Harm Reduction — A Real Life Account of How It Saved My Client's Life

September 7, 2026

Joshua Bennett-Johnson, Author, LADC-II, Licensed Counselor 

Tom O'Connor, Publisher

Editorial safety note: Alcohol withdrawal can be life-threatening and should be medically assessed; one client's experience is not medical advice.

This story was shared anonymously, with the client's consent, about their experience in treatment. Firstly, what exactly is "harm reduction" in the world of addiction treatment? Well, it is exactly what it sounds like: the effort to reduce harm with individuals who have problematic, dangerous, and sometimes fatalistic relationships with drugs and alcohol.

Abstinence, for instance, falls under the umbrella of harm reduction. In fact, it is the "ultimate" form of harm reduction, as not using alcohol or harmful substances all but eliminates the likelihood of experiencing negative consequences related to use.

But, and this may shock some readers, some clients come into the office of addiction specialists not to abstain from use. Rather, their goal is to reshape their relationship with their drug of choice. They want to use more safely, learn to moderate, cut down, and put themselves in a position where they can still enjoy their substance of choice without it ruining their lives.

READ: Harm Reduction or Bust 

Allowing clients to retain their autonomy in their treatment is a vital component of harm reduction and of therapy in general. The best 'gift' we can offer anyone in this life is their own independence and, in the therapist's office, an opportunity to design their own recovery plan based on their own preferences, not the therapist's.

It is the healthy way to administer counseling. Their life, their choices, their plans, their outcomes, and, sometimes, the consequences that stem from their choices. Yet, still, the best practices from the helper in the room.

I remember it was on a Saturday afternoon when I received their text: "Hey, Josh, really sorry to bother you on a Saturday, but I'm throwing up a lot of blood, and I'm not sure what I should do." My heart fluttered. "You need to call an ambulance and get yourself to the ER like right now!"

And so, that's what they did. They were given an examination by the resident on staff at the emergency department on that fateful weekend, who informed them that they had detected a tiny cut in the client's esophagus and that the blood coming out of them was coming from that abrasion.

It wasn't a serious injury, but it could certainly become one if you don't stop drinking alcohol for at least a couple of months so that this cut can heal," the doctor informed them. If it becomes infected, you could lose your esophagus, develop a bloodstream infection, and damage other vital organ systems, such as your heart, brain, and lungs. If this thing doesn't have time to heal properly, this could turn fatal."

This client had a severe alcohol and cocaine use disorder, and because of that, they spent a lot of time vomiting after days-long binges. Because of all of this throwing up, the esophagus had become inflamed, and that's where the cut had come into play. The skin had become tender and fragile, and if the puking continued, it would only further irritate the wound. Yuck.

At any rate, the doctor's advice to "stop for at least a couple of months" was enough to scare my client straight. Resistant to the idea of detoxing under medical supervision, per my recommendation to them, they instead went straight to a cannabis dispensary. They loaded up on a whole bunch of products. They went through the discomfort of a self-administered cannabis assisted detox for the next 3-4 days.

They made it through without experiencing any seizures, thank goodness, and the cannabis proved to be enough to ease the worst of the discomfort.

For the better part of a year before all of this, this client never missed a single session with me. They were always on my schedule for Monday mornings at 9 AM. The thing is, they got paid on Fridays from their lousy service industry job, and they would proceed to stock up on as much alcohol and cocaine as possible when the direct deposit hit their checking account.

So, by the time they were sitting across from me in the office, they had been up for the better part of 2 or 3 days, loaded on substances, and always severely impaired when 9 AM came rolling around. Still, they never, and I mean never, missed a session, not once, for that entire span.

That said, the sessions were not substantive in the context of conventional therapy. My client could barely communicate. They would try to share, but could not convey cohesive thoughts or form complete sentences, no matter how hard they tried. Essentially, our sessions were spent in relative silence, my client quietly weeping in the chair next to mine.

They would sometimes use up the whole box of tissues as they tried to express what they were feeling, experiencing, worrying about, or whatever else. But, again, they never missed a single appointment. Not once. I would sit across from them and just "be there," observing their inebriation and their pain. It was heartbreaking to watch.

When 10 AM hit, they'd leave and walk back home. They didn't own a car during this period, and I wouldn't have allowed them to drive on public roads in that state, even if they had. The whole thing was so confusing to me. Why did they keep showing up? Was this even therapy? What was happening in these sessions?

It felt like a performance by someone I truly believed wouldn't survive much longer. Not at the rate they were using during this period.

However, after the medical scare, they stopped drinking and using coke. They were using cannabis in a regimented way: a dose in the morning, a dose in the afternoon, a dose in the evening, and it was helping them get over the worst of the symptoms that they would otherwise be feeling if they had gone the "cold-turkey" route. Which, by the way, is never recommended. At least, not by me.

As this client began to sober up, our sessions shifted as they became more clear-headed, able to communicate in full sentences and have coherent conversations with me. A few months into this journey of being without the drink, they said to me one day, "Josh, I feel like I owe you an apology." "An apology?" I replied, "Why do you think you owe me an apology?"

They went on, "For a long time now, I've been showing up to our appointments, and I couldn't even talk. I couldn't even function. I was seeing two of you; my vision was so messed up. I was so fucked up. Awake for days, a head full of whiskey and cocaine, I feel like I wasted your time."

I responded, "I don't feel that way, if it's any comfort." They replied, "I just needed to know that I wasn't alone." Then they repeated it, and more tears fell. "I understand," I told them. "And you're not. I'm always here for you, in whatever condition you're in or not in; I get it." 

"I just needed to know I wasn't alone," they said again. "I just felt so fucking alone."

They went on to explain in the weeks ahead that this had been a pattern during their drinking career, that it wasn't uncommon for them to show up to their treater's office, clearly under the influence and in really rough shape, only to be told by their "helper", "I'm not going to work with you while you're drunk. Come back when you're ready to be sober."

The thing is, they weren't ready to be sober. At least, not yet. Doing that to a client in the midst of active alcohol or substance use, sending them away from the place that they're going to receive help for their disorder, is akin to kicking someone out of a cardiac unit for having a heart attack. That is why they are there. They are struggling with drugs and alcohol. I can't wrap my head around it.

Several treaters had sent them away under those circumstances, and guess who never returned to their office? If I had sent them away, I would have never seen them again. I know that for an absolute fact. They might not have survived their drinking and drug abuse. They might have ended up hurting themselves or someone else. They might have ended up behind bars, or homeless, out trying to survive on the streets. Who knows?

That client taught me a valuable lesson: though we weren't doing "conventional therapy" during that long period of their constant intoxication, we were still doing work. We were doing the work of "I just needed to know that I wasn't alone." I'm grateful I didn't show them the door, but man! Those sessions were difficult to do, just to witness someone at that level of pain, loneliness, and hopelessness.

I felt powerless to help them, but I learned that just by sharing a safe space with them and meeting them in that difficult place, I showed them they weren't alone in this battle for better health and hope that they could change. They had at least one person who would welcome them in without judgment or condemnation, watch them silently weep for an hour, and prepare to do it again and again for many weeks and months to follow. "I just needed to know I wasn't alone." That's where the work was happening.

The story has a happy ending: the client from this story is now three years sober from alcohol and cocaine use. They left a toxic job and found a new, better gig that paid a substantially higher salary. They go to the gym and do yoga several times a week. They've mended fences in some of the relationships that were damaged through the worst of their time actively using. They are actually dating again after, I don't even know, how long! 10 years? 15? They found an apartment with good-enough roommates and moved out from under their family's roof.

They are achieving independence and better health, and, yes, cannabis is still a part of that equation. But they don't abuse it. They use it like a plant medicine, in a very disciplined fashion. They just needed to know they weren't alone there for a while, through the worst of it, and I am grateful I was able to provide a place that felt safe for them at a time when they were feeling anything but safe.

Harm Reduction. A sea change is happening in the field of treating addictive disorders, and this is a powerful example of why and how it sometimes works, and why it qualifies as the best approach and practice to take.

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Read Joshua's bio by clicking his icon at the start of this article.

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