How Do You Know Harm Reduction is Working? Who Gets to Define Progress?

“The unifying force of decolonization lies in its ability to change the order of things.” – Frantz Fanon

There’s a question that circles back over and over when I present harm reduction in eating disorder spaces: “But how do you know if it’s working?”

The question itself reveals the limits of institutional logic—where progress must be tracked, documented, and scaled into measurable outcomes that fit someone else’s rubric for success.

Institutional models demand outcomes. They want data, they want compliance, they want to know how fast someone can recover so they can label the case resolved and move on. In this climate, harm reduction appears risky—because it refuses to speed up for the sake of optics. It disrupts the false sense of control that institutional frameworks cling to.

But the real question isn’t “Is it working?” The real question is: Who gets to decide what working looks like?

For too long, the dominant culture has defined healing as obedience. Recovery becomes a metric—measured in meal logs, weigh-ins, and symptom checklists. But people are not lab experiments. Survival is not data. And to believe that healing can be quantified without context is a dangerous erasure of lived experience.

Harm reduction, when practiced with integrity, refuses to play that game.

It holds space for ambiguity, contradiction, and resistance. It acknowledges that sometimes progress means someone choosing to eat once instead of none. It understands that sometimes “failure” by institutional standards is often just someone asserting their humanity in a system that doesn’t recognize it.

We are told that healing must move in steps. That there are benchmarks to meet. That success looks like behavior eradication. That struggling means we’ve gone backwards. But the bodies I know—mine included—don’t work that way. And neither does real life. Harm reduction makes room for that reality.

Harm reduction doesn’t operate on tidy timelines or diagnostic stages. It’s not something you introduce after someone has “failed” recovery; it’s not a consolation prize for those deemed “non-compliant.” Harm reduction, if understood in its full capacity, is a way of being—not a strategy you pull from the back pocket when the biomedical model has run out of answers.

And here’s what’s often misunderstood: Harm reduction does not ignore the severity or gravity of eating disorders. It recognizes how deeply eating disorders can impact the body and mind. But I don’t believe harm reduction only exists as a last resort in the face of death. Instead, harm reduction asks: What are the systems pushing people into self-harm in the first place? Not enough attention is paid to how the eating disorder treatment industry itself is broken—how people are often seen as the crisis, instead of being given access to adequate education and tools for navigating their eating disorders when they are not ready or able to commit to full remission. Instead of pathologizing people for being “resistant,” we need to ask why they are rarely given the chance to understand their options early on, and on their own terms.

Every person engaging in harm reduction holds different truths. Some want to reduce physical consequences. Some want to stop hiding. Some want to survive one more year, week, day. Some want to reclaim their relationship with food, slowly, quietly, without being forced into recovery mythology. Their pace is not failure. Their process is not regression. Their truth is not less valid because it doesn’t come with a discharge summary or a neat before-and-after story.

Self-Assessment in Harm Reduction: What Does Progress Actually Look Like?

In a framework that resists rigid timelines and predefined endpoints, one of the most radical things a person can do is define progress for themselves. Harm reduction doesn’t mean abandoning goals—it means redefining what goals can be. It means allowing for complexity, slowness, and survival.

If you're living with an eating disorder and walking a harm reduction path, your progress might not show up in a weight chart or symptom tracker. It might look like:

• Saying no to a behavior one time this week when previously it felt impossible.

• Choosing to eat something, even if not everything.

• Allowing yourself to rest without justifying it with productivity.

• Feeling the urge and pausing before acting.

• Disclosing eating disorder to providers, when it feels safe.

• Seeking out care that centers your reality, not someone else’s version of recovery.

• Feeling less shame—even for a moment.

• Being able to name your needs, even if you can't yet meet them.

Progress in harm reduction is deeply personal. You might ask yourself:

• What feels slightly more possible today than it did a month ago?

• When do I feel most supported, and when do I feel most alone?

• What has shifted in how I relate to food, body, or coping?

• What patterns are repeating, and what’s different about them now?

• What am I learning about myself in this process that I didn’t know before?

And let me be clear: harm reduction is not for the weak.

It demands a kind of patience that institutional care does not know how to hold. It calls on us—providers, peers, community members—to sit in the discomfort of witnessing someone struggle without rushing to fix or force them through a predetermined path. It requires the humility to admit we don’t always know what’s best for someone. And it resists the urge to coerce someone toward change they haven’t consented to.

Harm reduction honors a person’s own insight into their experience. It does not start from the assumption that providers are the authority, or that those who live with eating disorders are “in denial.” It begins with the belief that people know what’s working for them, what’s tolerable, what’s too much, and what’s next.

This work is not about perfection. It's about presence.

And presence is powerful—because it cannot be bought, billed, or bureaucratized.

We can’t keep pretending that delayed harm reduction is better than none at all.

If we believe people deserve care before they meet criteria, before they reach crisis, before they have the words to explain it—we have to build systems that support them from the start.

Harm reduction doesn’t need to be made more palatable to fit the current treatment system.

It’s already doing what the system won’t: keeping people alive, dignified, and in charge of their own lives.

Let harm reduction remain unruly, resistant, and full of contradictions. Let it grow in the cracks of what the recovery industrial complex deems unworthy. Let it be messy and real, because people are messy and real. And maybe, that’s what makes it so radical.