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.

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About Kenneth Anderson

Kenneth Anderson is the author of the book How to Change Your Drinking: a Harm Reduction Guide to Alcohol. He is also the founder and CEO of The HAMS Harm Reduction Network.
This entry was posted in Alcohol, alcohol harm reduction, codependency, enabling, hams harm reduction network, harm reduction and tagged , , , , , , . Bookmark the permalink.

One Response to Harm Reduction, Enabling, and Codependency

  1. Pingback: Alcohol Posts » HARM REDUCTION, ENABLING, AND CODEPENDENCY

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