Nway Linn, Chief Clinical Officer – RADIAS Health
One of the ideas I have come to appreciate in harm reduction is what I think of as “time in the bank.” Recovery is rarely a straight line. A person may enter treatment more than once. They may experience periods of sobriety, return to use, reduce their use, reconnect with treatment, or simply begin taking better care of themselves. We sometimes focus so heavily on whether someone has achieved sustained abstinence that we overlook everything they have gained along the way. However, that time is not lost.
Every period of recovery can put something in the bank: knowledge, coping skills, relationships, insight, connection to providers, safer practices, improved physical health, or the experience of knowing that change is possible. When someone returns to treatment, they are not necessarily starting over. They may start again with more experience than they had before. Over many years working in substance use and mental health treatment, I have witnessed people whose recovery included sustained sobriety and others whose journeys included many returns to use and multiple attempts at treatment. I have learned not to view those attempts as failures. The willingness to try again is itself a form of resilience.
Harm reduction also challenges us to look beyond substance use as the only measure of progress. The quality of life can improve in many meaningful ways. Someone may reconnect with family, obtain housing, take medications more consistently, prevent an overdose, improve nutrition, address a chronic health condition, return to work, reduce unsafe substance use, or simply begin trusting a healthcare provider again. These changes matter.
Research and national guidance increasingly recognize recovery as holistic and acknowledge that harm reduction and recovery can coexist rather than compete with one another. Recovery can involve improvements in health, wellness, purpose, connection, and quality of life, even when a person’s journey does not follow a perfectly linear path. Perhaps the most important principle is also the simplest: a person’s current substance use should never determine whether they are worthy of dignity or quality care. People should not have to demonstrate perfect recovery before they are treated with compassion.
They should not have to “succeed” in treatment before they deserve another opportunity to receive it. Our responsibility is to keep the door open, because sometimes what looks like another attempt is actually someone drawing on everything they have already put in the bank and trying once more.