Sober Living Support: Harm Reduction vs Abstinence Models of Recovery

Sober Living Support: Harm Reduction vs Abstinence Models of Recovery | Transcend Recovery Community

There are various ways to look at recovery from addiction. Likely the most common is the 12-step model which encourages abstinence, meaning its aim and goal for members is no use of alcohol or drugs whatsoever. The 12-step model is a recovery model that values one’s ability to remain sober for 1, 3, 10, or 20 years, and there are milestones of sobriety. For instance, an Alcoholic Anonymous participant would receive a pin and acknowledgement for being sober for a certain number of years.

However, other models recognize that abstinence is not the best option for a newly recovering addict. It might be difficult to take in the idea of abstinence while still heavily using drugs or drinking. Instead, drug counselors and experts in the sober living field focus on a reduction of harm.

Harm reduction is an evidenced based practice of identifying ways in which the physiological, psychological, social and financial burdens of substance and/or alcohol use can be minimized through education and empowering an individual. Although sober living might be the end result and perhaps the desired goal, a reduction of harm model accepts an individual where he or she is at and does not stigmatize them for their substance use. For instance, if an individual were to enter a sober living treatment facility and meet with a drug counselor. A reduction of harm model doesn’t promote abstinence. Instead, it explores ways that a person might be able to reduce the harm of the addiction. Perhaps that might be drinking two nights a week instead of four. Or it might be refraining from driving while drinking. Or a reduction of harm intervention might also be deciding not to drink or use drugs when on medication.

Some of the practices involved in a reduction of harm model include:

  • Determining the physical needs and concerns to keep an individual safe and healthy. This might include the need for medical detoxification and other medical intervention that might require a medical facility.
  • Utilizing motivational interviewing techniques such as open ended questions, rolling with resistance, asking permission, using positive affirmations and feedback in order to determine the current level of use. This is done through dialogue and drug tests. Once the current level of use is assessed, this is then used as a baseline from which a reduction of harm begins.
  • Determining where one is on the Stages of Change model and using interventions that are applicable for each stage.
  • Developing a drug treatment aftercare plan which are directly related to goals for reducing harm and identifying triggers to prevent relapse.
  • Identifying an individual’s goals and action steps involving substance use, safe using, reduction of use – if possible, and relapse prevention.
  • Providing psycho-educational information and tools based on the individual’s desire to change and their current level of use.
  • Based upon the information gathered, providing the individual with resources such as linking them up with other models , if they are appropriate, depending upon where an individual is in his or her recovery. For instance, if a user is actively seeking treatment and has reduced his or her drinking to only when triggered by emotional events, connecting that person to an Alcoholic Anonymous community might be helpful.

The reduction of harm model is different than most other recovery models in that its focus is on reducing the harm that an addiction creates. It does not strive for complete abstinence, although abstinence can be a long-term goal.

A reduction of harm model is relatively new to the addiction and recovery field. Historically, drug counselors have focused on sober living among new recovering addicts. However, the ability for this model to respect addicts for where they are in life as well as reduce the stigma of drug and alcohol use is making this model more and more popular among mental health professionals.


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