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

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

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

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

HAMS Is Not Gradualism

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

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

The ABCs of Harm Reduction: How Rational Emotive Therapy Can Be Applied To Harm Reduction

 There is an organization called SMART Recovery which has applied the principles of RET (Rational Emotive Therapy, aka CBT or Cognitive Behavioral Therapy) with a good deal of success to quitting drinking. It strikes me that these same principles can be used to good effect by someone taking a Harm Reduction approach.

 

Let us take the case of a person who has decided that it is a bad idea to drink when feeling angry or depressed or sad or anxious; a person who instead has decided that the only appropriate time to drink is when one is feeling good and celebratory. A person who has adopted the motto “Drinking when you feel bad is bad drinking.”

 

The RET model create by Albert Ellis uses something called “ABCs”. Let us see how these ABCs can be applied to Harm Reduction:

 

A) “A” stands for “Activating Event”. An activating event can be anything that happens in the world around you–or even an internal state. An activating event can also be thought of as a “potential trigger” for the behavior which the person is trying to change. Let us look at a concrete example. Say that at work your boss reprimanded you for something which was not your fault and also did not allow you to explain the situation. When you leave work for the day you are extremely angry.

 

B) “B” stands for “beliefs”. In the old behaviorist model people only looked at stimulus-response pairs. The Ellis RET model differs from the behaviorist model in that the Ellis model states that a person’s response to a given stimulus is contingent on what the person believes. In the Ellis model Activating Events correspond to what the behaviorist call stimuli. The Ellis model calls those beliefs which lead to the undesired behavior “Irrational Beliefs” (IBs). Beliefs which lead to the desired behavior are referred to as “Rational Beliefs” (RBs).  Let us see how this applies to the scenario about being yelled at by one’s boss. You leave work extremely angry and the following are your Irrational Beliefs: “I deserve a drink so that I can forget my sorrows.” “My boss was an asshole and I will get drunk to get even with him.” “I can’t stand to be this angry and I deserve to get drunk over it.”

 

C) “C” stands for “Consequent Actions”. Consequent Actions correspond to what the behaviorists call “response”. If you follow through on the Irrational Beliefs given above then as a result you get very drunk. Perhaps as a result of your angry drunk you get into a fight with someone and are thrown in jail. Perhaps you are just too drunk to wake up and go to work the next morning. Whatever happens, the end results of this angry drunk are not likely to be pretty.

 

D) “D” stands for “Dispute”. RET asks us to dispute our Irrational Beliefs and to replace them with Rational Beliefs. In the above scenario some Rational Beliefs are the following “Getting drunk will not eliminate my anger; it is likely to make my anger worse.” Getting drunk will certainly not hurt my boss–but it may well hurt me if I am too drunk to go to work in the morning.” “A better way to manage my anger is to go out jogging rather than to wallow in it.” Etc.

 

E) “E” is for Effect. The Effect of Disputing your Irrational Beliefs with Rational Beliefs is that you decide to not get drunk just because you are angry. Instead You decide to save your drinking until Saturday night when you are relaxed and can really enjoy it.

 

This is one example of how a person practicing Harm Reduction can use RET to maintain their abstinence days.

 

RET is about learning to monitor one’s thoughts from the outside and to change bad thoughts into good thoughts when they occur.

 

RET is quite solidly based in the Stoic philosophy of Epictetus.

 

I will end with two quotes:

 

No man is free who is not master of himself.

Epictetus (55 AD – 135 AD)

 

A wise man is he who does not grieve for the thing which he has not, but rejoices for those which he has.

Epictetus (55 AD – 135 AD)

 

 

Copyright © 2008, The HAMS Harm Reduction Network

 

A Harm Reduction Approach to Quitting Smoking

I just wanted to tell my story about getting off nicotine and how I used elements of harm reduction and use-extinction to do so.

 

I started by taking Chantix (which is a partial nicotine agonist). I chose Chantix over the patch or gum because it has the best success rate–up to 50% total abstinence.

 

However I totally rejected the idea of doing the Chantix plan. I needed to make my own plan, When I make my own plans I succeed with them because I am personally involved with them. When others impose plans upon me I am not interested.

 

This is the first Harm Reduction principle applied: When people are involved in creating their own plans then they are invested in completing those plans.

 

My insurance would not pay for Chantix–so I had to pay out of pocket. This is another principle which is universal rather than harm reductionist: people put value on what they pay for—whether they pay with money or effort.

 

One part of the Chantix plan online is a calculator which tells you how much money you save by not smoking. This would definitely be backfiring in my case. I only smoke Bugler rolling tobacco–and it costs me $50 a month to smoke. The Chantix alone costs $150 a month so smoking is much cheaper than Chantix for me.

 

The second harm reduction element which I worked into my quit cigarettes plan is charting. I started keeping a detailed record of every single cigarette I smoked and within a week of starting the Chantix I was down to half of what I usually smoked.

 

The third harm reduction technique I used was to stop keeping a supply on hand. I have always bought my Bugler tobacco by the can which is enough for a week or more. Now I started buying it only by the pouch so I would only have enough available for a day or so.

 

The fourth harm reduction technique I used was to get nicotine gum and chewing tobacco so that I would never have to feel deprived of nicotine any time that I chose not to smoke. I have never opened either the gum or the pack of chew–but I take great psychological comfort in knowing that they are in my backpack handy to me at any time.

 

I had some withdrawal a few days after starting the Chantix but it soon passed and my cigarettes started tasting really bad. I was hardly smoking at all except in certain situations such as staying at home and reading when the environmental cues would trigger chain-smoking behavior. So after two weeks on the Chantix I decided to buy nicotine-free cigarettes (Quest was the brand I found in New York) and stop inhaling nicotine entirely. I still had the gum and the chew if I felt a need for nicotine–I just would not inhale it anymore.

 

This illustrates a fifth harm reduction technique: Break the bad habit (undesired behavior–or what the steppers call “addiction”) into component parts and work on one piece at a time.

 

I have been smoking the nicotine free cigarettes for two days now and I have absolutely NO desire to use the gum or the chewing tobacco–the thought of either makes me nauseous as I type. I have no desire for my Buglers either–now that is a change since I have been smoking Bugler about 20 years now–and I have been smoking something or other every single day for the past 35 years.

 

Yesterday was my first nicotine free day in 35 years and today is my second.

 

So I have taken one step towards the final change–I have gotten free of the nicotine addition. I only had some withdrawal about 12 hours after going nicotine free.

 

Now the thing is to stop the smoking part of the habit. I have cinnamon sticks and I have been chewing on them sometimes instead of a cigarette for the past couple of weeks–it is not a bad substitute. I have also been sucking on Hall’s cough drops. These two techniques comprise a sixth harm reduction technique–substitute a less problematic behavior.

 

And what is the final goal? Total abstinence? I think not. I would still like to enjoy an occasional cigar now and then. And I think that is okay–because cigars were never a habit for my like the cigarettes. I smoked only pipes and cigars from age 15 to 20–only when I went to college did I start the cigarettes.

 

 Following the Chantix plan instead of using Chantix with my own plan would not have worked for me at all. When people tell me how bad smoking is then I want to smoke. It is only when people tell me that they want me to stick around for a long time because they like me that I want to quit, And total abstinence after one week of Chantix like Pfizer says? That would not work for me. And the money calculator? Hell–taking Chantix and buying nicotine free cigs is costing me roughly nine times as much as smoking Bugler.

 

So that is why My Own Plan works for me.

Harm Reduction, Enabling, and Codependency

 The term “enabling” was coined by the 12 step treatment industry. Some people in the 12 step treatment industry proposes a highly Puritanical model where all recreational use of alcohol or drugs is defined as a “disease”. I call this “the Puritanical model”. In the Puritanical model all users of drugs/alcohol have a fatal disease called addiction/alcoholism. According to the Puritanical model we must force all users to “hit bottom” by increasing the harms which they suffer as a result of drug/alcohol use in any way we can. The theory of the Puritanical model is that if we increase the harm enough we can force the user to accept 12 step treatment. Thus it is the job of the friends and family (hereinafter referred to as “FFs”) of the drug/alcohol user to do everything in their power to INCREASE the harm caused by substance use to the substance user. It seems that it does not matter if the user dies in the process. Anything less than causing the maximum amount of harm seems to be viewed as “enabling”.

 

Harm Reduction takes exactly the opposite view. Harm Reduction believes that the worse a person’s circumstances are, the more likely that person will be to continue/increase their drinking/drugging. The fundamental goal of Harm Reduction is to reduce or eliminate harm to all: to the drug users, to the user’s FFs (friends and family) and to society at large. A person dying of AIDS from a dirty needle or a person who has lost a leg in a car accident has MORE sorrows to drown than they did before, and hence less reason to abstain from or otherwise control their drug/alcohol use.

 

We should note that not all members of 12 step programs espouse the Puritanical model. Many members of 12 step groups are extremely active in the more humane Harm Reduction model.

 

To summarize: the Puritanical model views any DECREASE in harm to the user as “enabling”, since this enables the user to continue using drugs/alcohol. The Harm Reduction model views any INCREASE in harm to anyone as “enabling”, since this enables harm to come to people.

 

It seems as though this is the case because the Puritanical model views any drug/alcohol use as “the worst thing possible”–worse even than death or murder. The Harm Reduction model, on the other hand, views drug/alcohol use as innocuous in and of itself. The Harm Reduction model views only harm as negative. It matters not if the source of the harm is drug/alcohol use or even abstinence from drugs and alcohol. Harm is not good.

 

Harm Reduction states that first prerogative of FFs is to reduce the harms to themselves. The second prerogative is to reduce the harm to the drug/alcohol user and to society at large. If the situation has become completely intolerable for one of the FFs, then it is time for this person to terminate relations with the user, even if the means divorce or the end of a friendship or the disowning of a family member. Persons who resort to violence need to be dealt with using restraining orders. However, this is seldom the case. In most cases there is room to change for the better.

 

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Let us take a look at a few real life examples to see how the Harm Reduction model differs from the Puritanical model:

 

Case 1) A husband gives his car keys to his wife before he begins drinking to prevent himself from drinking and driving. After he is drunk he demands that his wife return his car keys so that he can drive to his favorite bar.

 

The Puritanical model says to give him the car keys. If he is arrested for DUI he will suffer. If he kills someone and goes to prison he will suffer. If he has an accident and loses a limb he will suffer. In any case you are helping him to “hit bottom”. If you do not give him the keys you will “enable” him to escape these harms and hence “enable” him to continue his alcohol addiction. And if he dies it is no loss–after all he is only a drunk not a recovering person.

 

The Harm Reduction model says do not give him the car keys. If you give him the car keys then you are “enabling” him to do harm to himself or others. If you do not give him the car keys then you are helping him to break the habit of drinking and driving and you are helping protect all from harm.

 

Case 2) A policeman stops a drunk driver.

 

In this case the Harm Reduction model and the Puritanical model are in agreement as to the course of action–but their reasons are different. The policeman should arrest the drunk driver–not let him go.

 

The Puritanical model says that this action will help the person hit bottom and go to treatment. If the policeman let’s him go then the policeman is “enabling” the drinker to continue his alcohol addiction.

 

The Harm Reduction model says that this action will show the person that acts which may potentially harm others are not acceptable to society, and this will help the person to realize that steps need to be taken to avoid drunk driving–these steps could involve giving up driving, giving up drinking, or always being certain to arrange for appropriate transportation when one drinks. Letting the drunk driver go sends the message that potentially harmful acts such as drunk driving will be tolerated by society, and thus “enables” the alcohol user to continue a pattern of high-risk behavior which may well kill him or someone else someday.

 

Case 3) A man beats his wife because she is a heavy drinker.

 

The Puritanical model would fully approve of this action. To let her drink and not beat her would be to “enable” her to continue her alcohol addiction.

 

The Harm Reduction model would absolutely not stand for this. The Harm Reduction model would wish to see the woman leave this man and seek safety. For her to stay is to enable him to harm her.

 

Case 4) A community is trying to establish a needle exchange program.

 

The Puritanical model would fully oppose this action. Allowing people to shoot drugs without getting AIDS or Hep-C merely enables them to continue drug use. Maybe a case of AIDS will help them to hit bottom and seek out the 12 steps.

 

The Harm Reduction model fully approves of needle exchange. Drug users with AIDS or Hep-C spread it throughout the community of non-users through sexual contact. The more people who have STDs the more likely it is to be transmitted. And hitting bottom never helps one to abstain. People change their habits when they choose to do so. Failure to supply clean needles “enables” drug users to harm themselves and others.

 

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That is enough concrete comparisons for now. HAMS says that if your drunken spouse falls in the snowdrift then you should pull him/her out so that he/she does not freeze to death. If a drug/alcohol user asks you to give or lend them money, well it is your money and your choice what you want to do with it. It is not a good idea to let your spouse lose his/her job by failing to call in sick for him/her when intoxicated. If the spouse is working at reducing harm then encourage that. If the situation is deteriorating and you must leave to prevent harm to yourself then do that. Every case is different, and each must be judged on a case by case basis.

 

In conclusion–HAMS does not believe that recreational intoxication is a disease. What HAMS considers to be bad is the harm which results from careless or excessive use of intoxicants.

 

However, HAMS believes that excessive puritanical morality which attempts to control and stifle others is a disease. HAMS believes that those who espouse the Puritanical model are the ones in need of treatment. Psychiatric treatment.

 

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A NOTE ON CODEPENDENCY

 

If you have a significant other who uses drugs/alcohol and who works to reduce the harm in his/her life which might be caused by this drug/alcohol use then by all means support him/her in this goal. (From here on out I am going to use the pronoun “him”  for the sake of simplicity, but what I am saying applies to both sexes.) This does not mean that you should make a harm reduction plan for him or count his drinks for him or nag at him. What you need to do is to show him love and to show him that the fact that he is doing better makes you feel good. Harm Reduction is a slow process and there may be slips backwards on the way. You may even have to call in sick for him at some point it he is too intoxicated to go to work. But the proof that Harm Reduction is working will be that such calls will grow fewer and fewer until they finally disappear entirely.

 

Also bear in mind that almost everyone who attempts Harm Reduction is capable of achieving it. Almost no one who attempts abstinence via a 12 step program achieves that. AA’s Triennial Surveys report that only five percent of new members are still attending meetings at the end or one year. And when AAers relapse—they relapse BAD.

 

However, if you have a significant other who uses drugs/alcohol and who does NOT choose to work at Harm Reduction, but who instead pursues drugs/alcohol regardless of the harm which it causes himself, his family and friends, and society, then you must look out for yourself and do nothing to enable him to cause harm to you or your family. If he insists on engaging in high-risk behaviors such as sharing needles or drinking and driving it may well be time for separation or divorce.

 

Remember this: drug/alcohol users who choose the substance over their families do no have a disease. They are making a choice. You have no obligation to stay with a person who refuses to take steps to minimize the risks involved with high-risk behaviors. First work to reduce harms which may accrue to yourself. If this means divorce then so be it.

 

Being supportive of a person who is working to get better is a healthy choice. Being supportive of someone who chooses to continue to go downhill is not a healthy choice.

 

If your significant other is working at getting better then beware of negative feedback loops. You cannot make his plan for him or carry it out for him. If you attempt to do this then he will very likely feel pushed and pressured. And remember that every action has an equal and opposite reaction. The more he feels pushed to change the more he will push back and resist change. Even if his conscious mind wishes for change his subconscious will rebel and resist. Hence attempts to help by “doing it for him” are almost certain to backfire and lead to worsened behaviors. You must let him do things for himself.

 

Some ideas from the Stages Of Change Theory can be useful here. Stages Of Change Theory recognizes the following stages: Precontemplation, contemplation, and action, among other later stages. Precontemplation is a stage which I prefer to call noncontemplation. This is the stage where a person is not even thinking about making a change. In the contemplation stage a person is thinking that making a change might be a good idea and in the action stage the are actually taking steps towards making that change.

 

The Puritanical model attempts to short-circuit the stages of changes process by provoking a “bottoming-out” event which will precipitate the user from noncontemplation directly into action. This rarely succeeds.

 

So what DO you do if you want to move a loved one from a stage of noncontemplation  to a stage of contemplation or a stage of action?

 

I am going to make a radical proposal.

 

The best way to do this is to start taking care of yourself. Regain your personal autonomy. It is not your job to force the user to change nor is it your job to protect the user from the consequences of his behaviors at your own expense nor is it your job to try and worsen those consequences. Remain humane but take care of yourself first.

 

Instead of being dependent on your spouse, become independent of him. If you depend on your spouse financially then get a job and become financially independent. The essential thing is to cut the bonds of dependence and become independent. If your spouse sees you moving ahead he may be motivated to move ahead himself. If he chooses to go down there is no need to let him drag you down with him. Once you are independent in thought word and deed it will be his own choice to sink or swim.

 

Remember, no matter what situation you are in you have three choices, you can attempt to change it, you can accept it, or you can leave it. If attempts to change it prove fruitless, you still have a choice of accepting it or leaving it. The choice is yours.

 

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Further information on this topic can be found in Chapter 9 “To the Friends and Family: Take Sides” of The Small Book by Jack Trimpey and in Chapter 11 “How to Talk to Friends and Family about Harm Reduction” of Over the Influence by Patt Denning et al.

Harm Reduction and Personal Responsibility

We at The HAMS Harm Reduction Network believe that individuals are always responsible for their own actions. Intoxication is never an excuse for a criminal act. HAMS believes that individuals need to plan their use of mood altering substances carefully in advance so that they use in such a manner which causes harm to neither themselves nor others.

Someone who is careless enough to drink and drive and kill someone merits the same legal sanctions as a dead sober driver who kills someone. Chemical dependency treatment should never be made a substitute for legal sanctions–this only serves to encourage unacceptable behavior.

The natural correlate of personal liberty is personal responsibility. We do not accept excuses such as “the alcohol made me do it”.

Acts which cause no harm to self or others such as the recreational use of marijuana should not be considered criminal at all. Legal sanctions should only be applied to actions which infringe upon the liberty of others.

I guess that you can tell that I have been reading Thomas Szasz today

pct