Addiction hooks you in. These substances, activities, behaviors, and things take the edge off, calm you down, numb you out, and bring temporary peace.

That peace, for many, justifies the risk of potential harm. It is worth it to finally find a break from painful or uncomfortable emotions- even if temporary.

Once you have a taste of that peace, you crave it. You NEED it. So you keep chasing it- even if it’s risky.

Harm Reduction for Addictive Behaviors

Harm Reduction as an ideology takes into perspective the humanity of the individual. Humans will typically do their best to avoid pain and discomfort, and addictive behaviors (defined here as using substances, shopping, excessive social media scrolling, binge/ restrictive eating, watching porn, gambling, etc.) provide an outlet to ease that pain. It’s fine to say, “don’t use that substance or do that behavior,” or “will power your way through that discomfort.” But for many, that approach doesn’t work.

Trauma and the Abstinence-Relapse Cycle

In my time as a therapist, I have never met someone struggling with addiction without a difficult history or trauma that preceded the addiction. At the root of addiction lies trauma. More often than not, those who struggle with addictive behaviors have survived difficult life experiences that have left incredible amounts of pain. All-or-nothing or abstinence-only approaches create an abstinence-relapse-shame cycle for trauma survivors struggling with addictive substances or behaviors. Addictive behaviors are a way to cope with trauma symptoms by protecting from the pain or discomfort connected with that difficult experience.

When a trauma survivor who’s been using addictive behaviors to manage that pain attempts recovery using an abstinence-based approach, in sobriety from that behavior, the individual experiences an increase in painful and difficult trauma-related symptoms and emotions. This feels overwhelming and increases the likelihood of relapse as they turn to cope with that discomfort by resuming what’s managed those painful emotions before- the addictive behavior.

Shame and the Abstinence-Relapse cycle

When emotions are too much to tolerate, it makes sense to use what’s worked before to soothe those emotions. When an individual relapses into addictive behavior, they often use that behavior as a panicked attempt to self-regulate difficult or uncomfortable trauma-related symptoms and emotions. The addiction worsens (the need to use those behaviors to soothe), and the individual sits in an uncomfortable place of shame. Shame about their behavior, shame about their use, and a feeling that no matter what I try, I always mess up and can’t seem to give up this behavior. Through this cycle, the shame acts as a catalyst by increasing the intensity of the cycle, as the addiction deepens each time there’s a failed attempt to “get sober.” In this space of intense shame, the individual may give up and resign to using those addictive behaviors to cope- because that shameful space is just too much to tolerate.

Harm Reduction works by meeting the individual where they are at.

Addiction treatment need not be an all-or-nothing, abstinence-based approach. For some, abstinence works well, but for others, harm reduction offers a gentler, safer (and more effective!) option. Harm reduction meets the individual where they are at by collaborating on goals they are ready to work on. Maybe that looks like gradually decreasing the addictive behavior or maybe this looks like reducing the risk or harm of the behavior. This helps build up that trust muscle- yes, I can make gradual changes towards changing or reducing harm from that behavior.

Why Harm Reduction Matters

Merriam-Webster defines addiction as “a compulsive, chronic, physiological or psychological need for a habit-forming substance, behavior, or activity having harmful physical, psychological, or social effects and typically causing well-defined symptoms (such as anxiety, irritability, tremors, or nausea) upon withdrawal or abstinence: the state of being addicted.”

In being “addicted, " there is an inherent risk of continuing behaviors that may cause harm. Harm reduction focuses on reducing this harm by implementing strategies and support to use safely and work with the individual on their own goals around that behavior- which may or may not include abstinence. For many in harm reduction-based treatment, once the underlying trauma has been treated, the addictive behavior becomes less necessary to cope with the trauma symptoms. The individual may see a path toward sobriety (or significantly reduced use). Traditional addiction treatment often skips ahead of the client by assuming they have the coping skills and readiness to cope without the addictive behavior. Focusing on abstinence above the individual’s current needs can increase the negative effects or harmfulness of the addictive behavior- entering into that abstinence-relapse-shame cycle. Harm reduction takes a humanistic approach by focusing on helping the human at the level they need the most support in that current moment- rather than pushing them towards sobriety before getting the support they need to make effective changes.

Harm Reduction Therapy in Oakland, CA

Are you stuck in the abstinence-relapse-shame cycle and looking to make some changes? If you are looking for more support and know abstinence isn’t for you right now (maybe later, or maybe not), a harm reduction approach might be a good fit for you.

If you are looking for help with harm reduction for addictive behaviors, anxiety & stress, complex trauma or PTSD, or couples therapy, you can read more about how I can help here. If you’re looking for more information about starting therapy, schedule a free 15-minute phone consultation through my contact page. I’d be happy to hear about what is happening and help direct you to the right person to get the help you need.