Archive for November, 2008

HAMS Is Not Gradualism

November 24, 2008

There is a school of thought within harm reduction philosophy called “Gradualism” which believes that abstinence (or sometimes moderation) is best for everyone, but that some people can only attain abstinence by taking tiny steps instead of getting there all at once. Scott Kellogg at NYU is one of the pioneers of Gradualism and has written about it in papers such as “Gradualism, identity, reinforcements, and change“.

HAMS is not Gradualism per se. HAMS can best be described as individualism. HAMS does not believe that recreational intoxication is a disease or a violation of morality. HAMS believes that intoxication is the choice of the individual. Just as we believe that homosexuality is neither a disease nor a crime nor an immoral act we hold that the same is true of recreational intoxication. What is a true crime is the fact the US drug laws imprison people for choosing to engage in recreational intoxication. This is as medieval and barbaric as jailing people for homosexuality.

HAMS supports every individual member in choosing their own goal regarding their substance use, whether that goal is abstinence or moderate use or safe intoxication. We would never seek to impose a goal on anyone from outside no more than we would seek to impose heterosexuality on everyone.

HAMS also supports each individual on their personal choice of methods to achieve their substance use goals. This includes the method of Gradualism for those who choose to use it. Gradualism is what I used to quit cigarettes, although I am maintaining a harm reduction approach to nicotine by limiting my smoking to one cigar per week.

Other methods which our members use include:

  • Using naltrexone via the Sinclair method to move from heavy drinking to more moderate drinking.
  • Using antabuse to achieve abstinence days alternating with intoxication days (warning—it takes several days for antabuse to clear the system)
  • Implementing safe drinking strategies
  • Counting and charting drinks
  • Etc, etc.

HAMS says that it is time to put an end to the pathologization and criminalization of recreational intoxication. Safe substance intoxication is neither crime nor disease–it is hobby.

Hence, although some members of HAMS use Gradualism to eliminate habits which they themselves choose to eliminate, HAMS itself never sets a goal of abstinence for any member. Hence, HAMS is not Gradualism.

Copyright © 2008, The HAMS Harm Reduction Network

AA and Harm Reduction

November 5, 2008

Hi all–I am posting this paper which I had to write for my addictions counseling class at The New School:

 

On Monday, October 27, 2008 I attended AA at St. John’s Episcopal Church, 139 St Johns Place, Park Slope, Brooklyn. I chose this particular venue because I have been employed as sexton by St John’s for the past two years and hence it is a physically comfortable space for me. I also knew that this was a rather large (50 to 100 people) open meeting which has a reputation for being somewhat laid back. This was actually two meetings for the price of one, the first was a “Beginners Meeting” which started at 6:30 and this was followed at 8:00 by a “Topic Meeting” which it turned out was an anniversary meeting.

 

One man came up to speak to me between the two meetings and I explained that I was there as an observer to fulfill a requirement for my CASAC. This man asked what populations I was interested in working with me and I explained that my primary interest was in harm reduction. He replied that this was a good thing since not all people were open to total abstinence. It was a welcome change for me to hear this since on many occasions I have been attacked by AA members for my work in harm reduction.

 

What I really learned from attending AA as an observer is that an observer cannot really comprehend what it is like to attend AA/NA as a person seeking help for a problem with alcohol or drugs. Hence I must speak a bit about my personal experience.

 

I was raised in the Evangelical Free Church of America which is essentially a religious cult–what Chaz Bufe has referred to as “cult lite”. This was an organization which ruled through fear in an attempt to suppress all normal human pleasure. From my earliest memories I remember being bombarded by the threat of eternal damnation and burning in hell forever. And what were the things that would lead one to burn in hell forever and ever? Drinking, dancing, playing cards, going to movies, smoking or believing in evolution. Not to mention extramarital sex or sexuality or the worst sin of all–a failure to believe–even though there was an absence of evidence. And of course all the Episcopalians and Catholics would go to hell because they worshiped idols (i. e. had religious statuary) and used demon alcohol in communion. By age 13 I had read Darwin and was an atheist and later read Spinoza and became a pantheist. I escaped that cult.

 

Later in life I was suffering from depression and loneliness and was drinking too much in response to this. I did not like the way in which I was drinking and sought help to change it. I encountered AA.

 

AA is in my experience another incidence of “cult lite”. AA has almost exactly the same cultish features as the cult which I had escaped as a child. AA rules its members through fear, but rather than the fear of hellfire it is a fear of a horribly alcoholic death. In point of fact people coming to AA are threatened with a horrible alcoholic death unless they come to believe in God. To quote the chapter “We Agnostics” from the AA “Big Book”, “To be doomed to an alcoholic death or to live on a spiritual basis are not always easy alternatives to face… after a while we had to face the fact that we must find a spiritual basis of life—or else.”

 

For me personally attending AA had an extremely negative effect. I went from having a moderate drinking problem to having a severe drinking problem. I found myself having to drink every time I left and AA meeting and finally after leaving one meeting I went on a bender so bad that five days later I came out of it with severe and life threatening withdrawal. I had to check into Ramsey County detox in St Paul to get some valium in my system before I died of a stroke or a heart attack. And it was at this point that I realized that I had to leave AA or die.

 

I found some support and friends in alternative groups and I began to get better. I used art therapy and online support to deprogram myself from AA. And once I had thoroughly rejected their path I began to find myself in control of my drinking. And with the help of CBT and Stoic Philosophy I began to feel happy and in good mental health. Volunteering in needle exchange during this period also taught me the essentials of harm reduction.

 

I have met many, many people whose drinking became worse while they were attending AA and who were only able to achieve successful moderation or successful abstinence after leaving AA.

 

However, certain other experiences of mine have convinced me that AA may perhaps not be a bad match for everyone; some people may actually find it valuable. When I founded HAMS Harm Reduction for Alcohol one of the people I invited to join our advisory board was Rae Eden Frank who was my former boss at Access Works, the Minneapolis syringe exchange. When we invited Rae to be our guest speaker in our online support group we were surprised to find that she was a member of NA. However, she explained to us that for her harm reduction and the 12 steps were entirely compatible. Harm reduction keeps people alive when the 12 steps can do nothing for them. If and when people decide to abstain the 12 steps are one possible option which they can follow.

 

Ultimately what I learned from this experience of attending an AA meeting is that the time has come for an end to the hostility between AA and other approaches. AA’s “Big Book” says, “Upon therapy for the alcoholic himself, we surely have no monopoly.” It is unfortunate that far too many people working in the chemical dependency treatment industry feel a need to use everything from lies to coercion to torture to attempt to force clients to succumb to the 12 steps.

 

I feel that it is time for all of us to realize that different people need different approaches. It will be good for people from 12 step programs and people from other approaches to join hands and to try to offer each individual a choice of what treatment approach will best benefit that individual. If we all work together some of the abuses of the 12 step system can reform themselves from within.

 

Copyright © 2008, The HAMS Harm Reduction Network