The Harm Reduction Gap

by Sheila P. Vakharia

This long-awaited book teaches how harm reduction can be a safety net for people with substance use disorders that our current addiction treatment rejects, abandons, and leaves behind. Harm reduction is an approach to helping people who engage in high-risk activities to develop the skills and strategies to keep them and their communities safe. This can include the provision of sterile equipment, low-threshold and low-barrier care, and the acceptance of non-abstinence goals in treatment. In this novel guide, Dr. Vakharia discusses the shortcomings of the dominant “Just Say No” drug prevention messages and abstinence-only treatment approaches, introduces harm reduction strategies and technologies borne from people who use drugs themselves, and suggests various policy options available as alternatives to the current policies that criminalize drugs, drug-using equipment, and the settings in which people use drugs. The final chapter calls on the reader to destigmatize drug use and support efforts to reform our drug policies. By highlighting the large gap in our current approach to substance use – the harm reduction gap – this book is the first step for those interested in learning more about the limitations of our current approach to drug use and support local efforts to ensure people who use drugs and their communities can stay safe.

Genres: Nonfiction, Drugs

192 pages, Paperback

Published February 9, 2024

Reviews

[Elyse Laura · Rating 4 out of 5]

great intro to HR and super accessible for those who are interested in learning about it

[Lauryn · Rating 5 out of 5]

If you work in field of addiction medicine/harm reduction you can probably skip this book (it’s great, but hopefully most of it is info you already know/practice), BUT everyone else should read this!! The author does a wonderful job providing an overview of what harm reduction is and why it’s so incredibly important and underutilized. My favorite aspect of the book is that the author thoroughly explains the barriers that everyone who uses drugs/looks for treatment faces and therefore addresses the stigma associated with this…Reaching your substance use goals and getting into/staying in treatment is NOT easy when the system works against you and/or you are unhoused, have low socioeconomic status, or limited social support!!!!!!!

[Carly Sinnott · Rating 4 out of 5]

a work read 🤓 good well researched info on harm reduction

[Ashton · Rating 5 out of 5]

This book is essential reading at a time when more than 1 million people have died from preventable drug overdoses since the beginning of the millennium. The Harm Reduction Gap is a brilliantly written exploration of the limits to abstinence-only drug education and treatment as well as the revolutionary potential of harm reduction policies & practices. Dr. Vakharia's writing is concise and accessible, making her book a valuable resource to those new and experienced in the field of addiction. The stories she shares from her lived and professional experiences highlight the role of drug use as a survival strategy when suffering in abject circumstances. Take this passage for example:

I had a long-time client at the SSP [syringe service program], a Vietnam veteran who acquired HIV in the 1990s due to injection drug use. He attended the local methadone clinic and did not inject heroin anymore. He did, however, binge drink and use crack cocaine occasionally. He told me that vodka was his 'anti-freeze' on cold nights in the streets; the false flush and warmth helped him tolerate sleeping on the sidewalk or alley when he couldn't secure a shelter bed. He explained how blacking out would numb him enough so he did not feel the bugs or hear the cruel remarks of passersby. In this situation, was it really my place to tell him that alcohol was the wrong way to cope with life on the streets?

When we narrow our focus to individual pathology, we ignore the many contexts and circumstances that drive problematic substance use (and, conversely, those that facilitate safer use). Dr. Vakharia challenges us to stop moralizing & penalizing substance use and start collaborating with people who use drugs to create a safer world for everyone.

[Juniper]

This book stands among few others that induced a massive paradigm shift for me. I never thought twice or questioned the dominant narrative before reading this. This book is a great overview and I especially appreciate the history and debunking of surrounding myths. It is also very approachable. Definitely recommend it.

I would also love to read a global comparison of drug policies and history of these drugs ex coca leaves and all their uses. I would also enjoy more about the history of harm reduction, especially harm reduction as a political movement and its philosophies and its legacy of activism, and further exploring how institutional co-option defangs these initiatives. I would also enjoy comparing drug related harm reduction compared with the evolution of harm reduction in a different field, like sexual health. So it suffices to say that this book inspires me to learn more. I also think an audiobook format would increase the book's reach, because more people need to read this.

Thank you for writing this!

[Ashley Updike · Rating 5 out of 5]

I can't explain how much I needed to read this book. I am a Substance Use Disorder Professional who worked in low-income outpatient treatment programs. I am now work in Public Health on Overdose Prevention. Vakharia also worked in similar treatment program. She paints why it doesn't work, and what needs to done to reform the industry. The solution, in part, is to fix the Harm Reduction Gap. This work was so relatable. I do not believe healers should work in partnership with systems of harm (probation, prisons, CPS). We can't build a healing, working relationship when our clients can't trust us as we report to those systems. I listen to this book on audiobook, but I will pick up a physical copy.

This book needs to be required reading to all social workers, addiction counselors or anyone curious why treatment doesn't work.

[Jason]

It's a good primer for people to understand what harm reduction is, and is a broad enough survey that even people experienced in providing harm reduction services will learn a thing or two. Conversational writing style that is easy to follow. Though, the theoretical alignment seems discordant across a couple chapters. In "Treatment and the Harm Reduction Gap" it seems like harm reduction is treated as a stepping stone or life buoy useful for people until they (re)attempt treatment. While in "What Harm Reduction Is Not" (probably the best chapter of the book) harm reduction is treatment as a modality unto itself, independent of its association with treatment models. Definitely a useful read!

[Natasha Przedborski · Rating 5 out of 5]

This is a powerful and timely book that highlights the limitations of the current addiction treatment system and the shortcomings of abstinence-only models. Dr. Vakharia examines the past, present, and future of harm reduction in a way that is both comprehensive and accessible. The book provides readers with the tools to think critically and compassionately about drug policy. A must-read for policy students, government officials, and anyone interested in gaining a deeper understanding of this important and often misunderstood issue.

[Klára Eisnerová · Rating 5 out of 5]

Skvěle napsaný náhled na problematiku Harm reduction z pohledu odborníka s výraznou zkušeností v oboru. Lidsky psáno, hluboký historický vhled do začátků, války proti drogám, diskriminace, která předcházela veškerým prohlubujícím se problémům v USA i ve světě.
Tolik věcí, kterým se mohlo předejít a zároveň neutuchající snaha pracovníků, kteří se snažili snižovat škody páchané užíváním drog ve společnosti.
Autorka skvěle a široce popsala benefity přístupu, bariéry, potenciál a důvody skepse a bydlení mi knih pomohla během psaní bakalářské práce. Skvělá práce.

[Bri Sheppard · Rating 5 out of 5]

Dr. Vakharia speaks clearly, from experience and from the heart, backed up by historical facts and the most recent data available in this well researched book that weaves in her personal journey. This is a must read for anyone who wants to understand how we got to the devastating level of loss of life we are currently experiencing related to drug use and also what we can do about it. She speaks with passion and compassion. Highly recommend.

[Hannah Gumina · Rating 5 out of 5]

An amazing look into harm reduction meant to challenge your bias and assumptions about drugs and PWUD. Echo other reviews that say you should know most of these things if working in the space, but particularly liked the discussion about “doing harm reduction”

[Abbie Correll · Rating 5 out of 5]

Really good book, all healthcare providers + public health and adjacent fields should be required to read