04/04/2026
Madness of our Drug and Alcohol Policy and Interventions.
WARNING: CONTROVERSIAL OPINION.
Today was a reckoning for me. A reminder of the insanity of addiction and the folly that is our current treatment ethos. Harm reduction.
Today, I was privileged to observe, for an hour or so, the operation of an established community based drug and alcohol treatment project, employing around 50 staff, and providing services to 100s of clients, Based in a typical northern town that might be described as a middling, deteriorating UK town. A town where ‘spot the non-user' is a difficult game you're likely to lose.
That one hour was enough to reaffirm my belief that our harm reduction approach is ineffective, and could actually be damaging to the people it exists to serve.
I think I can hear the concerned appeals from my liberal friends, crying that we have a duty to help our poor addicted fellow citizens. Albeit that they may already present in a state of sorry dereliction..', We must provide a service that meets them where they are at’... to accept that they find it hard to make change, to stop using, or just to get out of bed!
To tailor our approach accordingly…to somehow minimise harm.
Well, if the client who is recipient of this treatment approach fails to move forward in spite of the care inputs after say..one month.., maybe many years, Perhaps the system, the ‘Intervention’, isn't working?
How long have we been peddling ‘harm minimisation’ as an effective approach? It clearly doesn't work! It's predicated on the belief that addicts can be motivated and coaxed to make small gains towards recovery and there is an implied acceptance that we should not expect too much from the client. It's my view that a service that projects such limited expectations of progress, consequently gives the client a tacit permission to continue to use. Certainly, the environment of the waiting room that I observed, could be described as triggering or dangerous to anyone in fragile recovery. I observed a chaotic environment. A waiting room where clients were demonstrating signs of addiction - nodding off, sitting in a stupor, aggression, and ‘war story’ conversations and the glorification of drug use and ‘beating the system’. There was a sense of managed unpredictability.
‘Dangerous'? I hear the offended cry. Yep. Not necessarily in the normal understanding of aggression and violence although that's a definite possibility at any moment, (in fact, police were called during my visit.) But it's personally dangerous to anyone trying to change to be in such a chaotic environment. Is this really harm minimisation?
In my conversation with workers, they talked about ‘small wins’ stating that an example of success might be that their client has actually picked up the phone. A ‘win’ such as this may find its way into a prospective court report in active sentencing saying something like ‘doing well’, ‘engaging with worker’. The Bench is impressed! Imagining something much more rigorous and positive than it really is. And so nothing really changes; for that person, the people they damage, and the community at large. Nope. Not much harm reduction happening there!
Reducing harm? Really? Can't we do better than this?
We can, we truly can. But not like this.
I know this because I've worked in and created treatment centres that truly respect the possibility for change in EVERY client, whilst providing the necessary safety and ongoing support; physical, mental and emotional. A place where everyone's journey is celebrated with an understanding of the road ahead and confidence grows.
Where change is all around, and demonstrates hope and new possibilities of a life well lived. We need to create environments where the power dynamic is of respect, belief and possibility. Let's reduce the harm in people's own self-limiting beliefs, let's reduce the harm found in remaining in old damaging environments, let's reduce the harm that comes from people stuck in looking at the pavement covered in rubbish and help them raise their eyes to the sky. The trickle down ‘harm reduction’ from that is ongoing and lifelong.
We are keeping people stuck in the damaging system we say we want them to climb out of. I hear people say having too high expectations for users is setting them up to fail. All I can say is keeping them surrounded with their feet in the mud and expecting them to clear their feet to walk a different path is the biggest set up around. That's not respect or support, that is ‘harm preservation’.
All born out of government policy (of many different colours) who rather than support a system of treatment that works, decided a couple of decades ago that they needed more ‘boxes ticked’. More people seen, more people on the books, more intervention received. Hence, the drive towards shorter, community drug hubs, drops in, methadone clinics. Places where attendance is measured in ‘showing up’.. hence more ticks but not much change. Yes, yes…methadone scripts create stability, more community involvement, less acquisitive crime… none of that creates lasting personal change in attitudes, behaviour and emotional wellbeing. Is that enough?
Is it enough that in town yesterday one section of it was filled with people ‘hooked’ on to a system that keeps them where they are at? We need to open our eyes to what we have created. Here is the parallel process of addiction. We, who want to help, are mirroring the insanity of addiction. Doing the same thing over and over expecting a different outcome. It is indeed tragic for everyone concerned. Let's stop this madness and hold the space so we can actually start the process of ‘harm reduction’ by starting with a thorough and transparent examination of what we are actually achieving
