From Abstinence to Harm Reduction: A Journey Toward Informed Choice

More than just users
Written By NUAA Admin

Friday, 1 May, 2026

Content warning: this article discusses themes of abuse, mental health, stigma and lateral violence within AOD treatment.

I was in my early twenties when I first walked into an Alcohol and Other Drugs (AOD) peer support community. It was a volunteer group, self-organised and self-managed, with no professional or clinical oversight.  

Support came through informal relationships with members who had more time in the program than I did. My use of AOD had started to cause real problems in my life, and something had to change. I joined wholeheartedly. 

A lot of it was about shame. I wanted to claw back some dignity by presenting as the good girl I had been taught I needed to be if anyone was going to love and accept me.  

From my early twenties to my early thirties, I practised complete abstinence. In all that time, I never once heard the concept of harm reduction or the safe practice of drug use. Abstinence was the only option. Anything else was framed as a moral failing. Any use of drugs, they told me, would lead to institutions, incarceration or death. 

I am genuinely grateful for much of what I received during those years. Connection. Belonging. Relationship. These were things I had craved my whole childhood, growing up in a dysfunctional household. I learned how to be in relationship with other people. I essentially grew up in that community.  

For many people, abstinence-based approaches provide exactly this: a framework, a community, a path forward. Abstinence is a valid and sometimes essential choice, and within a true harm reduction framework, it is honoured as one option among many. 


When Support Becomes Harm 

But there was a darker side to my experience.  

I can only speak to my own lived and living experience (LLE). I had co-occurring conditions that went undiagnosed for years, and a history of abuse that left me vulnerable to dynamics I had absorbed as love growing up: coercive power, control, the expectation that I would comply to be accepted. I was never equipped to critically ask questions and make a fully informed decision about my own care. 

The ideology described people who use drugs as selfish and incapable of change. I was told my thoughts were diseased, that I could not trust my own mind, that every decision I made needed to be run past someone more experienced.  

I worked through my deepest trauma with a person whose only credential was their own LLE of AOD. Childhood abuse. Sexual violence. Domestic violence. I now understand how dangerous it is to work outside scope of practice. In my current professional practice, when we do not have the skills and expertise, we must refer people to specialists. 

What I experienced has a name: lateral violence.

It is the harm that members of marginalised or oppressed groups sometimes direct at each other, often unconsciously replicating the dynamics of broader systems.  

In peer communities, it can look like rigid hierarchies, shaming, exclusion of those who question group norms, and enforcement of conformity through fear. Any community that punishes critical thinking will attract people who thrive on control. 

I am sad to say I was part of it. I mentored many people at their most vulnerable. I supported hundreds more. I believed abstinence was superior. I held the same judgemental beliefs about people who use drugs that wider society holds. I am deeply sorry for the harm I caused. 

Throughout this time, I also lived with significant co-occurring mental health conditions: an eating disorder, anxiety and depression, complex post-traumatic stress disorder, undiagnosed neurodivergence, and suicidal ideation that moved into crisis care.  

The narrative was always the same: I was not working my program properly and I am a ‘dry drunk’.  

There was also a belief in community that antidepressants and ADHD medication were drug use. People were encouraged to stop taking prescribed medication without medical guidance.  

I internalised this stigma. This is what ideology can do. It causes real, tangible harm. 


Learning to Trust Myself 

It took me many years to understand that there is nothing inherently wrong with me.  

I started to question the ideology. I examined the relationships I was in and recognised how deeply abusive dynamics were embedded in the community itself. When I began asking hard questions, the people I thought loved me pulled away. 

One day I simply decided to trust myself. I walked away from everything I had known. I found online communities of people who were also trying to unlearn their experiences in these spaces. Eventually I found my way into the LLE workforce as a peer worker in a different sector.  

I learned that LLE is a powerful expertise in its own right, and that it can be used ethically, safely and sustainably alongside clinical care. 


Discovering Harm Reduction 

After some years, I returned to the AOD sector.  

Honestly, I was resistant. I assumed any AOD organisation would hold the same views I had encountered before. But something about harm reduction sparked my curiosity. For the first time in years, I felt curious rather than defensive. 

Working in harm reduction, advocating for the rights of people who use illicit drugs, has been the most healing experience of my recent life.  

I was astounded that in all my years in rehabilitation, in volunteer peer groups, seeing psychiatrists, psychologists and doctors, no one had ever mentioned harm reduction. 

Harm reduction is evidence-based. It acknowledges that drug use exists on a spectrum, that not all use is problematic, and that many people use drugs without developing dependence or significant harm. It meets people where they are, without requiring abstinence as a condition of support. It keeps people engaged. It keeps people alive. 

I began to see that the struggles of people who use drugs are not individual moral failings. They are shaped by systemic issues.  

Criminalisation has not reduced drug use. It has increased incarceration, marginalisation and death, disproportionately affecting First Nations people and people experiencing poverty. Stigma and discrimination in healthcare mean many do not receive adequate care or avoid services altogether.  

I also came to understand my own LLE differently: my neurodivergence, my queerness, my complex mental health history. I feel more connected to myself than I ever have. 


What I Stand For 

Harm reduction is not perfect. Like any framework, it can be implemented poorly. The point is not to swap one rigid ideology for another. The point is informed choice. Dignity. Meeting people where they are. 

I am not arguing that harm reduction is better than abstinence. I am standing for the individual. For their right to education, to self-determination, to make decisions about their own body and life. For the understanding that using drugs, including for pleasure, does not make someone a bad person. That abstinence is one option, not the only goal. 

I am standing against coercion, lateral violence, working outside of scope, and withholding information. These things can happen in any peer support setting when we lose sight of trauma-informed, person-centred practice.  

I am standing for the recognition that colonisation, laws and policies have created much of the systemic marginalisation that people who use drugs experience. 

Whether you work in this sector, love someone who uses drugs, or use drugs yourself, you have a role. Informed choice, accurate information, freedom from stigma and coercion. These are things we can all fight for. It starts with the conversations we have and the assumptions we are willing to challenge in ourselves. 

If the contents of this article has raised concerns for you or someone you know help is available. 

  • Peerline (available 9am – 5pm, Monday – Friday): Call 1800 644 413 or email peerline@nuaa.org.au. 

NUAA Admin
Next

Know Your Routes: Injecting Types & Risks