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.