Rank Your Risks

I thought it would be fun and educational to do a series on the 17 elements of HAMS.  But in typical Hamster fashion, I’m not taking them in order.  They aren’t steps – you don’t have to do them in order, or do them at all!

Ranking your risks is one of my favorite elements.  I never drove drunk – even when I had a car and drank a lot, I would never drive after even one sip of alcohol.  But I was terrible about drinking and texting.  When I re-read my drunk texts – which are mostly buried in my phone now – I shudder with horror.  I’d have to say though – those drunk texts gave me some insight into how I was really feeling, that the sober me was all too good at repressing.

What are your risks?  Drinking and driving?  Getting too drunk to do well at work, or even to show up?  Ruining family events by over-drinking and feeling bad the next day?  Forgetting to pay bills for weeks or months in a drunken fog?

We all have our risks.  Try to look at them without judgment, as you would look at someone else you cared about.  Our risks are often trying to tell us something.  My drunk behavior has told me to a) leave a relationship that was not healthy  b) leave a career that was killing me  c) do what I really love – go back to school, research and write!  If we can embrace the messages that our drunk behavior brings to light, while minimizing the harms, we can actually improve our lives.

Rank your risks, and start with the one at the top of the list.   If you drive home drunk from the bar, try buying a bottle and drinking at home.  If you send unfortunate emails when drunk, turn off the computer and put it in another room before you drink.

Don’t look at yourself as a failure, and don’t set yourself up to fail by expecting unrealistic goals.  Just minimize risk, one risk at a time.

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When Life Happens to Hamsters

What a week!

In a one-two punch, I’ve found out that my father is suffering from pulmonary fibrosis, a chronic and slow moving but fatal lung disease caused by asbestos in the home where he lived while pastoring a rural church.  At about the same time, my mom had much needed hip replacement surgery, but due to a medical error now has something called “drop foot” where she can’t raise her foot on her own, significantly impairing her walking.

I’m taking a course in Chronic Disease Prevention and Management for my PhD program, and I feel like this is more field experience than I bargained for!

Tuesday afternoon after I left the class I TA at school, I stopped at a fancy wine bar/gourmet shop to pick up some oil and vinegar for my mom’s roommate – I’m visiting them this weekend.  It was part of my plan to stop for a nice glass of red at the Happy Hour price.  I really enjoy a glass of fine wine in a nice wine bar – it’s one of the things I missed most when I was abstinent and in AA.  So I was enjoying my wine when I got a text from my dad, who had just been to the pulmonologist.

The good news is: there’s a drug that can double his life expectancy.

The bad news is: It costs $30k per year out of pocket, over and above what Medicare will pay.

It’s hard enough to deal with the fact that you know your parent is dying, if slowly.  But I knew that my dad and step-mother had wanted to spend the years while he’s still well traveling and having a good time.  I’m not privy to the details of their finances, but a hit of $30 k per year would sure take a chunk out of their ability to do much of anything.

For a moment, I really, really wanted to get wasted.  Just block out all the pain and stress.

But that wasn’t in my plan, so I didn’t.  I knew it would just make me feel worse to wake up hung over and with a bar bill that’s not in my budget.  So I went home, cooked dinner and another glass of (albeit cheaper) wine with dinner.

Moderation, not abstinence, is my goal and my plan.  It works really well for me – I don’t feel deprived and I enjoy wine and social drinking, but I avoid the binge drinking that’s been known to get me into trouble.

Our Dear Founder Kenneth Anderson has the saying, “Sad drinking is bad drinking.”  This is wise advice – drinking in reaction to events is almost never good, whether it’s happiness or sadness.  I think all of us have experienced drinking too much to medicate emotions, or getting carried away in a moment or triumph.  Making a plan and sticking to it, even as life happens, is a good Hamster tool.

So too is knowing that you can change that plan.  I used to try to be abs all week and then drink on weekends, which worked for awhile.  But eventually I found myself too tempted to drink too much on weekends.  By adopting an every day moderation plan, I keep alcohol in its proper place: something I enjoy with dinner at the end of the day, but something I don’t think much about otherwise.

(Unless you count that I research and write about it for a living!)

Whether we choose abstinence, moderation or safer drinking, we can use HAMS tools to get through those moments when life happens.

There’s a Cat Writing the Hamster Blog!

Hey Hamsters!

There’s a cat writing the Hamster blog!  Many of you know me by other names, but I’m writing as Harm Reduction Cat so that I can speak a little more freely than I can on platforms where I write under my real name.

Our Dear Founder, Kenneth Anderson, has graciously invited me to revive the Hamster blog.  I plan to share stories of Hamsters as we go through our daily lives, tips and tricks for reaching our goals, and a little bit of Hamster philosophy.  I’ll be inviting guest Hamsters to write entries, sharing their experience as we go along on this journey.  If you’re interested, drop me a comment!

The comments will be moderated, and trolls will be deleted.  Like our Facebook group, this will be a warm and welcoming, non-judgmental space where all goals are embraced and all positive change is applauded.

A little bit about me… I discovered HAMS and Harm Reduction via the great Monica Richardson, long time HAMS member and creator of the film The Thirteenth Step.  I had struggled with drinking after multiple traumas piled up on each other, and I ended up in a very traditional 12 Step rehab.  After dutifully doing my 90 in 90, becoming secretary of my home group and baking more cookies for meetings than you’d need to sink a battleship, I became disillusioned with that fellowship and began reading about other approaches.  As I read I came to believe that the disease model that had been drilled into me in rehab was not accurate, that I was not powerless, and that no one was doomed to jails, institutions and death if they did not follow the 12 Step path.

I discovered our Dear Founder’s writing, and downloaded the book, How to Change Your Drinking on to my phone.

After a few more weeks of reading and much consideration, I decided to try the experiment.  I had been abstinent from alcohol for 11 months, but I no longer believed that one drink would drive me to out of control madness.  Rather, I had come to believe that I have the power of choice.

Sure enough, I discovered that I could drink safely.  Within ninety days of that first drink, I had earned my Masters degree, gotten a new job, and been accepted to a prestigious PhD program.  So much for jails, institutions and death!

It hasn’t always been a smooth ride, and I do not hold myself up as perfect in any way. Harm Reduction isn’t about achieving some idealized, normative standard of perfection.  Rather, it’s about living as authentically as we can, minimizing the harms and maximizing the benefits.

The support of the Facebook group has been critical to my “recovery from recovery,” and we have recently started a live meeting, where the support is even more vibrant.  Together, we do better.

I’m looking forward to continuing this journey with all of you.  And remember…

BETTER IS BETTER!

Two AA Members Walk Into This Cafe…

An example of how the AA sponsor system inflates egos and encourages sociopathy and just plain bad manners.

I was eating dinner in one of my favorite Park Slope cafes the other night when two guys walked in and asked if they could join me at my table. I thought this was a pretty strange request because there were about four empty tables in plain view in the place at the time. But I don’t like to be rude, so I told them to go ahead and sit down. In retrospect I think I must have been targeted because I was wearing a Lower East Side Needle Exchange T-shirt that said “I [heart] Drug Users.” on the back.

Well before very long the arrogant one who had forced himself onto my table was telling the other one all about how to do his fourth step inventory for his AA program. It was quite clear that the arrogant one was an AA sponsor and the sheeplike one was his sponsee. This was not a conversation which was likely to improve the digestion of my meal, so I kindly and politely told them that their conversation was highly offensive to me and would they please move it to another table. At which the arrogant one piped up that if I didn’t like what was being said that I ought to move to another table. This in spite of the fact that I had been there first.

Then the arrogant one started saying “some are sicker than others” and I told him that I totally agreed because he was clearly sicker than anyone. At which point he hurled more insults at me and started talking about how everything he said was protected under the first amendment right of free speech. I explained to him that this did not apply in a private place of business which had the right to eject him if he was offending other customers.

At this point I called the waiter over, and the waiter asked them very nicely to move to another table and stop bothering me since I had been there first. Of course Mr. Sponsor Pants refused to move and said that the waiter ought to call the police on me. Perhaps he assumed that I was a drug user because of my shirt and assumed that I would be an easy target for oppression who would cower under the jackboot of the law. Although I am a staunch defender of the rights of drug users to be free from oppression and coerced religion such as is practiced by 12 step programs, it just so happens that all the drugs I like are legal, and hence I have no fear of the law. So I seconded the motion to call the police to eject these two interlopers who had invaded the privacy of my table and who were insisting upon offending me with their cult religious practices.

Oh I might also mention that between the two of them all they had ordered was one cup of herbal tea. Mr. Sponsor Pants finally finished his cup of herbal tea and announced that he was paying his bill and leaving.

Why am I sharing this with you? It is a perfect example of how harmful AA is to people’s mental health. This man is typical of the sociopaths who become AA sponsors and of how their egos grow even more inflated as a result of the power they are given by their sponsorship roles. I have seen this sense of entitlement before when the AA meeting that used to meet in our church was evicted. Of course they spent much of their meeting time talking about how organized religion had lost contact with God and how the true God could only be found in AA meetings. But the real kicker was that they thought they had a right to move our piano every time they had a meeting even though they had been expressly forbidden to do so. They kept it up until they broke the leg of the piano which they then refused to pay for.

If you value your mental health, then stay away from AA. I hope some of this bad behavior sunk into that sponsee’s head and he has the sense to leave before he gets sucked in any deeper.

On harm reduction radio Carl Hart on science, addiction, and the drug war

Our guest this evening is Carl Hart Ph. D., professor of neuropsychopharmacology at Columbia University and author of High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society.

http://www.blogtalkradio.com/harm-reduction/2014/09/18/carl-hart-on-the-high-price-of-the-drug-war

So-Called Moderate Drinking Study Actually Studies Severely Heavy Drinking

A recent article in Neuroscience titled “Moderate drinking? Alcohol consumption significantly decreases neurogenesis in the adult hippocampus” purports to study moderate drinking and prove that even moderate drinking may have a severely negative impact on the formation of brain cells. This experiment studied rats whose average BAC was kept at a level of 0.08 (the legal limit for drunk driving) 24 hours a day, 7 days a week for two weeks straight. So who here considers beer for breakfast and drinking 24/7 to be moderate drinking?

Since the average human being metabolizes one standard drink every ninety minutes it would require at least sixteen standard drinks per day to maintain a BAC of 0.08. This is 112 standard drinks per week. However, the NIAAA definition of moderate drinking is no more than 4 drinks per day and 14 per week for a man and no more than 3 per day and 7 per week for a woman. The amount of alcohol given these rats corresponds to 8 times the definition of weekly moderate drinking for men and 16 times the definition of weekly moderation for women. In fact it corresponds to levels typically found in severe alcohol dependence and maintenance drinking to prevent death from alcohol withdrawal.

This is just another example of fraudulent science being harnessed into providing false conclusions to feed the scare tactics of the alcoholism treatment industry

How can you tell when someone schilling for the alcoholism treatment industry is lying? His lips are moving.

References

M.L. Anderson, M.S. Nokia, K.P. Govindaraju, T.J. Shors. “Moderate drinking? Alcohol consumption significantly decreases neurogenesis in the adult hippocampus.” Neuroscience. Volume 224, 8 November 2012, Pages 202–209. http://www.ncbi.nlm.nih.gov/pubmed/22906480

Copyright © 2012, The HAMS Harm Reduction Network

Harm Reduction Therapy Center’s Fundraiser with Ethan Nadelmann

Get your tickets for Harm Reduction Therapy Center’s fundraiser with Ethan Nadelmann http://www.brownpapertickets.com/event/273529

Project MATCH Gets an F in Psych 101

If I made a wiener out of fifty percent pork and fifty percent beef and labeled it and sold it to you as a 100% all beef kosher hot dog would I be committing fraud? Of course I would! But this is exactly what the NIAAA did with their 12 Step Facilitation Therapy in Project MATCH. If you get a copy of the Project MATCH 12 Step Facilitation Therapy manual (which you can buy form NIAAA for 6 bucks) you will clearly see that what Project MATCH calls 12 Step Facilitation Therapy is comprised of  about fifty percent Alan Marlatt’s Relapse Prevention strategies and about fifty percent an interpretation of the first three steps of AA.

The Relapse Prevention strategies incorporated into Project MATCH’s 12 Step Facilitation Therapy are in diametrical opposition to both AA principles and the standard treatment practices found in 12 step treatment programs in the United States. For example, in typical US 12 step treatment programs it is standard operating procedure to kick people out for admitting to or getting caught using drugs or alcohol aka “having a relapse.” And although people are not kicked out of AA for “having a relapse” they are told that they have lost all their sober time and must start counting the days over again from day one. They are also told that they have lost all their progress and are back to square one. This also is standard procedure in the rare cases where relapsers are not kicked out of US 12 step treatment programs,

In the 12 Step Facilitation Therapy of Project MATCH, however, relapsers were told that every day which they abstained from alcohol was progress and a triumph whether the days were consecutive or not. No one was kicked out for relapsing. In fact, success was measured in terms or total number of alcohol free days instead of consecutive days and instead of making total abstinence a requirement! Can you imagine walking into an AA meeting and telling people that you are doing really well because you abstained 20 days out of the last 30? You would be shamed out of the room. You would be told that you had the “disease of denial.” Cherishing every day abstained comes straight out of Marlatt’s Relapse Prevention Counseling which is an evidence-based harm reduction strategy.

The simple fact is that it is impossible to tell in Project MATCH whether the results are a product of the 12 step element of the therapy or the relapse prevention aspect of the therapy. In Psych 101 we call this a “confound.” Here is a definition of a confound:

“Confounding is when a researcher does not control some extraneous variables that may influence the results…the only variable that should influence the results is the variable being studied. If a variable other than the one that is manipulated by the researcher has any affect at all on the measurements, then the study is said to be confounded. This is a very serious problem since the researcher can’t really claim that he/she established cause and effect. If the researcher is studying the effect of some pain medication (drug A) on the reduction of pain, but the researcher fails to control for participants taking other medications at the same time, how can the researcher claim that the results are due to the pain medication (drug A) or the other drugs that participants took? When the researcher controls all extraneous variables and can claim that only the variable that was manipulated has any effect on the results, the study is said to have internal validity.”

http://www.alleydog.com/glossary/definition.php?term=Confound

Everyone who takes Psych 101 is taught that they must avoid confounds in their experiments or their experiments will be invalid. Didn’t any of the researchers who designed Project MATCH take Psych 101?

We can, however, if we refer to certain other experiments make a good guess as to whether the Project MATCH results were due to the 12 step component of the treatment or the Marlatt Relapse Prevention component of the treatment. Brandsma et al (1980) studied a 12 step treatment which is representative of the typical 12 step treatment programs found in US treatment centers and found that it was highly ineffective since two thirds of the clients assigned to the 12 step treatment condition dropped out. Only one third of those assigned to the other treatment conditions dropped out so the other conditions were about twice as effective. Because of the high drop out rate it was impossible to tell whether those in the 12 step condition did better than the control group or not.

One other bit of evidence we have is that Marlatt’s Relapse Prevention strategies have been tested and proven effective in clinical trials (Marlatt 1985).

A second reason that Project MATCH gets an F in Psych 101 is that there was no control group!! This is not even Psych 101, this is so elemental that it is high school science!! This is the definition of a control group:

“During many experiments, researchers often include treatment groups (the groups that are given the treatment/IV) and a control group, which is identical to the treatment group in every single way except that the control group does not get the treatment. In this way, the researcher can study effect(s) of the treatment thoroughly. For example, if I am studying the effects of 2 different pain medications of headaches, I may give people who have headaches (the treatment groups) either Tylenol or Bayer. I can then wait one hour and ask participants to rate the level of pain they are experiencing. If the amount of pain in one group goes down significantly more than the other, I may conclude that one medication is more effective than the other in reducing headache pain. However, I can’t say that either are more effective than giving nothing at all. Maybe there was a placebo effect, and simply getting a pill made people believe their pain was reduced. So, I could include another group – a control group – which is treated and exposed to everything the other groups are except that they are given a placebo (maybe a sugar pill) instead of either Tylenol or Bayer. (Also see Experimental Condition).”

http://www.alleydog.com/glossary/definition.php?term=Control%20Condition%20%28control%20group%29

We have to conclude that the designers of Project MATCH were either knaves or fools to come up with an experiment this bad, deceptive, and meaningless.  Were they fools who were ignorant of this much elementary science? I sincerely doubt it.

There exists a multibillion dollar 12 step treatment industry in the US and the bottom would fall out if the public knew that it is paying for something which is not merely totally ineffective but quite possibly did more harm than good. There was one hell of a monetary incentive for a fraudulent experiment and that is exactly what we got in Project MATCH.

Here is one other thing which we learned from the Brandsma study and this is surely the reason that Project MATCH deliberately avoided having the necessary control group.

At the end of treatment in the Brandsma study there were significant improvements in the groups which received CBT or psychodynamic therapy when compared to the control group–the 12 step group was not comparable because of the high drop out rate. At the three month follow up there were significant differences on 10 different variables. At the six month follow u p there were only significant differences on four different variables. At the 12 month follow up there were only significant differences on one variable: Total Days of Drinking.

It was not just that some of the gains of treatment were lost. The control group itself got significantly better in its drinking habits with no treatment at all. This is very common in Psych experiments. Since improvement without treatment is the norm a control group is always essential for any meaningful results in any Psych experiment!

Of course of Project MATCH had had a control group we would be able to still compare the treated group with the control group now these many years later. The odds are very strong that there would be no difference at all between the treated group and the untreated group.

The only conclusion we can derive from Project MATCH is that TREATMENT DOES NOT WORK.

If it worked the fraud would be unnecessary.

On the other hand harm reduction does work. Ten million clean needles can’t be wrong.

REFERENCES:

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

Marlatt GA, Gordon JR. (1985). Relapse prevention : maintenance strategies in the treatment of addictive behaviors. New York, Guilford Press

NIAAA (1995).Twelve Step Facilitation Therapy Manual, 123 pp. NIH Pub. No. 94-3722.

   Copyright © 2012, The HAMS Harm Reduction Network

The Difference Between A Moderate Drinking Program And An Alcohol Harm Reduction Program

Moderate drinking programs are aimed primarily at early stage problem drinkers who wish to stay within moderate drinking limits, such as the NIAAA limits of 4 standard drinks daily and 14 weekly for men and 3 daily and 7 weekly for women. Research such as that of Martha Sanchez-Craig shows that these programs can be quite effective with early stage problem drinkers but that those with more severe problems are less likely to stick to such limits.

An alcohol harm reduction approach is aimed at all drinkers but in particular offers options to those who are unwilling, unable, or not yet ready to abstain from alcohol. A harm reduction approach always supports successful abstinence or successful moderation as ways to resolve alcohol problems, but in addition it offers options for those who are not abstaining or sticking to moderate limits.

Just as it is true that the more heroin one shoots, the more one needs clean needles, so it is true that the more alcohol related problems one has the more one needs to apply harm reduction strategies to deal with them.

The old idea that people with drug or alcohol problems need to “hit bottom” in order to change has been quite discredited. The reality is that many people who use drugs or alcohol do so because they have suffered trauma, and increasing their trauma only serves to increase their drug or alcohol use.

People often need to be built up to get strong enough to recovery from their drug or alcohol problems—tearing people down dos not help. Helping people to reduce drug or alcohol related harm and to improve mental, physical and financial health does NOT enable people to continue their addiction, rather it enables people to recover.

Sometimes recovery can be defined in terms of abstinence, and sometimes it is defined in terms of non-problematic drug or alcohol use.

However, it is always of the first importance to keep people alive and healthy. Safety first. Because once you are dead you are beyond recovery.

   Copyright © 2012, The HAMS Harm Reduction Network

The Stages of Change Model Vs. the “Hitting Bottom” Model

When Prochaska et al did their extensive research on the change process they did not find evidence that a dramatic and traumatic event such as AA’s notion of “hitting bottom” caused people to change their behaviors. What they found instead was that change occurred in six distinct stages:

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance
• Termination

In precontemplation people are not even thinking about making a change. In contemplation mode people are thinking about making a change. A trigger is needed to move people from precontemplation to contemplation–we will call this trigger the “tipping point.” However, this tipping point does not have to be something huge and dramatic like AA’s conception of “hitting bottom”; it can be an accumulation of small things or even just one non-dramatic incident. My tipping point for deciding to quit cigarettes was my 5 year old adopted nephew’s insistence that I quit so that I didn’t die like his grandmother had.

Then why does AA talk about the need to “hit bottom”? “Hitting bottom” is a very useful tool when we look at the process of Religious Conversion. Religions with a tradition of intense proselytization such as the Hare Krishnas or the Unification Church (Moonies) seek out people when they are at their most vulnerable, because this is when people are ripe for religious conversion. For example, the Cult Hotline and Clinic tells us that, “Everyone has the potential to be susceptible to cult recruitment and coercion at particularly vulnerable points of their life.

Transitional times tend to increase vulnerability:

• During a vacation
• First year away at school
• A year “off” or after graduation
• A job change or loss
• After suffering any loss
• Upon reaching new life stages
• Following the break-up of a relationship
• Soon after moving to another city or country
• During a search for meaning, or to “find oneself.”
• Lonely, without, or away from friends or family”

http://www.cultclinic.org/qa6.html

Religious proselytization in AA is known as “doing 12th step work.” The 12th step says, “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.” In fact, the “Big Book” essentially says that proselytizing others is necessary to avoid an alcoholic death: “Practical experience shows that nothing will so much insure immunity from drinking as intensive work with other alcoholics. It works when other activities fail.” (Big Book p. 89) AA finds ripe grounds for converts by battening on people who have lost wives, or jobs, or who are in prison or hospitals due to their drinking. Since vulnerability makes one ripe for religious conversion it is no wonder that so many AA members speak of how they affiliated with AA after another AA member approached them when they had “hit bottom.”

Can a dramatic and traumatic event such as “hitting bottom” trigger change in the absence of an AA recruiter who fastens onto the vulnerable person? Yes it is possible that the “tipping point” can be triggered by a dramatic and traumatic event. However, it is far more likely that such an event will lead to increased drinking or drug use than it will to stopping drinking or drug use. “Tough Love” approaches which seek to traumatize people in order to make them “hit bottom” are more likely to lead to increased drinking and drugging than to reform. The evidence shows that the more resources which people have intact and the less they are traumatized, the better their chances of recovery. A harm reduction approach which minimizes the damages caused by drugs and alcohol will have far more success in leading people to recovery than will torture therapy. Torture therapy is practiced by sadists and not by the compassionate–they have been with us to prey on the weak, vulnerable, and socially rejected in every generation from the concentration camps of Nazi Germany to the Tough Love camps of the American addiction treatment system. The evidence shows that the normal outcome of addiction is spontaneous remission; torture therapy camps prevent spontaneous remission and lead to greater drug and alcohol use than no treatment at all.

In conclusion, “hitting bottom” is great for leading people to religious conversion and affiliation with AA; however, hitting bottom is not necessary for changing an addiction and may actually lead to deeper addiction instead. AA itself often becomes the new substitute addiction for those who “hit bottom.” By way of contrast, harm reduction enables recovery from addiction.

REFERENCES:

Denning P, Little J. (2011). Practicing Harm Reduction Psychotherapy, Second Edition: An Alternative Approach to Addictions. The Guilford Press.

NIAAA (2009). Alcoholism Isn’t What It Used To Be. NIAAA Spectrum. Vol 1, Number 1, p 1-3. http://www.spectrum.niaaa.nih.gov/media/pdf/NIAAA_Spectrum_Sept_09_tagged.pdf

Prochaska JO, Norcross JC, Diclemente CC. (1994). Changing for good. New York, Avon Books.

Wilson, W. (1939, 1976). Alcoholics Anonymous. New York: Alcoholics Anonymous World Services.

Wilson, W. (1953). Twelve steps and twelve traditions. New York: Alcoholics Anonymous World Services.

  Copyright © 2012, The HAMS Harm Reduction Network