimensions of Human Health and Wellness Model of Care here. Another fundamental difference is our belief in the harm reduction model in addition to the more common abstinence model. We are an abstinence program wrapped inside a harm-reduction model. The harm reduction model might seem shocking to those who are not familiar as it has long been enforced in mainstream thinking that abstinence is the only path to recovery. However, according to the National Institute on Drug Abuse in 2022, the relapse rate for those struggling with substance abuse issues is in the range of 40%- 60% so we have to look deeper and be realistic about the efficacy of the abstinence model and also the hidden danger it creates. We find this high rate and the danger unacceptable. We continually seek ways of pushing things forward to improve substance abuse disorder recovery outcomes. As a result, what we have realized over the many decades of our work in this industry, is that recovery is not always black and white- it is in fact, many shades of gray.

Typically, in residential substance abuse treatment things are black and white. There is only one model of care offered: abstinence. One must conform or be disconnected from the help they desperately need. Along with this comes the loss of privileges and many harsh and punitive rules that one must abide by, forfeiting their autonomy and sense of control over their lives. As long as one can conform, they can stay in the program. When they fail- as is unfortunately often characteristic of chronic relapse disorders, they are cast out. While the abstinence model sounds safe on the front end, it actually creates several critical safety issues. First, it puts the client in extreme danger as they are now cut off from the team of people they had come to rely on for monitoring and support. Second, it is also a little-known fact that once one has been sober for a time they are much more susceptible to overdose or worse, overdose death. A third reason the abstinence model creates danger is that trauma and especially attachment wounding are often at the root of substance abuse issues. So as one finds themselves in their most fragile state and disoriented due to all that goes along with relapse, on a deeper level their attachment wounds are activated as well. This all comes together to exacerbate the relapse and create extra layers of extreme risk.

One of the biggest contributing factors to relapse and relapse death is disconnection. A person entering relapse is often not honest about their urges and intent and may disappear, leaving loved ones and those working to support their recovery powerless to help until they resurface or something terrible happens.

At Red Door Life, we see things differently. We know that recovery is not so black and white- as each human being is unique, recovery too- is many shades of gray. Often the path to recovery (the path to abstinence) is first about shortening relapse duration, increasing the time between relapses, and staying connected- keeping people safe during the time when they unfortunately make the decision to use.

One of our core principles is supporting our members through an attachment-focused approach. This means remaining connected with compassionate support through all the twists and setbacks no matter what. When a suffering person who is dysregulated and impacted by neurobiology that is injured by substance abuse and trauma is met where they are at- wherever that may be, with consistent love, compassion, nonjudgement, and steady reliable support, over time this unconditional stable attachment and changes them and they begin to be able to make better choices for themselves of their own free will. They begin to evolve. They begin to transform.

To be perfectly clear: There is no illicit substance abuse tolerated on our properties. The only substance use we permit on our properties are doctor-prescribed medications which are carefully monitored and administered by qualified professionals. The harm reduction model is used as a pathway to abstinence- as a means of supporting and caring for those who are not ready yet, instead of leaving them alone in danger.

One of the factors that correlates to positive recovery outcomes is honesty. As our members learn to be honest and that they will not be cast out by bringing their urges and relapses out of the shadows and into the light it undoes the aloneness and strengthens the bonds that are critical for healing. It lessens shame and the need to sneak and hide which always amplifies the substance abuse.

The concept of harm reduction may sound shocking to those outside the direct circle of addiction, but we believe in meeting our members where they are at- and if they are not ready for abstinence, we work with them to reduce the risk of harm- and hopefully, reduce the severity of the using.

One of the key concerns with employing both the abstinence and harm reduction model is balancing the protection of the individual who is relapsing and also protecting the residential community they are a part of. We do this through the use of certified companions who stay off-site around the clock with the member who is going through relapse. This helps the member in several ways. They are helped to stay in contact with the rest of their multidisciplinary team (therapist, psychiatrist, medical doctors, client advocate, etc.). They are helped to find safe temporary housing offsite. They are helped to stay connected to family and loved ones, who are informed rather than completely in the dark as to what is happening. The client is watched over, guarded against overdose and accidental suicide. The companions also work to keep the client re-engaging with the reasons they came into treatment in the first place even if they cannot act on them in the moment. There is constant encouragement to stop using as soon as possible and make choices that value their life and future. In the worst situation, they are helped to make the best decisions possible. They are helped to develop the resilience to try again…. and come back to residential treatment and all that is offered at Red Door Life. As they have remained in connection to their path and support, they have a direct and easy path back. This lessens the damage and danger. At Red Door Life, we firmly believe that no matter where one is in their journey to recovery, they are worthy of care and support. We are continually honored to see how our innovative, evidence-based methods save and transform lives.

For a more personal story about how Red Door Life rehab & treatment center co-founders Alex Shohet & Berni Fried came to understand the value of the Harm Reduction model click here.

Red Door Life is a Los Angeles, California rehab, substance abuse treatment, recovery, detox, addiction & trauma healing center also featuring companion services, entrepreneurship empowerment, community & education.

Co-founded by Alex- Shohet & Berni Fried



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