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.