Pubdate: Tue, 21 Jul 2009
Source: Vancouver 24hours (CN BC)
Copyright: 2009 Canoe Inc
Contact:  http://vancouver.24hrs.ca/
Details: http://www.mapinc.org/media/3837
Author: Matt Kieltyka
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)

ABSTINENCE VERSUS HARM REDUCTION

What approach works better or are they both needed to help addicts?

Ann Livingston may not always agree with the "cold  turkey" crowd, 
but there is a lot to admire about the  Last Door, she says.

One of the city's outspoken advocates for harm  reduction and drug 
maintenance, the Vancouver Area  Network of Drug Users organizer has 
often come to  loggerheads with groups pushing abstinence-based 
treatment programs.

"The people these programs turn down are the people I  deal with, the 
ones who have been shooting heroin for  so long they can't go cold 
turkey," Livingston told 24  hours. "Sustaining abstinence is hard to 
do when you've  never been given any harm reduction tools."

She believes the number of addicts ready to quit cold  turkey pales 
in comparison to the people in need of  clean needles, drug 
maintenance programs and safe  injection sites.

"They're just not ready," she says. "The Insite data  has shown ... 
you can't access programs and get help if  you're shooting up in an alley."

But despite their different priorities, Livingston and  Last Door 
manager Louise Cooksey are running in the  same direction.

Cooksey says the success of Last Door depends on the  client's 
willingness to get clean - and each newcomer  is screened to make 
sure the commitment is there.

"To me, it's an absolute given that you have to take  responsibility 
for your recovery," she says. "If  someone could do it for you, 
everyone would be clean."

Many of the Last Door clients have tried, and failed,  to kick their 
addictions in the past through other  options. Some even relapse 
while in the program.

"There are struggles," she admits. "I've seen people in  treatment 
for five months before they finally surrender  to the process. I 
usually tell families that you can  expect, in the first week or so, 
some kind of a crisis.  But generally within 30 days they're usually 
getting into a kind of rhythm."

Livingston says those success stories are influential  to other drug addicts.

"Those are the people I'd like to speak to at VANDU,"  she said. 
"Even if the people listening won't quit, it  can have quite an 
impact. It's very spiritual. That's  how these 12-step abstinence 
programs work. I admire  that."

It's that peer-to-peer support that keeps the Last Door  running. The 
New West facility houses 60 addicts who  are at various stages of recovery.

It's by design.

"The therapeutic value of one addict helping another is  just the 
idea that someone who has been through that  can understand," Cooksey 
says. "It's about being there  for the next guy, so when a person 
comes in, they find  themselves swept up in the feeling."

Livingston says there is definitely room for  abstinence-based 
programs in the spectrum of services,  and wants to see Canada adopt 
a European drug treatment  model that offers a breadth of 
low-threshold treatment  options before people are ready to kick 
their habit all together.

In the meantime, both harm reduction and  abstinence-based approaches 
will continue to operate in  silos.
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MAP posted-by: Jay Bergstrom