Accountability for Alcoholism Treatment

When a doctor prescribes a medication to treat an illness, you know that medication has been tested and retested for effectiveness and side effects before it can ever get FDA approval. Even with these safeguards in place sometimes unsafe medications sneak through.

But there is no FDA for chemical dependency programs. Anyone can set up any sort of treatment center that they want to and make any claims about success rates that they want to and there is no organization that holds them accountable for any of it. The chemical dependency treatment industry is as full of snake oil as the patent medicine industry was before the advent of the FDA.

The only evidence one ever sees for chemical dependency treatment programs is testimonial evidence, which all scientists know is worthless because of the placebo effect and the existence of random chance.

Under the current system, a chemical dependency treatment center will get paid regardless of whether their clients get better, stay the same, or get worse. There is zero motivation to provide effective treatment. The “revolving door” nature of the treatment industry–the fact that as soon as a client leaves treatment he/she goes out on the street and does drugs or alcohol and is back in  treatment the next day with another exorbitant price tag to be paid–is a joke. Chemical dependency treatment centers do not care if anyone gets better so long as the centers get paid every time the client recycles through.

The only way to ever get effective and meaningful treatment for people with drug and alcohol problems is to hold treatment centers accountable for the quality of treatment that they provide. If a treatment center promises abstinence from drugs and alcohol, then that treatment center should not be paid for its services until after the client had remained abstinent from drugs and alcohol for a year. If the client “relapses” within the first year, then the treatment provider does not get paid.

A system like that would get rid of snake oil based treatment centers in short order. 12 step treatment centers would be the first to go, since clinical evidence from as far back as the 1980s has shown that 12 step treatment is not effective.

In its place we would see treatments based on psychological science rather than one man’s belief that a “Higher Power” had contacted him and put the cure for alcoholism into his hands. And we would see the proliferation of harm reduction based treatments which could actually deliver on the promises that they make.

Copyright © 2010, The HAMS Harm Reduction Network

“Alcoholism” Antisocial Personality Disorder, and Homelessness

In my experience it seems that the people who engage in highly destructive behaviors related to substance use always have a dual diagnosis of substance abuse AND antisocial personality disorder.

When these people fall into the hands of the chemical dependency treatment industry they are virtually always given a single diagnosis of “addiction” and their antisocial personality disorder goes unrecognized.

Yet the junkie on the street who will rob you for ten dollars is NOT representative of junkies in general–there are a lot of white collar junkies that fly under the radar.

The same is true of boozehounds.

In self righteous American society we always talk about “alcoholism” causing homelessness and never the reverse.

Yet I often wonder if most of the alkies living on the street were driven to drink like that BECAUSE of the fact that they had to live on the streets.

I would like to see some evidence of whether drunkenness is more likely to cause homelessness or homelessness is more likely to cause drunkenness.

Copyright © 2009, The HAMS Harm Reduction Network

Calling People Bad Names Never Solved Anything

It is quite amazing to me how so many people who consider themselves liberal and enlightened go around calling other folks bad names like “alcoholic” or “addict”. These same people would never think about calling others bad names based on their race, ethnicity, religion, IQ, sexual orientation or even sanity.

It seems that even most of the liberals in American society need a scapegoat and people who like to engage in recreational intoxication or other vices such as gambling or even promiscuity are now subject to getting labeled as an “alcoholic” or an “addict” by every uneducated un-degreed yay-hoo on the street.

The fact is that the words alcoholic and addict do not even occur in the DSM-IV and even if they did then you would still be diagnosing folks without a license if you used them to label people.

The simple fact is that “alcoholic” and “addict” are merely dirty words that some people use to make other people feel bad about themselves. If you use them, then shame on you–you oughtta have your mouth washed out with soap.

Copyright © 2009, The HAMS Harm Reduction Network

Let’s Get Rid Of The Stigma For Real

It is just as wrong for the segment of society which does not use drugs or alcohol to attempt to impose their value system upon people who choose to engage in recreational intoxication as it is for the heterosexual majority to impose their value system and sexual practices on the homosexual minority. We no longer lock homosexual men in prison for the practice of consensual sodomy. Nor do we send them to therapists to “treat” their “mental illness” of homosexuality. In 1973 the American Psychiatric Association voted that homosexuality was no longer a disease and removed it from the DSM.

We are told by many people that homosexuality is genetic and inherited and that since people cannot choose to be other than what they are that we should accept it and not blame them for who they are–they cannot help it.

Yet we are also told that people who choose to engage in recreational intoxication by using drugs or alcohol are diseased. Why are they diseased? Because they are born that way and they cannot help it and therefore they must be treated until l they change whether they like it or not.

Homosexuality is NOT a disease. This is because it is genetic. Recreational intoxication IS a disease. This is because it is genetic. HUH???!!

What an outrage it would be to take all the homosexuals in America and lock them up in religiously oriented brainwashing camps and to tell them that every time they engaged in homosexual sex it meant that they had “relapsed” into their “disease” and that their only hope was to admit that they were powerless over their homosexuality and to ask a “Higher Power” to give them a daily reprieve from their homosexual behavior.

Yet this is exactly the sort of gross and repellant violation of basic human rights which is accorded to those in America who choose to engage in recreational intoxication. Just get caught even once in possession of a joint and you will be locked up in a religious brainwashing camp and be told that that which you like to do is a disease and that the only cure for your disease is to spend every day for the rest of your life sitting around some godawful religious meeting. Good grief–it is enough to drive one to drink!

Calling something a “disease” or a “mental illness” does not remove stigma. Calling it a personal lifestyle choice is what removes the stigma.

No gay person of my acquaintance has ever said to me “Let is put homosexuality back in the DSM and call homosexuality a mental illness instead of a lifestyle choice so that we can remove the stigma.”

Classifying things as crimes or diseases stigmatizes them. Classifying them as lifestyle choices removes the stigma. The NIAAA wants to refer to recreational alcohol intoxication as “binge drinking” in order to stigmatize it and to force people to stop engaging in it because the NIAAA feels that it has an inalienable right to force its value system upon others against their will.

From my perspective forcing one’s values upon others against their will is a far worse addiction than is engaging in a bit of recreational drug or alcohol use. So is locking someone up in a religious brainwashing camp and forcing your conception of a “Higher Power” on them against their wills.

I do not believe that G.O.D. stands for Group Of Drunks. I don’t believe in creationism in the first place–but even if I did I would not believe that a group of drunks created the universe. Nor do I believe that AA created the universe. Group Of Drunks = G. O. D. indeed!

Let us recognize that engaging in recreational drug or alcohol intoxication–just like homosexuality–is a lifestyle choice. Yes–drug or alcohol use can be a high risk behavior–but so can homosexuality. Both call for personal responsibility and good harm reduction practices to reduce the accompanying risks.

Just as safe sex is good sex–safe intoxication is good intoxication.

How about doing away with abstinence-only programs for drugs and alcohol and teaching kids about safe drug and alcohol use instead?

And how about doing away with abstinence-only programs for sex and teaching kids about safe sex whether it is straight sex or gay sex?

The life you save may be your child’s.

Copyright © 2009, The HAMS Harm Reduction Network

How HAMS Split Off From MM

“Breaking up is hard to do.”

It was quite inevitable that the harm reduction faction within Moderation Management (MM) would eventually split off from MM and move on to do its own thing. The events of the summer of 2006 merely served to hasten things along.

I have nothing but the utmost respect for the MM program; MM was the only place for me to go when I was seeking support for the changes which I was making in my drinking. However–MM was never a good fit for me–although MM is a good fit for many people.

My other great source of support and learning was needle exchange where I worked as a volunteer–however since my drug of choice was alcohol and I didn’t do any illegal drugs much less shoot drugs there was limited support available to me via this avenue as well.

First let us look at some of the things that the MM program is about:

The following is from MM’s website (http://www.moderation.org/whatisMM.shtml, accessed Oct 4, 2009)

What if moderation does not work for you?

After completing 30 days of abstinence (step two of the MM program) and then starting the moderation part of the program, you may discover that it is more difficult for you to moderate your drinking than to abstain. In this case, consider a self-management goal of abstinence. Some members of MM who choose abstinence remain in our program; others find an abstinence-only group to attend.

MM’s definition of moderate drinking is as follows according to the current MM trifold (http://www.moderation.org/images/tools/trifold2008_sample.pdf accessed Oct 4, 2009)

For Men:

No more than 14 drinks per week or 4 drinks per occasion.

For Women:

No more than 9 drinks per week or 3 drinks per occasion.

For All:

3-4 non-drinking days per week.

Current statements by MM are actually somewhat milder than the ones found earlier in MM–for example those found on this earlier trifold of MM’s which reiterate statements in the Kishline book (http://www.doctordeluca.com/Documents/MM%20Tri-fold.pdf accessed Oct 4, 2009)

MM is not for alcoholics, chronic drinkers, or those who experience significant withdrawal symptoms when they stop drinking. MM is also not intended for former dependent drinkers who are now abstaining. Chronic drinkers should consider contacting an abstinence-based support group. MM is intended for problem drinkers who have experienced mild to moderate levels of alcohol-related problems.

What I learned by volunteering in needle exchange was that it was essential to foster and encourage every positive change rather than to think about who was a “problem user” and who was an “addict”. Indeed–it would be nothing but bizarre to offer clean needles only to people who shot heroin in moderation but to tell those who exceeded some sort of imaginary moderate limit that they would not be allowed access to clean needles or other harm reduction resources because they were addicted and therefore needed an abstinence based program!

My harm reduction goal with alcohol was to drink a fifth of booze (17 standard drinks) safely at home one night a week and to abstain the other six nights per week–clearly a harm reduction goal when compared with the fact that I had previously gotten this intoxicated 4 nights per week–but also clearly at odds with MM’s definitions of moderate drinking.

I spent around four years from 2002 until 2006 working as an administrator for MM and during this time I introduced many harm reduction concepts which I had learned at needle exchange into the MM online community–these concepts were received with great enthusiasm by those who were unable to “toe the line” of the strict MM limits and who also did even worse if attempts were made to impose abstinence upon them.

Then around August of 2006 a faction arose within the MM online community which proceeded to viciously and sadistically attack anyone who failed to be either perfectly moderate or to be perfectly abstinent. I say a faction but it was primarily a single individual. Rather than banning these sadistic attacks the MM administration decided to ban swear words.

September 13, 2006 I created the modsabshr yahoo group as a subgroup of MM for people who wanted to escape the sadistic attacks and the censorship that was occurring on the main MM email group. I also resigned as administrator of the main MM email group at this point in time.

In December of 2006 I decided that it was a bit ridiculous for me to continue working a 40 hour work week running MM’s chat room since I had neither job title at MM nor even a nominal stipend from MM for doing so.

Therefore on January 15, 2007 I created the hamshrn yahoo group and thus founded The HAMS Harm Reduction Network as an entity independent of MM. HAMS was incorporated in the state of New York August 21, 2007 (the same date as our first live meeting by coincidence) and we were granted 501(c)3 status by the IRS November 15, 2007.

This is the first time I have spoken publicly about what happened since we split with MM way back in 2006. That is because I have finally calmed down a bit and can now speak objectively without flying off the handle and acting like an asshole.

MM is a good fit for a lot of early stage problem drinkers and many people have benefited from MM–if you are an early stage problem drinker then you may find that MM is a good fit for you, too. SMART is a good fit for rational abstainers and even the dreaded AA can be a good fit for some people who want to abstain and who have the right kind of personality type to fit with a 12 step program.

HAMS is a good fit for a lot of us who want to define our own programs and who want to make positive changes which might be quite different from moderation–HAMS also fits those of us who want to abstain or moderate in our own way.

Copyright © 2009, The HAMS Harm Reduction Network

Let’s Put An End To Discrimination Based On Treatment Goal

The following is a true story: A short time ago I was under a tremendous amount of situational stress involving leaving an old job and starting a new venture. Not only was I leaving an old job behind, this new venture also entailed leaving many close old friends behind. I was depressed and stressed from all sides from emotional to financial. I needed someone to talk to so I sought out a mental health professional.

I filled out an intake questionnaire which asked if I had any problems with drugs or alcohol. Since I currently had no problems with drugs or alcohol, I truthfully answered “No”. Then it came time for my intake interview and the interviewer asked if I had ever been in a chemical dependency treatment program. I truthfully replied yes that I had checked myself into such a program many years before. I was then asked if I had been perfectly abstinent from alcohol and all other recreational drugs (except for nicotine and caffeine) for the past six months. I truthfully replied that I was not totally abstinent from alcohol because I was drinking within NIAAA approved guidelines for moderate drinking.

I was told by the intake person that I would not be allowed any mental health services until I had been totally abstinent for all addicting drugs (except for caffeine and nicotine) for six months and that I would have to enroll in their chemical dependency treatment program for six months before I would be allowed access to any mental health services to deal with my stress and depression.

I tried to explain that my previous experience with chemical dependency treatment had been damaging and had caused me to drink more and that it had taken me two years to recover from the treatment and establish a non-problematic relationship with alcohol. I was still refused necessary mental health treatment unless I was willing to undergo a chemical dependency treatment which was not only unnecessary but which was in violation of my religious beliefs and which had proved harmful in the past.

It is a total outrage and morally reprehensible to deny client needed mental health services which might save their lives simply because the client’s goal vis a vis alcohol or drug use might be moderation or harm reduction rather than total abstinence. It is a violation of the most basic principles of humanistic psychotherapy for the therapists to force their goals and beliefs and values on the clients against the clients’ wills.

The time has come to eliminate discrimination against clients who are successfully pursuing treatment goals of moderation or harm reduction. The evidence from the NIAAA itself shows that people are just as likely to resolve and alcohol problem with a goal of moderation as with a goal of abstinence and that most problems with drugs or alcohol are resolved successfully without recourse to any sort of formal chemical dependency treatment at all.

People like Patt Denning and Andrew Tatarsky have clearly demonstrated that drug and alcohol users respond to psychotherapy even while they are still actively using drugs and alcohol and that giving them access to mental health treatment while actively using can actually help them to resolve drug or alcohol problems successfully via harm reduction, moderation or abstinence.

The time has come for the Department of Health and Mental Hygiene of the City of New York and the New York State Office of Alcoholism and Substance Abuse to insure that no active user of drugs or alcohol is refused access to mental health services for refusing to undergo chemical dependency treatment. Let us put an end to this sort of discrimination once and for all.

Copyright © 2009, The HAMS Harm Reduction Network

AA and Terminal Identification-itis

There is a horrendous peer pressure on anyone who ever attends an AA meeting to renounce one’s identity as an individual and to identify with the group. And there is horrific social pressure on anyone who ever has a problem with alcohol to join AA in spite of AA’s lack or any track record of success. People who attend AA and insist on showing any trait of individuality are told that they suffer from a condition called “Terminal Uniqueness”–that if they insist that they have a personality of their own it means that they will drink and die.

People who do not have the sense to preserve their personal identities and leave AA often stay and become more and more miserable and depressed with each meeting. When the depression gets bad enough they commit suicide. If they don’t commit suicide they go out and drink and all the AA programming about powerlessness kicks in and they kill themselves or someone else by driving drink or die of alcohol poisoning or withdrawal.

What is it that these people really died of?

Terminal Identification-itis .

These people forced themselves to identify with AA and everyone there even if it killed them.

And it did.

At AA meetings you always hear it said that “we are all the same”.

In HAMS we know that everyone is different.

Copyright © 2009, The HAMS Harm Reduction Network

To the wives

This title of course is a take on a chapter in the AA ‘Big Book”.   Everything that we are saying here holds true for any significant other or friend or family of any drinker–male or female.

Here at HAMS we have a saying:”perfectionism is the enemy of the good”

If your husband improves in his drinking habits then you need to support that no matter how small the improvement. It doesn’t matter if he drinks more safely, or cuts back or even quits–every positive change is a positive change and needs to be recognized as such.

If you keep demanding that your husband be perfectly abstinent because that is what he has to do to satisfy you the odds that you will make him actually become abstinent are infinitesimal. It is far more likely that his drinking will become far worse than it ever has before.

Alanon is poison. Demands for perfection almost always backfire and blow up in your face. If you want to see your husband dead in a drunk driving accident then go ahead and throw that Alanon shit and those demands for perfection in his face.

Alanon has probably killed more drinkers and broken up more marriages than any organization since AA itself.

If you really love your husband and want to see him get better then you need to recognize that better IS better and you need to encourage every positive change. Harm reduction may be just the thing that works for your husband.

People like Miller and Rollnick who invented Motivational Interviewing have taught us that the way to get people to change is not to nag them. It is to give them a chance to examine what they really want and to support them in making positive changes.

The life you save may be your husband’s.

Copyright © 2009, The HAMS Harm Reduction Network

Is PAWS an Iatrogenic Artifact of 12 Step Treatment?

Post Acute Withdrawal Syndrome–PAWS–seems almost entirely iatrogenic–in other words it is an artifact of the treatment modality which would not occur if people were quitting naturally on their own because they chose to instead of quitting through a 12 step treatment program and against their will because someone forced them to be there.

Just think of it–suddenly you are deprived of your favorite hobby in the world and told that you will NEVER EVER be able to enjoy it again. Isn’t this enough to make anyone miserable even if the hobby were knitting or reading comic books rather than drinking?

You are horribly shamed by your “recovery” group if you ever drink again.

You are forced to attend these godawful brainwashing meeting which are a torture in and of themselves and on top of that you are forced to believe in one of the sickest and most twisted theologies on record–the god of Bill Wilson’s 12 steps who has created alcohol to torture humainty and before whom we were all lost until finally god in his infinite mercy revealed the 12 steps to Bill Wilson who could now go and become the savior of humanity.

BARF BARF BARF BARF BARF!!

Sitting in AA meetings and listening to this sort of garbage is sure to make you sick–if you stay away from the 12 steps and if you quit by your own choice–whether cold turkey or through pharmacological extinction or through gradual reduction you will never have PAWS.

Brain disease my great aunt’s sweet patootie!!!

Copyright © 2009, The HAMS Harm Reduction Network

Why hide the fact that you’re a hamster?

Hamsters should be loud and proud. We are actually taking steps to get better! Maybe that asshole sitting next to you in the bar is planning to get in his car and put his life and the lives of others at risk when he leaves tonight. We hamsters are not. We are taking the steps to make sure that neither ourselves nor others are harmed by our drinking. This is not a badge of shame. This is a badge of honor. Be a hamster loud and proud!

Copyright © 2009, The HAMS Harm Reduction Network