The Integration of Harm Reduction into Abstinence-based Therapeutic Communities: A Case Study of We Help Ourselves

Traditionally, therapeutic communities (TCs) have focused on providing abstinence-based treatment. However, with the emergence of HIV among injecting drug users, some TCs have evolved to include risk management or harm reduction strategies into their previously abstinence-based programs. We Help Ourselves (WHOS), a group of TCs in Australia, integrated harm reduction into their services in the 1980s. WHOS passed through a series of stages as it moved from a goal of “abstinence only ” to one of “abstinence eventually. ” Following these changes, client retention and length of stay increased and HIV risk behaviors decreased. The process by which WHOS integrated harm reduction into their services while maintaining a commitment to abstinence is outlined and a guide for TCs interested in adopting harm reduction is provided.