Use Extinction Contrasted With Harm Reduction

A few years ago I read Andrew Tatarsky’s book “Harm Reduction Psychotherapy”. This is an excellent book which I highly recommend to anyone interested in dealing with drug or alcohol problems or working with clients who deal with the same. This book collects case histories of several clients treated by various therapists. Tatarsky is the editor–the chapters were written by various therapists. I plan to reread this soon and write a more in depth article about it–however, this book recently popped into my mind and I wished to make some blog comments about what I remembered about it. If my memory errs–please forgive me.

The 12 step/abstinence-only model tells therapists that they must not waste their time doing any sort of psychotherapy with drug or alcohol users–these “lepers” can only benefit from psychotherapy after a long period of abstinence which can be granted them only through indoctrination in a 12 step/abstinence-only program. This is because their supposed “addictive brain disease” precludes any benefit from any sort of psychotherapy.

Dr. Tatarky was quite brave in saying that giving psychotherapy to people who were still using drugs or alcohol could help them to stop using.

However–the predominant message I get from Dr. Tatarsky’s book is something which could better be characterized as “use extinction” rather than “harm reduction”. As I recall, therapists saw clients who were actively using drugs or alcohol– and successful outcomes weer those which involved abstinence from alcohol and drugs and AA attendance (if I recall correctly one successful outcome was drinking within MM limits).

I applaud Dr Tatarsky in championing psychotherapy for people who are not abstinent from drugs or alcohol. I personally have been refused psychotherapy at an extremely stressful period in my life because I was honest enough to admit that I had been through alcohol treatment previously and that I now drank unproblematically.

However–a purely harm reductionistic approach should not assume the elimination of recreational drug use or recreational alcohol intoxication as a goal. I got the feeling from the book that the therapists who contributed articles were imposing their personal values on the people who received therapy–and that therapy was only considered successful if and when the client accepted the goals which the therapist felt that the client ought to accept–i.e. abstinence.

Refusing therapy to someone who chooses recreational drug use or recreational alcohol intoxication is as bad as refusing medical treatment on the grounds of race or religion or sexual orientation. It is pure antihumanistic discrimination. Although people do not choose their race–they do choose their religion–and they also choose their forms of entertainment–such as recreational drug use or alcohol intoxication. This does not make them “lepers” who should be denied a needed medical treatment such as psychotherapy.

The purely harm reductionist approach should offer psychotherapy to people even if they choose to continue to enjoy recreational drug use or recreational alcohol intoxication.

The goal should be to help a client become a happy and healthy individual who likes him/herself.

We should no more attempt to “cure” someone who likes to overdrink a bit than we currently attempt to “cure” homosexuals. Homosexuality was officially a “disease” in the United States according to the DSM until 1974. In 1974 it became an “un-disease”.

It is past time that recreational drug use and recreational alcohol intoxication were un-diseased as well
.
Using psychotherapy to get an active drug or alcohol user to abstain should properly be called “use extinction”. This is in contrast to a pure harm reductionist model which respects the individual and which recognizes the individual’s to choose his/her own goal regarding intoxicants–which may include continued use.

Let us once and for all separate the issues. If someone requests psychotherapy let us give it to them regardless of race, color, creed, sexual orientation or choice of recreations.

I still find TV more addictive than alcohol and am on a major abstinence from watching TV.

Alternatives To Alcoholics Anonymous

When the vast majority of Americans hear the words “drinking problem” the first and only thought which pops into their minds is AA. Whereas it is true that AA has helped a large number of people become abstinent from alcohol, it has also become quite clear that AA is not a good fit for all problem drinkers. Brandsma (1980) has reported that forced AA attendance leads to increased binge drinking in a sample population. AA’s own “Triennial Surveys” (1990) report that only 5% of new AA members are still attending meetings at the end of one year. This number may be too low due to people moving to new cities, etc., but it is still suggestive that many new AA members soon leave. Moreover many people find that AA’s insistence on powerlessness, the surrender to a “Higher Power”, and the spiritual aspects of AA are offensive to their personal religious views.

Fortunately in the past three decades many alternatives to AA have sprung up which have proven helpful for those who were unhelped by AA. This article gives a brief summary of these alternative programs. None of them require a sponsor or a Higher Power or Twelve Steps.

HAMS

HAMS (Harm reduction, Abstinence and Moderation Support) was founded in 2007 to support any positive change individuals make in their drinking habits–including safer drinking, reduced drinking, or abstinence from alcohol. HAMS welcomes all drinkers who wish to make a positive change regardless of how much or how little they may drink.

The HAMS program is based on 14 elements. These are not steps. All the elements are optional and may be done in any order. The 14 elements of HAMS:

1. Hang out and interact with other Hamsters.
2. Deprogram from the disease model.
3. Track your use.
4. Take steps to reduce harm.
5. Take steps to reduce use.
6. Do a Cost/Benefit Analysis.
7. Choose/create your plan.
8. Address any issues which led to overdrinking.
9. Honestly report your progress/struggles.
10. Learn to have fun without booze.
11. Learn to cope without booze.
12. Praise yourself for every success!!
13. Tweak the plan.
14. Don’t be afraid to get back on the horse.

HAMS offers live support groups for its members as well as online support via and email group and a chat room.

HAMS is modeled on harm reduction programs for injection drug users which have had much success in curbing the harms of injection drug use. HAMS believes that alcohol is a drug and that strategies which work for other drugs will work for alcohol as well. HAMS encourages members to prioritize goals and to eliminate high risk behaviors first. HAMS is pragmatic in accepting that alcohol intoxication is a fact. HAMS is nonjudgmental in that it believes that safe intoxication is better than unsafe intoxication. HAMS members who choose abstinence do so because they feel empowered rather than powerless.

HAMS is based on research by Alan Marlatt (2002), the Open Society Institute (2004), and others which has demonstrated the efficacy of harm reduction approaches.

HAMS is organized around democratic principles–all members have a say in the governance of the organization.

HAMS has not as yet published a book–all the information about the HAMS program is available on the HAMS web site. HAMS recommends Patt Denning’s book Over The Influence.

HAMS rejects the disease model of addiction.

For more information visit the HAMS web site at http://hamsnetwork.org

MWO

My Way Out (MWO) was founded in 2005 by Roberta Jewell (pseudonym). MWO offers a great deal of information about medications, dietary supplements, hypnosis, relaxation CDs and more to fight alcohol. MWO supports both goals of abstinence and moderate drinking. Ms. Jewell bases the MWO program on her own experiences with the medication Topamax (Topiramate) which has been shown in clinical trials to be very helpful in reducing cravings for alcohol.

MWO offers online support via a forum and a chat room.

The MWO handbook is My Way Out by Roberta Jewell.

For more information visit the MWO web site at http://www.mywayout.org

MM

Moderation Management (MM) was founded in 1993 as a support group for people who wish to pursue moderate drinking as a goal. The MM handbook Moderate Drinking was published in 1994. MM sets moderate drinking limits of no more than 14 standard drinks per week and no more than 4 per day for men and no more than 9 per week and 3 per day for women. A standard drink is defined as a drink containing 0.6 oz of ethyl alcohol.

The MM program is based in its Nine Steps Toward Moderation and Positive Lifestyle Changes:

1. Attend meetings or on-line groups and learn about the program of Moderation Management.
2. Abstain from alcoholic beverages for 30 days and complete steps three through six during this time.
3. Examine how drinking has affected your life.
4. Write down your life priorities.
5. Take a look at how much, how often, and under what circumstances you had been drinking.
6. Learn the MM guidelines and limits for moderate drinking.
7. Set moderate drinking limits and start weekly “small steps” toward balance and moderation in other areas of your life.
8. Review your progress and update your goals.
9. Continue to make positive lifestyle changes and attend meetings whenever you need ongoing support or would like to help newcomers.

MM offers live support groups for its members as well as online support via and email group and a chat room.

MM strongly suggests that persons who fail to remain within moderate drinking limits, who do not complete a 30 day abstinence or who score 20 points or more on The Short Alcohol Dependence Data Questionnaire (which can be found on the MM web site) leave MM and pursue an abstinence based program instead.

MM is based on research by Mark and Linda Sobell (1973, 1978), Martha Sanchez-Craig (1995) and others which demonstrated that people who did not have severe alcohol problems could be taught moderate drinking skills.

The book Responsible Drinking (2002) has supplanted the book Moderate Drinking (1994) as the MM handbook.

MM accepts the disease model of addiction for alcoholics but not for problem drinkers.

For more information visit the MM web site at http://moderation.org

WFS

WFS (Women For Sobriety) is an abstinence-based program founded in 1976 by Jean Kirkpatrick. Ms. Kirkpatrick felt that the AA tactic of “breaking down big egos” was harmful rather than helpful to women. WFS assumes that women drink because they are disempowered and offers a program to empower women and make them strong enough to quit drinking.

WFS is based in the 13 Affirmations of the New Life Acceptance Program:

1. I have a life-threatening problem that once had me. I now take charge of my life. I accept the responsibility.
2. Negative thoughts destroy only myself. My first conscious act must be to remove negativity from my life.
3. Happiness is a habit I will develop. Happiness is created, not waited for.
4. Problems bother me only to the degree I permit them to. I now better understand my problems and do not permit problems to overwhelm me.
5. I am what I think. I am a capable, competent, caring, compassionate woman.
6. Life can be ordinary or it can be great. Greatness is mine by a conscious effort.
7. Love can change the course of my world. Caring becomes all important.
8. The fundamental object of life is emotional and spiritual growth. Daily I put my life into a proper order, knowing which are the priorities.
9. The past is gone forever. No longer will I be victimized by the past, I am a new person.
10. 1All love given returns. I will learn to know that others love me.
11. Enthusiasm is my daily exercise. I treasure all moments of my new life.
12. I am a competent woman and have much to give life. This is what I am and I shall know it always.
13. I am responsible for myself and for my actions. I am in charge of my mind, my thoughts, and my life.

WFS offers both live meetings and online support via a forum and a chat room.

WFS accepts the disease model of addiction.

For more information visit the WFS web site at http://www.womenforsobriety.org

RR

RR (Rational Recovery) is an abstinence program which takes the stance that all individuals are capable of self-recovery–no support groups, treatment centers or therapists are necessary to overcome an addiction. All that is required is a mastery of AVRT (Addictive Voice Recognition Technique). A complete course in AVRT is available free-of-charge on the RR web site. More detailed descriptions of AVRT are available in books published by RR. RR claims that groups are not only unnecessary, but that groups are detrimental and become an addiction in and of themselves. RR has taken this stance since 1994.

RR was founded by Jack Trimpey in 1986. Between 1986 and 1994 RR operated support groups which in 1994 became the basis for SMART Recovery. During this period the RR handbook was The Small Book. In 1994 Trimpey announced that the discovery of AVRT had made support groups obsolete. SMART and RR went their separate ways.

RR offers a complete AVRT course online for free, books and DVDs on AVRT, and seminars on AVRT for which there is a charge.

The core of AVRT is identifying any desire for drugs or alcohol as outside the self. All desires for abstinence are identified with the self. AVRT says “I want to abstain, IT wants me to drink.” Anecdotal evidence from AVRT users suggests that it is highly effective for a number of people.

RR rejects the disease model of addiction.

For more information visit the RR web site at http://rational.org

SMART Recovery

SMART (Self Management And Recovery Training) is an abstinence program which teaches members how to use techniques from RET (Rational Emotive Therapy) and CBT (Cognitive Behavioral Therapy) to deal with their urges to drink or drug. SMART meetings are free of charge–but they are led by a trained facilitator rather than a pure layman. SMART concentrates at working on feelings underlying the urge to use.

SMART offers both live meetings and online support via a forum and a chat room.

SMART is an offshoot of RR which became an independent entity in 1994 as detailed above.

SMART concentrates on teaching its members The ABC Model developed by Albert Ellis as the basis of Rational Emotive Behavioral Therapy (REBT or RET).

The ABC Model is a refinement of the Stimulus Response Model. Ellis says that C, the Consequent Reaction (i.e Response) to A, and Activating Event (i.e. Stimulus) is mediated by B, the Belief System of the individual. When one changes one’s Beliefs about the Activating Event then one also changes one’s Consequent Reactions to the event. The ABC model is all about disputing Irrational Beliefs and replacing them with Rational Beliefs.

As a very simple example, if one has a bad day at work (A: Activating Event) one may believe that life is awful and that one might as well kill oneself (N: Beliefs) and one will have thoughts of suicide (C: Consequent Reaction). REBT teaches people to dispute the Irrational Belief and replace it with a Rational Belief such as “Today may have been hard, but tomorrow is a new day and I can start fresh”. When Beliefs are changed so are Consequent Reactions.

SMART rejects the disease model of addiction.

For more information visit the SMART web site at http://www.smartrecovery.org

SOS

SOS (Secular Organizations for Sobriety - Save Our Selves) got its start when Jim Christopher published and article titled “Sobriety Without Superstition” in Free Inquiry magazine in 1985. Christopher had given up alcohol with no help from a “Higher Power” and felt that others could do the same. SOS was formally incorporated as a nonprofit in 1990.

SOS meetings have no steps and no “Higher Powers”. The basis of SOS is the Sobriety Priority–the idea that abstinence from alcohol is the most important thing in life since if one fails to abstain one can accomplish nothing else. Members of SOS share tools for maintaining sobriety and mutual support at meetings. The following is an excerpt from Your Sobriety Toolkit, a brochure published by SOS:

• No matter what - there is no valid reason on earth to drink again.

• Here’s sobriety - there’s everything else - separate and prioritize sobriety.

• Seriousness - this is nothing less than life or death.

• Determination - there is no turning back, especially if it gets rough. You’ve gotten another chance at life. How many really have that chance? Sobriety doesn’t fix everything, but it makes it possible.

• Information - retrain your brain; stimulate it with things related to alcoholism: books, audiotapes, videotapes, movies, pamphlets, brochures, meetings, plays, television and radio, newspapers and magazine articles, etc.

• People - human contact is powerful. Try to meet people, at least one, and be sure to meet other alcoholics. Interaction fights the old patterns of isolation.

• Honesty - this is the time to get things into the open. Get rid of the shadows and darknesses of the past. Put light on the dark things and they lose their power. Things can be dealt with reasonably when they’re seen as they truly are.

• Listening - especially to people with long-term sobriety.

• Take notes - anytime; but especially in early sobriety when memory can be tricky.

• Meetings - be with people who want better lives and are taking actions to get what they want. Meetings are a good place to establish or re-establish social skills in a supportive environment. There is a lot to learn and feel in a meeting. You are not alone. You have not done the worst or been the most; there are always those who have ‘bettered’ you. Think about what you hear and see, but better yet is to feel what you hear and see at meetings.

SOS offers support via live meetings and an email group.

SOS leaves it to the individual member to accept or reject the disease model of addiction.

For more information visit the SOS web site at http://www.cfiwest.org/sos/index.htm

LifeRing

LifeRing split from SOS in 1997, was formally incorporated as a nonprofit in 1999, and adopted democratic bylaws in 2001. The clearest difference between LifeRing and SOS is organizational structure–SOS is hierarchically organized like a typical corporation whereas LifeRing is organized on the principles of democratic governance. LifeRing also differs from SOS in that SOS encourages abstinence from all mood altering substances whereas LifeRing only encourages abstinence from substances to which individuals are addicted. The LifeRing handbook is titled Recovery By Choice. The following is an excerpt from the LifeRing Sobriety Toolbox:

Change your self-image to a non-drinker/user. While this is much easier said than done, consider the benefits once it’s achieved.

1) You don’t feel sorry for yourself because you can’t drink or use because you don’t want to.

2) You aren’t jealous of people who do drink or use because that’s not you anymore.

3) You won’t relapse because, eventually, you won’t even get the urge.

4) You don’t have to attend endless meetings to stay clean and sober.

5) You don’t have to worry about never being able to drink or use again because you don’t want to anymore.

6) You avoid all the baggage associated with “alcoholic” (whatever that means) because you are a “non-drinker”.

How to get there:

The mind is a powerful thing controlling all our behavior. Consciously, or subconsciously, we all act on or reflect our self-image. Consider the come-from-behind victories won by Joe Montana and Michael Jordan. They knew they were going to win, their teammates knew they were going to win, and, I’ll bet, even their opponents knew they were going to win. Positive thinking brings positive results.

LifeRing offers support via live meetings, an online forum and a chat room.

LifeRing leaves it to the individual member to accept or reject the disease model of addiction.

For more information visit the LifeRing web site at http://unhooked.com

References:

Alcoholics Anonymous World Services (1990) “Comments On A.A. Triennial Surveys” Alcoholics Anonymous World Services (internal document)

Brandsma, J.M., Maultsby, M.C., & Welsh, R.J.. (1980) Outpatient treatment of alcoholism: A review and comparative study. Baltimore: University Park Press.

Christopher, James (1989) Unhooked : Staying Sober And Drug-Free. Prometheus Books.

Denning, Patt (2003) Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol. The Guilford Press.

Jewell, Roberta (2005) My Way Out: One Woman’s Remarkable Journey in Overcoming Her Drinking Problem and How Her Innovative Program Can Help You or Someone You Love. Capalo Press.

Kirkpatrick, Jean (197 Turnabout: Help for a New Life. DoubleDay.

Kirkpatrick, Jean (1986) Goodbye Hangovers, Hello Life : Self-Help For Women. Ballantine.

Kishline, Audrey (1994) Moderate Drinking: The New Option for Problem Drinkers, See Sharp Press.

Marlatt, Alan (Editor) (2002) Harm Reduction: Pragmatic Strategies for Managing High-Risk Behaviors. The Guilford Press.

Nicolaus, Martin (2006) Recovery By Choice, Living and Enjoying Life Free of Alcohol and Drugs. A Workbook. third printing LifeRing Press.

OSI (2004) Evidence for Harm Reduction. Open Society Institute.

Rotgers, Frederic, et al (2002) Responsible Drinking: A Moderation Management Approach for Problem Drinkers, New Harbinger Publications.

Sanchez-Craig, Martha (1995) Empirically Based Guidelines for Moderate Drinking: 1-Year Results from Three Studies with Problem Drinkers American Journal of Public Health, Vol. 85, No. 6

Sobell, M.B. & Sobell, L.C. (1973). Alcoholics treated by individualized behavior therapy: One year treatment outcomes. Behavior Research and Therapy, 11, 599-618.

Sobell, M.B. & Sobell, L.C. (1978). Behavioral treatment of alcohol problems: Individualized therapy and controlled drinking. Plenum Press.

Steinberger, Henry (Editor) (2004) Smart Recovery Handbook. SMART Recovery, Inc.

Trimpey, Jack (1989) Rational recovery from alcoholism. Lotus Press.

Trimpey, Jack (1992) The Small Book (Rational Recovery Systems) (Revised), Delacorte Press.

Trimpey, Jack (1994) The Final Fix For Alcohol And Drug Addiction: AVRT, Addictive Voice Recognition Technique. Lotus Press.

Trimpey, Jack (1996) Rational Recovery: The New Cure for Substance Addiction. Pocket.

 

HAMS Wholeheartedly Endorses Moderation Management

 MM founder Audrey Kishline had a great idea–not everyone who sometimes drinks too much needs to go to AA. Problem drinkers who have had only occasional problems with alcohol and who are not drinking large amounts daily are more likely to benefit from a moderation program than a program of total abstinence. MM has proven very successful with people who fall into this category. It is unfortunate that Audrey herself did not.

 

I do not wish to harp on Audrey, those of you who know me know that I knew Audrey and was a member of MM during Audrey’s Minnesota days. Even back then I was working a harm reduction plan which involved getting schnockered once a week and abstaining the other six days. Audrey did not approve, as well she should not have, as it did not belong in MM. But since there were NO alcohol harm reduction programs in those days she did not throw me out.

 

Where could I have gone? AA has never made me abstain–it nearly made me drink myself to death.

 

This is why I founded HAMS. For the many who fit neither AA nor MM nor any other approach. Many of my friends from my MM days have done excellently with MM. I am very happy for them. MM limits would have never fit me–but I am infinitely better than I was before.

 

MM–we salute thee for the good work thou hast done.

 

For those who need another way–HAMS is one possible approach.

 

pct

 

Heroin and Alcohol

It is my firm conviction that the harm reduction strategies used to deal with alcohol use are at heart identical to those used for injection drug use.

When a heroin user comes to a needle exchange for clean needles no one would ever think of saying to this person “I think you use too much heroin. You may not have clean needles because I think you should pursue a goal of abstinence from heroin.” It should be clear as crystal that the greater the problem with heroin, the more there is a need to practice harm reduction.

In the early days of needle exchange some attempts were made to make the supply of clean needles contingent upon the user complying with some conditions such as participation in a program aimed at abstinence. What we found was that this simply does not work. When the supply of clean needles is made conditional, large numbers of users do not come back and return to sharing dirty needles instead.

When an injection drug user comes in to a needle exchange the proper thing to do is to thank the person for helping to get dirty needles off the streets, because this person is indeed doing a public service.

It is our contention that harm reduction alcohol is the same as harm reduction for injection drug use. The greater the problem that an individual has with alcohol, the more that person is in need of harm reduction strategies. People will choose alcohol abstinence as a goal only if and when they personally are ready to do so. Attempts to coerce abstinence from the outside will only lead to increased alcohol abuse and ever greater harms as a result.

I am in complete disagreement with Marc Kern’s statement that “Harm reduction is not for everyone. Clearly some people need to abstain from drinking.” http://www.highsobriety.net

Yes–it might be wonderful if everyone would simply abstain from heroin or alcohol or other bad habits just because we wished it to be so. The world does not work that way. AA’s Triennial Surveys tell us that only five percent of new AA members are still attending AA meetings at the end of the first year. Hester and Miller’s Handbook of Alcoholism Treatment Approaches: Effective Alternatives shows us that the most commonly used abstinence-based treatments in the US not only have extremely high failure rates, but that they may also be actively harmful for some clients.

Abstinence succeeds when chosen by the client, not by the therapist. For all others harm reduction is the most effective way of minimizing the damages done by alcohol abuse to the individual user and to society at large.

Marijuana Laws Kill Alcoholics

We generally shy away from using the word “alcoholic” at HAMS, but there are some severely dependent drinkers who experience severe and life-threatening withdrawals virtually every time that they drink. Many of these drinkers would prefer to give up alcohol and substitute marijuana instead–since marijuana does not induce similar withdrawal symptoms.

Research has shown that many highly dependent drinkers can successfully substitute marijuana for alcohol. We can see an example of this in Tod Mikuriya’s article Cannabis as a Substitute for Alcohol: A Harm-Reduction Approach

The problem is that for many homeless alcoholics the price of marijuana is just too high to make it a viable substitute for alcohol. Moreover there are many places in the US where possession of marijuana is still considered a highly criminal offense and results in jail.

It is past time that these archaic and puritanical laws were repealed. Lives could be saved.

Ottawa Wet House

For details about the Ottawa wet house see the story
How some homeless alcoholics are drinking their way to good health

Drinking Law That Kills Teens

There is one asinine law on the books which guarantees an increase in teenage deaths from drunk driving and alcohol poisoning as well as guaranteeing an increase in teenage date rape, unwanted teen pregnancy, and teen STDs including HIV. This is the law which makes it illegal for parents to host parties for their children and their children’s friends which serve alcohol.

Such a law will do nothing to stop teenagers from drinking alcohol; all it will serve to do is to drive teenagers away from a safe and supervised drinking environment to an unsafe and unsupervised one.

If parents are allowed to host such parties then they can see to it that no one attending the party drives. They can allow guests to sleep over until they are sober enough to leave in the morning. And a chaperon can see that guests do not engage in insane drinking which leads to alcohol poisoning. A chaperon can also insure that this is not an occasion for an orgy.

Other countries in the world encourage parents to teach children safe and sane drinking behaviors in the home. The United States is very backwards on this one.

US News and World Report has an article on this topic: A Host of Trouble

Seaton House - Toronto Canada

The Annex Harm Reduction Program at Seaton House is home to 140 homeless chronic alcohol abusers. Many of these men have resorted to drinking things like rubbing alcohol or mouthwash while living on the streets. Rubbing alcohol and mouthwash are much easier to shoplift than whiskey.

The Annex supplies its clients with monitored quantities of wine (one glass per hour) to help keep them safe and reduce further harm from alcohol use. It is reported that clients at the Annex have reduced their drinking from levels as high as 46 drinks a day to levels as low as 8 drinks a day.

More information about Seaton House can be found at the Seaton House home page at:

http://www.toronto.ca/housing/sock/see.htm

and in the wikipedia article on Seaton House at:

http://en.wikipedia.org/wiki/Seaton_House

HAMS - A Harm Reduction Approach to Alcohol

Programs which insist on abstinence as the only way to treat a drug or alcohol problem have never been very successful. AA’s Triennial report that only five percent of new members are still attending meetings at the end of the first year. Drop out rates from abstinence only programs are also notoriously high.

Harm reduction programs such as needle exchange, on the other hand, have a very high client retention rate. This is because harm reduction programs do not impose their own goals on clients. What we learned from needle exchange is that any attempt to impose an agenda on a client is a sure way of insuring that the client does not return. Unconditional acceptance of the client is necessary.

It is withthese expereinces in mind that HAMS was formed. HAMS is a harm reduction program for people who drink alcohol which encourages every positive change. HAMS supports goals of safe drinking, reduced drinking or abstinence from alcohol.

The acronym HAMS stands for “Harm reduction, Abstinence and Moderation Support”. The HAMS web site can be found here: http://hamsnetwork.org