Differences between Disease and Harm Reduction Models - Research Paper Example

Differences between Disease and Harm Reduction Models There are two prominent models of alcohol and drug use; disease model and harm reduction model. Although the two models share an end, they have significant differences in their philosophy and execution. Both the disease model (abstinence model) and harm reduction model have analogous goals. Typically, when drug users seek help, they undergo the process of assessment, formulating a care plan, and then introduction to diverse services that the philosophy of treatment prescribes. The paper compares and contrasts the two models in light of written accounts by drug user (N. Sheff) and his father’s perspective. Both books (Beautiful Boy by David Sheff and Tweak, by Nick Sheff) avail a fascinating perspective on addiction, and how it is a family disease affecting afflicted member, as well as all who interact with the person. Differences between Disease and Harm Reduction Models Introduction Models of Alcohol and Drug Use The moral model, which was prominent during the 1930s, stipulates that excessive alcohol use and practically any drug use indicates signs of weak moral character and absence of spiritual strength. Disease Model The disease model of addiction stipulates that individuals addicted to alcohol and other drugs possess a chronic disease that can never be cured, although it can be contained. The model holds that the ideal outcome for individuals with addiction is total abstinence, since anyone who still uses any quantity of drugs continues to activate the strong cravings for drugs of choice. The disease model defines alcoholism and any other drug addiction as a biogenetic disease in need of treatment. Disease model is less stigmatizing compared to moral model and, thus, represents an advantage. Nevertheless, both models perceive the user as powerless over consumption and emphasize abstinence as the only feasible means of recovery. According to the disease model, chemical dependency represents a psychosocial phenomenon (Wormer, 1999). The disease model comes out as scientifically and morally correct and effective with motivated clients. Disease model perceives alcoholism or any other drug use as irreversible and the drug user as a person having an abnormal condition. Disease Model Assumptions Disease model holds that addiction is a biologically-based syndrome embracing psychological and social components that influence its expression. The model holds that predisposition to addiction is invisible and can be inherited. Other assumptions of the model include the premise that addiction remains dormant (in remission) unless reactivated by alcohol/drug use. The model stipulates that if left unattended, the disease becomes progressively worse, leading to disability and death. Disease model holds that disease is generic to all psychoactive substances regardless of the distinct substances that the individual may happen to choose (Marlatt & Witkiewitz, 2002). Disease Model Treatment Implications A lasting total abstinence from all psychoactive substances is perceived to be the only acceptable treatment goal. The disease model also considers confrontational and coercive tactics as essential to break through denial. Disease model views successful recovery as requiring acceptance of the disease, hopelessness, and submit to a higher power (McCrady & Epstein, 1999). Harm Reduction Model Harm reduction infers a model that aids clients control their drinking and drug use. The model does not pay attention to the notion of addiction as a disease but addresses the consequences of high risk behavior, such as substance abuse. The model does not promote total abstinence; rather, it promotes changes in behavior that will minimize harm to the individual who chose high risk behavior. Similarly, the model with its empowerment emphasis perceives consumers as both a teacher and a learner and desists from the use of labels and forced dichotomies. Harm reduction model encompasses a set of practical strategies that minimize negative consequences flowing from drug use and incorporates a continuum of strategies from safer use to managed use and abstinence. Harm reduction strategies pursue substance abusers “where they are at,” addressing the conditions of use, as well as the use itself. The approach matches recovery to any positive change, whereby recovery is a process in which the consumer outlines the tempo and parameters of that process (Marlatt & Witkiewitz, 2002). However, harm reduction is not tacit consent to drug use, anti-abstinence, or a “Trojan horse” for drug legalization. Principles of Harm Reduction The approach accommodates user’s decision to use. In addition, the approach allows drug users to be treated with dignity. The model allows the drug user to take responsibility for his or her behavior. Furthermore, drug users have a voice on a broad array of issues, especially those affecting them directly. In the model, there are no pre- defined outcomes with the aim of reducing harm rather than consumption. Differences between the Disease Model and the Harm Reduction Model Harm reduction model accommodates that drug use is a reality, and pursues to minimize harmful effects, instead of simply ignoring or condemning drug users. The model understands drug use as an intricate, multifaceted phenomenon embracing a spectrum of behaviors from dependence to abstinence, and accommodates the view that some ways of drug use are concisely safer than others. Harm reduction approach emphasizes personal responsibility and self controls with the aim of aiding the consumers evaluate the course of action (Denning, Little & Glickman, 2004). Harm reduction approach bears no pre- defined outcomes and calls for non judgmental, non- confrontational provision of care and services to individuals who use drugs and the communities in which they live so as to assist them in minimizing attendant harms. The disease model, on the other hand, perceives cessation of drug use as the only treatment. Therefore, the most prominent feature of treatment is detoxification in hospitals or other institutional settings. The therapeutic goal in this case is a drug-free patient. People who do not remain abstinent after detoxification lack enough motivation, are weak or even morally corrupted by their disease (Denning, Little & Glickman, 2004). The disease model utilizes the 12 Step approaches, while the counseling harm reduction model is multifaceted, client-centered, and non-directive. The term 12 Step applies to self help groups that have emanated from the original Alcoholics Anonymous. Tenets of Harm Reduction Model Compared with Disease Model Continuum vs. Dichotomizing Disease12 Step model hinges on a polarized conceptualization; either an individual is a drug user (alcoholic) or not. Addiction under harm reduction model, on the other hand, is conceptualized as running along a continuum. Drug users bear the capability to curb their intake. Thus, the goal of harm reduction model is not abstinence (abstinence comes out as a viable, although not essential option), but to reduce the harm (Wormer, 1999). Client Naming of the Problem vs. Labeling Appellations such as “I am an addict” or “I am an alcoholic,” have no place in harm reduction model. Instead, the client may be asked “why do you see drug use as a problem?” Harm reduction model allows clients to define the situation. Drug users define the problem, as opposed to disease model, which is judgmental (Marlatt, Larimer & Witkiewitz, 2012). In harm reduction model, clients are not defined in term of the illness, rather, clients are encouraged to recognize that having an illness or a drug use problem is only part of life. Choice vs. Standardization In order to be empowered, individuals should realize that they possess the power to choose from a broad range of options. Although the overriding myth has been that harm reduction model facilitates controlled drinking and drug use, clients in harm reduction model pursue their own solution. This makes harm reduction model a client- centered approach (Wormer, 1999). The disease model, on the other hand, adopts the one-size-fits-all approach demonstrated by list of steps or standard processes. The disease model perceives addiction as a disease and irreversible. Harm reduction model centers on the notion that all individuals have free will and the decision to drink or use drugs is not a sign a disease but a free choice. Belief in Motivation vs. Resistance Harm reduction model views clients as willing to change. On the other hand, in disease model, resistance to change is met with confrontation and individuals resisting change are perceived to lack motivation. Harm reduction model meets resistance with empathy and reflection (Marlatt, Larimer & Witkiewitz, 2012). This creates a positive atmosphere that facilitates change. Focus on Health vs. Disease Harm reduction model assessment is in terms of the positive where fitness is measured instead of disease, unlike the 12 Step approach exemplified in the disease model. Despite the differences, central to both approaches is the perception that drug use is highly likely to undermine the user’s health, as well as impoverishing the user’s social environment. The Importance of Stages of Change/Treatment in Relation to Successful Recovery Attempts Individuals may have a number of problem areas and will address each stage of change in a way that is consistent with the phase in the change process. The stages of change/stages of treatment include pre-contemplation/engagement stage, contemplation/persuasion stage, determination/preparation stage, active change/treatment stage, and maintenance/relapse stage (Wormer, 1999). The stage of change aid care providers, drug users, and their families in enhancing their understanding of therapeutic change. The stages of change also make drug use treatments more effective. How the Models Assist in Understanding Nics Road to Recovery “Beautiful Boy” explores the probability of a cure for methamphetamines addiction, although he comes up with a little reason for hope. Mr. Sheff concludes that his son might have benefited from rehab, especially in keeping him substance free during the critical phase of adolescence. Disease model and harm reduction models avail a critical platform on which to analyze and understand Nic’s road to recovery as outlined by both himself and his family. In a special way, the stories, told from different perspectives, lay out some of the goals of the models, especially goals of harm reduction. These include the significance of validation and normalization, the significance of intact and better functioning families, the struggle of getting off drugs, and minimizing stigma. Conclusion Harm reduction and abstinence models bear highly harmonious goals. The approaches can be credited for expanding the therapeutic conversation by allowing providers to mediate with active users. The models should not attempt to reduce or ignore the prevalent real and tragic harms and dangers associated with drug use. The accounts (of both the father and son) bring out the addiction models values such as being non judgmental, availing choices, valuing consumer’s information/input, avoiding preconceived goals, building rapport and trust, viewing small changes as successes, emphasizing consumer strengths, and avoiding unnecessary labeling. References Denning, P., Little, J. & Glickman, A. (2004). Over the influence: The harm reduction guide for managing drugs and alcohol. New York, NY: Guilford. Marlatt, A. & Witkiewitz, K. (2002). Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment. Addictive Behaviors, 27 (1), 867-886. Marlatt, A., Larimer, M. & Witkiewitz, K. (2012). Harm reduction: Pragmatic strategies for managing high-risk behaviors. New York, NY: Guilford. McCrady, B. & Epstein, E. (1999). Addictions: A comprehensive guidebook. New York, NY: Oxford University Press. Wormer, V. (1999). Harm induction vs. harm reduction: Comparing American and British approaches to drug use. Journal of Offender Rehabilitation, 29 (2), 35-48. Read More