Addressing Addiction: 12-Step or Harm Reduction?

Prescription Drug Pic

The death of Prince died at the age of 57—apparently due to an overdose from prescription pain medication—has brought national attention to opioid use. How should congregations respond?

Commonly prescribed for pain relief, opioids are increasingly being abused by young and old, rich and poor, urban and rural, white and black. Prescription drug use is the most common bridge to heroin abuse, which is currently at epidemic levels.

What’s a congregation to do? Two options are readily available: 12-Step Recovery and Harm Reduction. Here’s the dilemma: one promotes abstinence-first, the other promotes intervention-first. How to respond?

The 12-Step Approach

12-Step recovery models such as Alcoholics Anonymous and Narcotics Anonymous are by far the most common type of recovery ministry provided by congregations nationwide. It seems like every church or synagogue in the country houses an AA group. Beyond that some congregations, most notably Saddleback Church in Irvine, California, are pioneering a “recovery worship” style service based on a spiritual appropriation of the Twelve Steps.   This recovery approach views total abstinence from drug use as the baseline for health and wholeness.

The Harm Reduction Approach

The harm reduction approach has taken hold in some parts of the country, notably in cities like New York City, San Francisco, Seattle, and Louisville.  According to the Harm Reduction Coalition, the harm reduction approach seeks to reduce the negative consequences of drug use while leaving it up to the user to decide when and whether to stop using drugs. The stigma attached to drug use, they say, is a major obstacle to recovery. Non-users need to watch out for judgmental attitudes that get in the way.

The harm reduction approach offers an alternative to abstinence-only. It says, we need to intervene first in order to ensure the user’s safety and wellbeing. Only later should we offer options for treatment. The question of whether to seek treatment at all can only be answered by the user, not the provider.

Harm reduction practices include:

  • Needle exchanges for heroin users,
  • Instruction in safe practices,
  • Counseling on treatment alternatives, and
  • Overdose prevention through making Naloxone—a drug that can dramatically counter the effect of a heroin overdose—widely available to friends and family of users.

The 12-Step approach offers spiritual encouragement, typically in a group setting, that grounds participants in the sorts of practices that faith communities seek to foster: fellowship, acceptance, mutual encouragement, and believe in a “Higher Power.” The 12-Step approach, its proponents argue, offers a method that leads to transformation through leaving the life of addiction behind.

Questions for Faith Communities

  1. Which model, 12-Step or harm reduction, should faith communities consider as they attempt to deal with drug abuse in their community? Are the models mutually exclusive? Can harm reduction and 12-Step recovery coexist within the same outreach ministry?
  2. To what extent does the American church’s own history with the Temperance movement still affect its views of recovery?
  3. How can people of faith address the stigma of drug use, and a self-righteousness that our faith traditions warn against?

Photo:  Eric Hunsaker, 3.25.2012.  Flickr Creative Commons.







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