What is harm reduction? This approach to substance use treatment is improving outcomes in Indiana

Across the U.S., overdose-related deaths have climbed steadily since 2019. Data from the Centers for Disease Control and Prevention in 2021 reported 107,600 American deaths—the highest annual death toll on record. Today, more than 20 million Americans ages 12 and older suffer from the effects of substance use disorder (SUD); however, the shame often associated with addiction can prevent people from seeking treatment.

In Fort Wayne and its surrounding communities, Parkview Behavioral Health Institute is the largest healthcare system serving patients who struggle with SUD. According to Caroline Braun, PBHI’s clinical programs manager, Parkview’s approach is to meet clients where they are—rather than perpetuate the stigma and misunderstanding that surrounds addiction. This is known as a harm-reduction approach to SUD treatment, meaning healthcare providers focus on reducing the deadliest effects of SUD and educating clients on how to better protect themselves against an overdose or relapse.

“Science shows us that a harm-reduction approach is better than an abstinence approach when it comes to substance use,” says Braun. “An abstinence-based approach stigmatizes people with SUDs and isn’t very trauma-informed.”

Portrait of Caroline Braun, Clinical Programs Manager for Parkview Behavioral Health Institute at Park Center.

According to the National Harm Reduction Coalition, harm reduction is “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.” Strategies include advocating for safer or managed use and addressing conditions of the use along with the use itself. For many people, substance use is a coping mechanism—and directly removing that coping mechanism is not the safest or healthiest course of action. 

Dr. Timothy Kowaleski, D.O., is a family medicine doctor at Parkview Physicians Group who specializes in addiction medicine. In his experience, harm reduction has changed—and even saved—his patients’ lives. Dr. Timothy Kowaleski, D.O.

“It’s easy, especially for people who don’t struggle with SUD, to think people should just be able to stop using drugs,” says Dr. Kowaleski. “But the success rate of an abstinence-based approach is really low. The philosophy for harm reduction is more long-term. If I can prescribe treatments that keep people alive and prevent them from buying drugs on the street, then they’ll take the next steps toward recovery when they’re ready—and in the meantime, we keep them from overdosing and ending up in the hospital.”

Harm reduction has proven especially valuable in treating opioid addiction because several FDA-approved medications, such as suboxone and methadone, work with opiate receptors in the brain to keep patients out of withdrawal. 

“The main reason people continue to use is that withdrawal feels like death—and they don’t want to get sick,” says Dr. Kowaleski. “Suboxone and methadone are opiates, but patients aren’t overdosing on them. In fact, we see those patients follow treatment recommendations, stay out of the hospital, improve their quality of life, and even reunite with their kids.”

For many people, substance use is a coping mechanism—and directly removing that coping mechanism is not the safest or healthiest course of action. 

Because harm reduction focuses on reducing negative consequences surrounding substance use, rather than eliminating the substance use entirely, some people mistakenly believe it encourages continued use and prevents people from seeking treatment—but Dr. Kowaleski hasn’t found that to be the case.

“Today, anytime you use fentanyl, you might die,” he says. “But I know you won’t die if I give you suboxone or methadone—and I’ve had patients come to me after being on suboxone for awhile to tell me they’re ready to do the work to get better. They come to it on their own terms, but harm reduction strategies have kept them alive long enough to be able to make that decision.”

Exterior of the building at Park Center, 1909 Carew St. Fort Wayne, IN.

Another area where harm reduction methods have proven effective for Parkview is with the maternal population. Erica Deathe, LSW, MSW, worked as an inpatient social worker at Parkview Women’s and Children’s Hospital before becoming a maternal recovery specialist just over a year ago.

“I was interacting with women facing SUD when they came in to deliver, but my relationship with them was so limited because I only saw them after they were admitted,” Deathe says. “I grew up with family members who struggled with addiction, and I knew becoming a maternal recovery specialist would allow me to support women and babies by walking alongside them through really difficult, longer-term situations than just in the delivery room.”

The sign on the front door at Park Center, 2710 Lake Ave.

In her role, Deathe works with women who currently struggle with SUD or have a history of use, and she builds relationships with them both during and after their pregnancy, up to a year postpartum.

“As a maternal recovery specialist, my job is to connect with a woman as early in her pregnancy as possible and provide support, resources, and education to ensure that she and her baby stay healthy through and after the delivery,” says Deathe. “A lot of women who use substances during pregnancy actually fear seeking medical treatment because they’re afraid providers will judge them—or they’re afraid that DCS will get involved and remove their baby from their care. Part of my role is removing the stigma associated with SUD, advocating for my clients, and encouraging them to seek care because that’s ultimately what’s best for both them and the baby.”

Parkview has implemented various harm reduction initiatives for the maternal population, the most notable of which is an intensive outpatient program (IOP) specifically for mothers struggling with SUD during pregnancy and postpartum. IOPs provide acute, short-term treatment for people who need more resources and accountability than traditional therapy might offer.

A room is set up for IOP (Intensive Outpatient Program) group sessions at Park Center.

Maternal patients can also receive medication-assisted treatment (MAT) at Parkview as part of their journey to recovery. Through MAT, women can receive FDA-approved medications that replace their substance use and prevent withdrawal symptoms. Through the entire process, maternal recovery specialists empower their clients to manage recovery in whatever way looks best for them—and take a healthy baby home at the end of their pregnancy.

“I have some clients whose hospitalizations could have been much more stressful and overwhelming without advocacy from a maternal recovery specialist,” says Deathe. “Patients sometimes feel too guilty to disclose pertinent information. They don’t use substances because it’s a fun pastime; A lot of my clients desperately want to stop using, but they can’t. They know stopping in the middle of their pregnancy could jeopardize their child’s life, or they know withdrawal symptoms will be terrible. When they develop a rapport with me, we can start working together to find a solution that is safe and manageable for them.”

Despite the common misconceptions surrounding harm reduction, the success rate speaks for itself. People are alive today because organizations like Parkview Health—and people like Dr. Kowaleski and Erica Deathe—take a modern approach to substance use and addiction.

“Everyone is on their own journey and their own path,” says Deathe. “Who are we to judge? We need to support and guide people toward what works best for them. When an individual reduces their use and engages in harm reduction strategies, they’re still using less than they were before. That should be considered a success.”

Dr. Kowaleski echoes Deathe’s sentiments. 

“Maybe people who follow harm reduction methods don’t have the same recovery as someone who does an intense, 12-step program,” he says. “But they do stay alive. They’re keeping their jobs. They’re staying out of the hospital. If your desired outcome is saving people’s lives, harm reduction checks that box.”