Beyond the Prevention and Treatment Binary: Leveraging Harm Reduction as a Critical Component of the Drug User Service Continuum

By Magalie Lerman September 26, 2016

In honor of National Recovery Month, I want to recognize the variety of different ways that recovery from substance dependency can manifest in people’s lives. Many times I hear people and organizations talk about the drug user service continuum as a prevention and treatment binary. This highlights the importance of diverting people’s desire to experiment with substances as well as the need to enhance our society’s capacity to provide services and support to people who wish to discontinue drug use. But this completely erases the needs of people who continue to use drugs.

Harm reduction is a critical component of the drug user service continuum as it encompasses our collective ability to provide services and support to people who use drugs. Anyone who has used drugs for a period of time knows that drug use is not black and white; you aren’t just doing drugs or not doing drugs. Rather you are managing the many different ways that you do drugs including what supplies you are using, the variety of different drugs you are doing, who you are doing them with, and where you are doing them. You are balancing the knowledge that you have about drug use with the emotions that you have about drug use. This balancing act doesn’t go away once a person enters a period of recovery. Instead, people have more to balance and learn to balance it differently.  

The word “recover” means to regain the strength, composure, balance, or the like of oneself. By this definition, people don’t need to stop doing drugs to recover. An experience of attending health education classes at a syringe service program (SSP) and incorporating best hepatitis prevention practices into one’s daily injection routine is an act of self-care which off-sets the harm of putting a substance into the body. Advocating for more just drug laws within a drug-user union is an act that declares self-determination and an interest in public welfare. People who use drugs can and do take care of themselves and their communities; these are acts of strength and balance. For some, it is easier to recover via treatment modalities such as substitution therapies, recovery-support groups, and cessation of certain substances. I am one such person, but I recognize that treatment is not the end-all and be-all of the drug user service continuum.

Being a harm reductionist who practices abstinence from drugs and alcohol isn’t easy. I am constantly holding the tension between two different philosophies. Treatment providers are often weary of programs that support drug use (safe or not) and harm reduction providers are distrustful of programs that enforce dogma and strict boundaries. Traditionally, the two don’t play well together in the same sand box. The opioid epidemic is requiring that these two parties make sand castles together, and for this I am grateful. Many traditional treatment programs are beginning to offer and accept medication assisted treatment (MAT) as part of the recovery continuum and SSPs are partnering with behavioral health organizations to offer naloxone trainings and more. Harm reduction is beginning to get traction as not only a public health intervention but also a pillar of the drug user service continuum.

I hope this means that there will be more spaces for people like me who love drug users but don’t do drugs, who have felony records but work in public health advocacy, and who define recovery in terms of positive change and growth rather than a measure of what people aren’t doing. Public health departments can create these spaces by evaluating your hiring practices to ensure that people who are most affected by hepatitis C can gain employment in infectious disease prevention and care. This includes changing educational requirements, felony restrictions, and actively recruiting people in recovery for employment. It also means evaluating the place that alcohol holds in your work functions and conversations. Furthermore, health departments can support contracted SSPs to provide leadership opportunities to people who currently and formerly use(d) drugs including peer-health navigators, peer-recovery support, and outreach workers. These measures better ensure that people in recovery with knowledge and experience of harm reduction continue to leverage harm reduction as a necessary component of the drug user service continuum, and public health interventions are recognized as integral to recovery.

Learn more about National Recovery Month by visiting You can also share your story using #recovery on social media.