Seatbelts, Harm Reduction, and Enabling

In a perfect world no one would ever exceed the speed limit or engage in reckless driving. In a perfect world no one would ever violate a traffic law or make an error in judgment while driving. In a perfect world there would be no automobile accidents because everyone’s driving would be perfect. However, we do not live in a perfect world. To err is human–and automobile accidents are an inevitable result of human error. It is for this reason that a simple and wonderful little harm reduction device called the seatbelt was invented–a harm reduction device which saves countless lives each year.

Would anyone in their right mind propose that seatbelts are “enablers” of reckless driving? Would we ever propose that the only way to learn good driving habits is to lose life or limb in an automobile accident? Would anyone propose that we must do away with seatbelts because they prevent people from suffering the consequences of their behaviors and keep them from “hitting bottom”?

Of course not! Even proposing such a thing sounds nonsensical!

So how can we treat other obvious harm reduction strategies such as needle exchange as a form of “enabling”? Is a person more likely to quit heroin after contracting AIDS? Hell no!!! Then there is more reason to shoot up than ever before!

Now where did this utterly bizarre notion of “enabling” come from? It is not really present in the AA “Big Book”. It seems rather to be a product of the 12 step treatment industry. The idea seems to be that anything that kept you out of treatment was bad. So the sicker you were the better. Getting better was bad because if you got better then you might not become a life-long AA member. You might even become a moderate drinker.

But getting worse was better–if you lost a leg in a drunk driving accident then it might scare you into treatment where the staff could work at scaring you into attending AA for life.

The people who believe in “enabling theory” seem to buy into the following:

Better is worse

Worse is better

Black is white

White is black

It reminds me of what George Orwell said:

Freedom is slavery

War is peace

Ignorance is strength

Now you know why Hamsters say “Better Is Better!!”

Copyright © 2008, The HAMS Harm Reduction Network

Psychotherapy and Drinkers – Harm Reduction, Alcohol, Suicide and Depression

It is understandable that a psychotherapist might object to doing therapy with a client who always showed up at sessions dead drunk and never, ever remembered one session to the net because he/she was in a blackout during the session.

However it is an outrage for persons seeking help with severe psychiatric problems to be refused psychotherapy because they have been drinking within moderate limits within the past several months.

I personally had the experience of being refused treatment for depression and suicidal ideation because I did not lie to the intake person and claim that I had six months of “sobriety”. At that point in time my drinking had been within perfectly moderate limits for the preceding month but because I told the truth I was refused therapy. This was at a hospital based provider that took Medicaid–and not in Podunk USA but in supposedly enlightened New York City. I am lucky to be alive.

All the evidence we have points to the idea that drug and alcohol users benefit from voluntarily sought psychotherapy regardless of their alcohol or drug use (Tatarsky, Dwnning). It is morally wrong and inhumane to refuse mental health services to people who choose to use alcohol or drugs. It is just as bad to stigmatize people for their alcohol or drug use as it is to stigmatize them for the color of their skin, their ethnicity, their religious beliefs or their place of birth.

The World Health Organization (WHO) has the following to say about depression:

“Major depression is now the leading cause of disability globally and ranks fourth in the ten leading causes of the global burden of disease. If projections are correct, within the next 20 years, depression will have the dubious distinction of becoming the second cause of the global disease burden.” http://www.who.int/whr/2001/dg_message/en

WHO also tells is that “Suicide is a leading cause of death for young adults. It is among the top three causes of death in the population aged 15–34 years…[S]uicide is predominant in the 15–34-year-old age group, where it ranks as the first or second cause of death for both the sexes. This represents a massive loss to societies of young persons in their productive years of life. Data on suicide attempts are only available from a few countries; they indicate that the number of suicide attempts may be up to 20 times higher than the number of completed suicides.” http://www.who.int/whr/2001/chapter2/en/index6.html

WHO also tells us that “The most common mental disorder leading to suicide is depression, although the rates are also high for schizophrenia. In addition, suicide is often related to substance use ­ either in the person who commits it or within the family.” http://www.who.int/whr/2001/chapter2/en/index6.html

And yet the United States is filled with psychotherapists who refuse to treat people for mental illnesses such as depression unless these people first abstain perfectly from all drugs and alcohol for six months.

Let us give three cheers for all the harm reduction psychotherapists like Dr. Tatarsky and Dr. Denning and many, many others who treat people for their mental health problems regardless of their alcohol or drug use.

Stigmatizing people for their drug or alcohol use and refusing them essential mental health services which might save their lives is–in the words of Penn and Teller–BULLSHIT!

References:

WHO – The world health report 2001 – Mental Health: New Understanding, New Hope

http://www.who.int/whr/2001/en

Harm reduction psychotherapy : a new treatment for drug and alcohol problems / edited by Andrew Tatarsky with forward by Alan Marlatt.

Northvale, NJ : Jason Aronson, 2001.

Practicing harm reduction psychotherapy : an alternative approach to addictions / Patt Denning ; foreword by G. Alan Marlatt.

New York : Guilford Press, c2000.

Copyright © 2008, The HAMS Harm Reduction Network

Why I Choose Harm Reduction

If I wanted to extend my life span to the maximum here is what I would do: I would have myself locked in a padded cell so it would be impossible for me to be injured by anyone or to injure myself. I would eat a perfectly balanced diet with no meat or sugar or anything else that tasted good. No drugs or alcohol or other fun stuff either. I would have to be in a padded cell because I would be so frigging miserable and bored that I would definitely kill myself given the choice.

Instead of choosing to merely maximize my life span I have chosen a harm reduction approach to all aspects of my life. I quit the cigarettes because they are too likely to kill me and give no real pay-off, but I still allow myself a cigar a week if I want it–no inhaling. I get intoxicated on alcohol twice a week but do it safely at home and I abstain on work nights so that it does not interfere with my life. I eat a lot of pork fat but my doctor says my cholesterol is good. I abstain from TV because it is too addictive for me and it wastes my time too much.

I have never done any illicit drugs but marijuana–but it started making me depressed so I gave it up decades ago.

Mostly I enjoy myself in a reasonable manner and have fun with life–that is why I choose harm reduction.

Copyright © 2008, The HAMS Harm Reduction Network