All for alcohol harm reduction

While people undertake the journey of abstinence and recovery, there is always the risk of a single lapse or multiple relapses. Within the category of alcohol abuse, abstinence is usually only appropriate for those who score 8 to about 15 on an AUDIT. This is variable and individual-specific. However, generally, abstinence is only suited for those who range between moderate to severe alcohol dependence.

In some instances, people may be disinclined to consider abstinence as a recovery goal. This, thus however should not sway the support they receive from the service. A comprehensive psychosocial intervention shall give them all the information they need about alcohol abuse, its effects on mental health and physical health coupled with an enhanced harm reduction approach. This way, the specialist practitioners and the service user as a team can draw up goals for reducing harms that sit within the health and social paradigm in terms of heavy alcohol drinking and dependence.

Within a therapeutic alliance, a service user must feel unjudged, safe, and respected. This thus promotes a shared understanding of the existing issues. This also encourages the development of good therapeutic rapport which is highly essential for the success of a harm reduction approach. This is pertinent in people with complex needs such as co-occurring drug abuse, dual diagnosis or interactional offending history and involvement with criminal justice systems.

A comprehensive, holistic assessment precedes the formation of harm reduction goals. The core component of this assessment shall include risk assessment and recovery planning. While it is useful to draw up recovery goals at the time of the assessment, these are not stonecast. The goals are relevant to the stage and pace of recovery of the service user. As they progress or regress in recovery, their needs change accordingly. Thus, regular evaluation of needs informs well-developed goals and consequently enhanced harm reduction.

People engaging with a specialist practitioner may continue to drink harmfully thus having effects on their physical health. Since the specialist practitioner need not always be a medical practitioner, it is important to work in conjunction with the registered general physician. The GP can thus regularly monitor the service user’s physical health.

Any amount of reduction in alcohol consumption is ceaselessly beneficial, although this may not always be a part of the harm reduction approach. If a person prefers cutting down on their drinking to a level that is significantly or slightly lesser instead of complete sobriety, the specialist practitioner must still support this. The clinician in this instance should evaluate if any safety considerations make this inappropriate, especially if there is a risk of withdrawal. If a drastic decrease is identified as risky to the service user, the clinician can then develop a plan for gradual reduction along with the service user. This then can be shared with the specialist practitioner for continuity of key work, support and monitoring of the planned reduction.

GPs or allocated medical practitioners should then evaluate the necessity of thiamine. Risks of Wernicke-Korsakoff syndrome and other neurological problems consequential of harmful alcohol use can be reduced by the oral or intramuscular administration of thiamine. All staff working in an alcohol treatment service should be trained in advice, information, and goals within an alcohol harm reduction approach.

When drawing up goals, service users must always be given all-inclusive information about the risks involved in abrupt cessation of drinking coupled with guidance on why this should not be done.

Orientation around reduction in tolerance levels post-abstinence should be explained in tandem with discussing how drinking at pre-abstinent levels can affect this. Risks of alcohol poisoning, and risk of overdose when combined with other illicit/ prescription drugs, should be explained in detail. Specific groups of people such as those who are young, older, pregnant, or chronically ill must be given situation-specific information and advice. All these together constitute a holistic harm reduction approach that can support the service user through the process of recovery.

If you’re a service user or caregiver, feel free to request harm reduction strategies from your treatment provider if you have not already been provided with them.

(The author is a multidisciplinary professional who works in the UK.)