Understanding Harm Reduction and Abstinence – Learnings from our public conversation

On November 19, 2019 Edmonton’s Interfaith Housing Initiative hosted a public conversation on harm reduction and abstinence at Beth Israel Synagogue on Edmonton’s west side.

Our shared goal was to come to a shared understanding of how harm reduction and abstinence approaches work to support a person with an addiction on their road to recovery.

We heard from people with lived experience of addictions at various stages in their recovery; speaking to their story and what was helpful or unhelpful to them along the way.

We heard from professionals in the field overseeing addictions work in a supportive housing facility or in abstinence-based treatment programs, and those working as peer support workers with both experience and a positive view of both harm reduction and abstinence-based approaches.

And we heard from each other as participants, together seeking wisdom on how to walk with, support and encourage loved ones on a painful and difficult journey.

The bottom line in our learning together:

Treating harm reduction and abstinence approaches as polarized extremes is unhelpful.  Both approaches are important and necessary to support a person with an addiction; even helping someone at different stages of their journey, and both work toward the same goal: the healing and restoration of the person.

Please note: This discussion focused less on harm reduction and abstinence practices in Emergency Response (such as safe injection sites and shelters) and more on Accommodation and Supports (such as affordable and supportive housing) as illustrated below; seeking to learn what best helps people recover from addictions and related concerns.


The stories we heard showed why both approaches were necessary and helpful in some circumstances.

In the abstinence stream, we heard examples from the drug court, where a person might be unable to visit or regain custody of their child until they were able to stabilize and stay clean of their addiction.  Prison provided some with a wake-up call and set them on a path of abstinence that they were able to maintain on the outside.  We heard about sober-living facilities that provided on-site controls that were both wanted and needed by their residents.  Some supportive housing facilities even had a harm reduction focus but took an abstinence approach on drugs and alcohol.  And too, we heard the need for more such places; housing with supports for people with complex needs that maintained a substance-free environment.

In the harm reduction stream, we heard about a managed alcohol program where participants are given measured amounts of alcohol every few hours to help with their cravings.  Peer support workers talked about building relationships and trust with people to help them succeed one step at a time, in attending dentist appointments and court dates, learning budgeting and self-care, and as they are ready in challenging their addictions.   Permanent Supportive Housing facilities served as another example as their approach helps people who are pretty fragile.  People with a lack of physical or mental health, and facing these in combination with poverty, homelessness and trauma have little strength to tackle something as significant as an addiction.  But provided with safe and stable housing, healthy food, medical care and support workers these folks gradually get stronger.  Many can find the strength to challenge their addictions and become abstinent.

Our keynote speaker, Karen Bruno stressed the need to break from an ‘either this or that’ mentality.  She noted that both philosophies emphasize reducing harm in what someone is experiencing.  She then talked about recovery and medical models.

The recovery model places the individual at the centre of the journey in setting goals and making decisions.  They are encouraged to make goals, supported in reaching them, and constantly challenged to reach higher and pursue the next goal.

The medical model involves experts telling someone what they have to do.  A level of outside control is in place to protect the person and push change.

Karen observed that the goals are the same, but how they approach the work is different.  Some people need the medical model and some people need the recovery model.  She stressed the need for a fluid practice that responds to people with the different helps that will work best for them.

Watch Karen’s full keynote address in the video below.

Here are five points of clarity that emerged in our conversations:

  1. Abstinence and harm reduction approaches both work toward the same goal: the restoring, strengthening, and healing of a person. Both approaches emphasize reducing harm and achieving abstinence or greater self-control.
  2. No one succeeds alone. Human connection and encouragement is necessary.  “Who helped me along the way? – people who were stable and sober and never gave up on me.”
  3. One size does not fit all. Harm reduction approaches work well for some and others need abstinence.  Most of the time, a person will need and respond to a combination of both.
  4. A flexible and fluid practice that incorporates both approaches is needed to meet people where they are, with the kinds and combinations of treatment that will best help them.
  5. Both models are powerful, but both take time. Relapses are part of the journey and the accompanying emotional journey is very difficult.  “It takes years for trauma to take form, it can take years for it to be resolved.”

Our panelists helped draw out some of these insights.  Watch their conversation in the video below.

How do we best help people on a path to recovery from an addiction?

In Pursuit of a fluid approach:

We need to be ready to accompany people on a very complex journey.  There are challenges that surge forward when someone finds themselves suddenly sober.  Rob Gurney, a peer support worker with Alberta Health Services noted that “Stabilization is wonderful, but then emotions come out and they fail.”  He stressed that if we’re not there to help with the emotional challenges that come out after someone stabilizes in their addiction, then we are only setting them up for failure.

Every approach should be trauma Informed.  An experience of trauma is often at the root of addiction, with substance use an attempt to drown or bury the pain experienced.  Trauma from sexual abuse, isolation or abandonment, violence, growing up with addicted parents in an unstable home, spending time in homelessness, being forcibly separated from family, negative experiences in the foster care system or residential schools…  people’s pain comes from many places.

Resist Warehousing.  People are used to being put in a docking pen and being treated all the same.  We need to strengthen efforts to see and respond to someone at a personal level.

Create a recovery culture.  One of our table groups, reflecting on our learnings together, made the following list that perhaps describes some of the ingredients for such a recovery culture:  “Community; support; acceptance; purpose; healing; choice; love; compassion”

Provide for closer and longer-lasting connections.  This can/should include more formal supports like peer support workers, trained staff (including some whose experience and learning is off the street), access to professional counselors, as well as supportive natural connections like friends, family and faith community relationships.

Creating places and spaces.  Long waiting lists for affordable and supportive housing are known to be a significant enemy of a person’s recovery.  Addressing that shortage is critical.  But we also discussed the need to think creatively in how we design these spaces, so they meet formal safety requirements, but feel more home-like, supporting a person’s sense of worth and dignity.  Even the look of a place, with white walls and locked doors can trigger trauma for those who may have spend a lot of time in hospitals or jails.  Getting residents involved in painting or redesigning  elements of the space is one strategy that has been helpful.

Strengthening a rapid response system.  Current efforts are hampered by various agencies and ministries working in silos.  This slows the work and makes the needed help difficult to access.  Waiting lists for help are also a significant concern, and people in addictions may take serious damage while on a long list.

Beware of stigmas that can get in the way.  If a person has to go to the Hospital because they are unwell, they may face the discrimination that they are drug-seeking, with medical staff reluctant to give them the needed medication.

Give people time to heal for lasting change.  Intergenerational poverty and trauma both have strong roots in a person’s character.  They formed over the course of many years, and it may take many years for healing and change and for new roots to be set down.  If housing and supports are taken away prematurely a person can fall all the way back down.  And the work really does take time.  Pamela Spurvey, a peer support worker with Alberta Health Services, described how it took her eight months to get someone to the dentist, and when her friend got there she curled up in a ball on the floor), but with that one step (and one victory) at a time approach her friend was improving.

Flexibility and Fit.  The managed alcohol program at the Grand Manor (Excel Society) was discussed as an example of a strong program in a supportive housing environment, but Becky Elkew, the director of care acknowledges it is not for everyone.  People who want to binge drink are not likely to succeed.  Intake staff really try to ensure the program fits with someone’s goals (including asking whether the bright liquor store sign across the street will be a problem).  Grand Manor has some flexibility built in to help people one on one if they need that, accommodating either abstinence or harm reduction approaches in different parts of the facility.

Providing for Hope.  We acknowledged that so many on the streets were really very strong; living in tents but coming three times a day to get their medication.  Supporting and encouraging these folks involves recognizing that strength and refusing to give up on them.  A spiritual care reinforcement is often an enormous help for people trying find hope and strength to heal from wounds in their past.

The panel took questions from our participants that generated a few more insights.  Watch the following video to see that exchange:

How do I or someone I love find access to existing resources in Edmonton.  Call Continuing care access – 780.496.1300; *211 for more information

A Closing Reflection from one of our participants:

“There is a stigma around mental health and addiction that keeps people in the shadows, without community, without support and it needs to be brought to light for things to change. Challenges that remain hurdles include facing stigma, negative messaging, judgment, living in silos, complex systems with complex paperwork, stains on records, work histories, trauma, waiting lists, transportation costs, intergenerational poverty, lack of support resources and more.”  – Jesse Edgington, Participating on behalf of the Northern Alberta Deaconal Conference.

Recognizing this stigma and the barriers to understanding so many of our brothers and sisters with addictions face, musician Roylin Picou chose to close our gathering with the song, Tear that curtain down; a reflection on Martin Luther King’s reaction to the curtain that used to separate people of colour from the caucasian population on public transit.  You can hear Roylin perform this song in another setting via the following video.

This summary of learnings is provided by Interfaith Housing Initiative with gratitude to Karen Bruno, our panelists, to the people with lived experience who shared their story, and to the many participants who joined us for a rich evening of learning.  Special gratitude to the Beth Israel Synagogue for their hospitality and to Paula Kirman for providing video footage for our event.


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