Blog post author header image John Makohen recovery coaching in nyc

John Makohen
Arise Recovery Coaching in NYC

Why Harm Reduction combined with recovery coaching meets readiness for change.


When I became a certified recovery coach I promised to meet you (and other persons in recovery ‘recoverees’) where you were at in your readiness for change. 

If you choose to work with me and are still active in your addiction it is okay. The goal I will first help you achieve is reducing  the harm your substance use disorder creating in your life.  With precautions made you and I can begin our journey together. The outcome and path is based on what you need today.

Think back on your experiences when you were active. Did you hear when friends or family pleaded with you to stop using, threatened to leave, or when the world crashed down all around you?

You probably didn’t this is why recovery coaching is incredibly useful in guiding you along your path in recovery. Our primary goal is to meet you where you are at. In my recovery coaching service, I will never force change or abstinence down your throat. You will decide what you need and want. My role is to ensure that you are safe from harm. I don’t expect you to go from pre-contemplation to action the first time we meet. Recovery is a process, and you need to create a system for recovery. If harm reduction is the path you choose, then it is precisely what we’ll do. There will be no rebuttals, ultimatums, or hidden agendas.  I will help guide you through the turbulence of active addiction.

With the opioid crisis still raging strong, you have to find a way to bridge the gap between the desire to change and the fear and pain of drug-sickness.

Before you can embrace harm reduction, let me tell you what harm reduction is and how it works.


In the United States, every 11 minutes, a family suffers from an opioid-related death.

If there were safe-injection sites available in every city and town in America, how many families would not be suffering over the death of a loved one today from an accidental overdose?

Opposition to harm reduction policy

Harm reduction meets the you where you are at. It’s an attempt to reduce the harm of a substance use disorder or other behavior which creates unnecessary risk in your life and to public health.  Advocates of harm reduction understand and accept a person’s readiness to change. Due to this acceptance, harm reduction reduces the likelihood of possible adverse outcomes to the individual and public health.

What comes to mind when you hear these different forms of Harm Reduction?

Sex Education? Breathalyser-Ignition Keys? Needle Exchange? Narcan? Naloxone? Methadone Maintenance? Safe Injection Sites? Legalization?

All of these forms of harm reduction. The opposition is the real enemy of these policies established to reduce harm. Society fearing such a radical change created slander, misinformation, stigma, disapproval. Reducing harm meets the current opioid epidemic head-on. In regards to harm reduction policy, our society as a whole has a long road to travel.

Opposition to harm reduction feels acceptance sends a message of approval.  Of course, there are always pro and cons to any theory, but opposition to harm reduction creates fear and perpetuates stigma.

Those who oppose harm reduction still exhibit fear and are ignorant of individual pathways in recovery. These organizations believe that “forced total abstinence” is the only way in which a person will heal from a substance use disorder.

Unfortunately, not finding a way to reduce harm creates pain and suffering, at physical, emotional, and economic levels. It is not only the person who uses heroin or other drugs, but research also proves addiction is a family disease. And a financial burden on society.

When a recovery coach embraces harm reduction policy and procedure, the coach is meeting your readiness to change.

Let’s take a look at my personal case study of how harm reduction saved my life.

I came of age, in the NYC neighborhoods of the Lower East Side.

Image of a grimey subway station wall with rat bait warning. Heading to the LES needle Exchange harm Reduction location on Alan Street.

“Heroin was abundant. The streets were littered with discarded syringes and dope bags.
Metal tree guards on St. Marks Place doubled as sharps containers.
It was a danger to public health, but an anthem to street junkies and gutter punks.

The first time I walked into a needle exchange program, I was scared. I didn’t trust the staff.
It was hard to comprehend that these people wanted to keep me safe.

And in doing so, they were keeping the lives of the children and others in the community safe.”


John Makohen – excerpt from Homeless, alone, Hungry, and Cold: Street Junky

Image of the Harm Reduction Needle Exchange Drop Box 25 Allen St. NYC
In the late 1980s and early ’90s, syringes could not be purchased without a prescription, so if you used drugs intravenously, you had to buy the needle on the street. Most of the time they were previously used, at least once, by the diabetic who was selling it to me. The price was 5 dollars a syringe. A bag of dope cost 3 dollars. I reused my needles until the point would break off in my vein. Sharing needles without rinsing it with bleach was common, especially the devil dope-sickness was knocking at my door.
I would make sure to get every last shot out of a needle. I worked hard to keep it safe next to the bundle or two I kept on me at all times. The roughness of the scars and tracks on my arms and veins would bunt the syringe quickly, so I would sharpen the point on a matchbook cover. If I was shooting up in a quiet place I could hear the needle breaking through each layer of scar tissue marking up my arms. I would tell myself the burr piercing my flesh helped steady the needle in my vein. Funny right, I always had a positive outlook, except when it came to getting clean and sober.

All that mattered was getting the hit and feeling the dope running in my veins.

Some days I’d have to wait my turn to use a friends syringe. The wait was agonizing and often led to using the rig without bothering to rinse it out. Getting the chance to watch my blood dance with my friends inside the needle was a treat. Plus I got to shoot what little bit of dope he didn’t get into his veins. Bonus!  The rewards for waiting patiently and not rushing my friend’s shot.  

NYC Poster flyer How Can You Prevent Hep C? Harm Reduction and safe heroin injection practices.
“We knew about HIV infection, HepC and other blood-borne diseases we could get from sharing a needle, but we were young, reckless, and going to live forever.”

John Makohen excerpt Homeless. Alone. Hungry and Cold: Street Junky.

Pin for the blog post Harm reduction works

HIV infection, Hep C, and other blood-borne diseases


“We knew about HIV infection, HepC and other blood-borne diseases we could get from sharing a needle, but we were young, reckless, and going to live forever.”

It didn’t long for Hep C to become a reality in all of our lives. Today scarred tracked-marked arms, and Hep C (until recently)  breaks my anonymity just like the swastikas Aldo Raine (Brad Pitt) in the movie Inglorious Bastards carves in the foreheads of Nazi’s to mark them for life.

I wear my tracks proudly. I used to hide them from the view of other New Yorkers, but today these scars remind me of the time I spent on the front lines of my own war on drugs.

I’m not anonymous about my past, my recovery is public. I was lucky and managed to live. It wasn’t because of AA or NA, inpatient/outpatient drug treatment, halfway houses, prison, hitting a lower bottom daily, it was because of HARM REDUCTION.

Don’t get me wrong. I have been forced in detox after detox, in-patient, out-patient,  jails, and prisons. I have participated in AA and NA. but powerlessness and God didn’t speak to me. My path for recovery is my path and yours is yours. Reducing harm from your heroin use disorder is insurance to help you find your path.

What is Harm Reduction Poster from the student health education center at McMaster's Student Union.
Image Source

What is Harm Reduction?

Harm reduction meets the “addict” where they are at.  It’s an attempt to reduce the harm of a substance use disorder or other behavior which creates a risk to a person’s life and public health.  Advocates of harm reduction understand and accept a person’s readiness to change. Due to this acceptance, harm reduction reduces the likelihood of possible adverse outcomes to the individual and public health.

Opposition to harm reduction feels that in this acceptance a message of approval of the behavior is sent to these same individuals.  Of course, there are always pro and cons to any theory, but opposition to harm reduction creates fear and perpetuates stigma.

Those who oppose harm reduction still exhibit fear and are ignorant of individual pathways in recovery. These organizations believe that “forced total abstinence” is the only way in which a person will heal from a substance use disorder.

In their attempt to discredit harm reduction practices the International Task Force on Strategic Drug Policy states;

“We oppose so-called ‘harm reduction’ strategies as endpoints that promote the false notion that there are safe or responsible ways to use drugs. That is, strategies in which the primary goal is to enable drug users to maintain addictive, destructive, and compulsive behavior by misleading users about some drug risks while ignoring others.”


Statements like these cause more harm and risk to the lives of those persons caught in the maelstrom of the current opioid epidemic.

Image of Alan Clear holding a sign that reads Needle exchange is Harm Reduction
Alan Clear Lower East Sife Harm reduction
Image Source

Harm reduction and The Opioid Epidemic

Needle Exchange

Syringe exchange is a program which distributes new hypodermic instruments and other paraphernalia an injection drug user employs to prepare and inject illicit drugs. The program works by exchanging new syringes for used syringes. In addition to syringes, exchange programs distribute caps used to mix the shot, cotton, tourniquets, alcohol swabs, and sharps containers to carry used needles in until returned to the program safely. These portable easy to carry sharps containers keep an IV drug user, or other persons searching in a bag, safe from accidental needle punctures.

Needle exchange programs can be traced back to 1983 when a pharmacy in the Netherlands began distributing sterile syringes to illicit drug users. The plan was executed due to an outbreak of Hepatitis-B. 

In 1998 in a press release, Donna Shalala, Secretary of Health and Human Services for the Clinton Administration, stated:

“A meticulous scientific review has now proven that needle exchange programs can reduce the transmission of HIV and save lives without losing ground in the battle against illegal drugs.” 

In a weekly report published on, December 11, 2015, the CDC released findings of research concluding that not only do syringe exchange programs remove HIV, HCV, and Hep C contaminated syringes form a community the programs also have established a gateway for services for substance abuse treatment and other social services.

The research concludes that needle exchange not only reduces risk and harm of injecting illicit substances, but also provides a safe haven to educate and motivate persons struggling with substance abuse disorders about the benefits of recovery, wellness, and personal health.

Picture shows 3 take-home bottles of methadone as a form of harm reduction and process of overcoming heroin addiction.
“Harm Reduction saved my life: Methadone maintenance needle exchange, and safe injection sites combined to slowly create the desire to change. Most importantly, the people who embraced harm reduction policy into there organizations were key to my ultimate positive change. These clinicians, staff members, volunteers, and my recovery coach set the stage for my readiness to change. The way I was treated, respected, and spoken too caused me to question the way I was living. The respect showed to me created a sense of acceptance and respect for the first time in over a decade.” 

John Makohen excerpt Homeless. Alone. Hungry and Cold: Street Junky.

Methadone Maintenance Treatment Programs (MMTP)

MMTP is a Drug replacement therapy which reduces risk by providing a less harmful, longer-lasting opiate for those who have severe opiate use disorders. In MMTP, Methadone is prescribed, administered, and regulated by medical staff (licensed nurses). When a program is responsible for distributing methadone, structure and stability start to replace the unhealthy chaos associated with opiate addiction.

Ultimately, the goal of harm reduction is abstinence while respecting the individual’s readiness to change. The road to recovery I followed was through MMTP. I wasn’t planning on getting sober when I first came to the program. My goal was not to wake up, dope-sick and broke on the streets. My addiction to dope and the needle never let me hold onto a shot for the morning. But methadone allowed me not to fear waking up because my dose lasted throughout the day and night.


Christopher Morris/Corbis via Getty Images

Insite in Vancouver B.C Canada, a safe injection site has not only created a safe place for heroin users to use heroin but a place where the message for recovery is talked about openly without coercion or force.

Safe injection sites

In my opinion, safe injection sites are the ultimate form of harm reduction. The most controversial, too. Recently safe havens to inject illicit substances is creating a public outcry. Opposition to new harm reduction policy and procedures is typical.

A safe injection site provides clean supplies and equipment, along with medical assistance, and education about how to safely use and discard of injection equipment. Besides these fundamentals, safe injection houses provide information convening medical and mental health and substance abuse treatment.

More importantly, employees are available to establish caring relationships with participants using the services provided by the site.  The workers employed by safe injection sites are accessible to engage participants in conversations concerning recovery and change. Frequently these conversations have more impact because the setting is non-confrontational.

Not only do workers provide safety information they are available to assist in the event of an accidental overdose.

here is an example of how Insite a safe-injection site in Vancouver immediately responds to another’s readiness for change.

One morning at Insite,  Tim Gauthier, Insite’s clinic coordinator spotted a man slumped up against the facility’s doorway. Instinct urged him to check for an accidental overdose, but the man was alive. When he was awake he asked for information about detox. Tim Gauthier states in an interview, “That’s very typical, that’s usually how those things play out,”

Insite meets the people of Vancouver with heroin use disorders where they are at and when the interest and readiness for change peeks, the person is referred to Onsite which is located on the second floor of the facility. Onsite has beds for detox and long-term recovery stairs available.

Before I chose to work a program of recovery, I was able to find the security of several organizations which offered a safe place for me to fix. I welcomed the freedom to use a restroom which was safe, clean, and free from public scrutiny.

Not only did the facility allow free use of the restroom, but they monitored the amount of time spent behind the door. Every 5 minutes, a worker would knock on the door if I did not reply, the worker was coming in armed with Narcan.

The workers made it a point to befriend each newcomer to the organization. Eventually, the facility became a place to enjoy a cup of coffee, use the internet, charge my phone, and engage in friendly conversations. I started to crave spending time discussing sociology and philosophy with social workers at the facility. Our discussions covered healthcare, HepC, and HIV testing, Prep, needle exchange, diet and nutrition, and life in general. 

Safe injection sites will save lives, increase safety to public health, and properly discard of medical waste. More importantly, these sites will provide social services in the form of empathy and care for the well-being of those persons who feel devastated and without hope.

Why Harm Reduction Works Key Takeaways

Let’s recap how harm reduction worked in my life:

Needle Exchange- provided me with sterile syringes, clean kits, education and information about HIV/AIDS, Hep B and C, overdose, social services, and most importantly accepted my readiness to change.

Methadone Maintenance (MMTP)– allowed me to follow my own path along the road to recovery without ridicule, contempt, or pressure. As I matured in my medicated assisted treatment (MAT) program, I learned that I could live life without heroin. Heroin, and more importantly the needle. Methadone helped me rewrite my definition.

Safe Injection Houses– I’ve never been in a state-run facility, but I’ve had the opportunity to take part in organizations which allowed me to use the bathroom to work up. There was always someone keeping watch on a clock outside the door, to prevent an accidental overdose. Every 4 minutes the person would call out and expect a reply immediately or else the staff would be coming in NARCAN in hand. Clean syringes and kits were readily available.

How do you feel about harm reduction now?

I am just one of the thousands who are living and breathing free from chemical dependency and trauma of our past.

I’ve outlined my personal case study of how Harm Reduction worked in my life. I’m alive and well, due to the individuals who’ve accepted to reduce harm first and treat me with respect.  

Staff at the facilities I chose to become a part of, spoke to me with respect, dignity, and care. I was treated equally. They looked past the dirt ground into my hands, uncleanliness, and repulsive smell. They didn’t stare at the bruises on my arms, the bags under my eyes and sunken-in cheeks upon my face, or my cynical toothless grin.

I wasn’t just some homeless street junky kid.  I was another human being struggling to live one more day, and that is all that mattered to them.

Instead of pressuring me into change, I was embraced for who I was at a time in my life when I couldn’t find on an ounce of love for myself.

Meeting me where I was at sparked a friendship. Over time this connection helped me connect with who I was,  what I believed, and remembered of myself without heroin.

Discussions with staff and volunteers rarely covered my plans for change. However, hearing and seeing their stories of triumph over heroin and other drugs helped me realize that I had a choice. I could choose a futile painful life or embrace change.

Harm reduction worked for me. It’s working right now in someone else’s struggle to find the road to recovery.

Now that you have a better understanding of harm reduction how can your recovery coaching clients benefit from you meeting them where they are at without pressure, attitude, and ultimatums.

Start reducing harm, so you can build long-lasting relationships which create the readiness for change.

Stay informed about how you can use harm reduction in your recovery coaching business by signing up for our newsletter. 


Before you can overcome your high-risk situations and relapse triggers, you have to know the situations most dangerous to you and your recovery.

Download your FREE High-Risk Situation Workbook Today

The Addiction Recovery Coaching Blog

Blog post header image for the post explaining why Arise Recovery Coaching supports harm reduction and uses a case study to support the claim. Harm reduction save my life
Arise Recovery Coaching in NYC supports harm reduction policy to help you reduce the harm from heroin or other drugs. Read my case study explaining why harm reduction works.
Blog post header explaining what a Harajuku Moment is, and how Arise Recovery Coaching in NYC can help you find yours.
Do you know what a Harajuku Moment is and why it initiates change? In this post, you will learn why and how a Harajuku Moment initiates change and leads to freedom from heroin or other drugs.
Blog post header learn how arise recovery coaching in nyc can help you breakthrough your roadblocks keeping you from finding fulfillment in recovery

A recovery coach will help you recognize the barriers holding you back. Learn what roadblocks keep you from fulfillment in recovery and how to work through each one.