Integration of harm reduction and twelve step approaches to treatment: Oppositional, complementary, or something in-between?

Harm reduction and twelve step approaches to substance abuse treatment are typically seen as oppositional. However, some harm reduction workers view them as complementary, arguing that Alcoholics Anonymous in its origins was indeed a harm reduction approach as its focus was on “progress not perfection” where “everyone deserves a seat at the table.” This article reports qualitative interview data in which staff members conceptualize the relationship between harm reduction and twelve step approaches to treatment. Data were selected from a study investigating individual participant outcomes of two harm reduction programs: a community-based drop-in center providing case management services to active users who were homeless and another providing individual harm reduction psychotherapy. Face-to-face, qualitative interviews were conducted with 18 staff members and 32 participants of both programs in which outcomes emerged in the areas of demarginalization, consistent engagement in the program, quality of life, social functioning, changes in use, and articulation of future goals and plans.