Drinking Again

If you have successfully resolved your problems with alcohol via long term (6 months or more) abstinence from alcohol then HAMS urges you to use great caution before you consider drinking again. Studies (NIAAA 2009) show that about half of persons with Alcohol Dependence resolve the problem by quitting completely. HAMS is always supportive of total abstinence as a recovery goal; since the “A” in HAMS stands for Abstinence we like to say that “Quitting drinking is our middle name.” Harm reduction strategies are aimed at those who are unwilling, unable, or not yet ready to abstain from alcohol. This includes people who have attempted abstinence and ultimately not succeeded at it but instead have gone on major benders after short abstinence periods. It also includes those who have never attempted abstinence or who currently have no interest in abstinence. Increased trauma produces increased drinking (Denning & Little 2011). The more resources people have intact, the better their odds of achieving recovery–whether abstinent or non-abstinent recovery. Harm reduction helps keep people’s resources intact enabling them to recover more quickly and easily than if they lost all.

If you are succeeding at abstinence and your alcohol related problems have disappeared or are disappearing then we strongly urge you to continue with what you find to be working–i.e. abstinence. However, if you have already decided that you are going to dink again then HAMS is a safe place to experiment with controlled drinking and you will be far safer here than if you attempt this on your own with no support at all.

If you are wavering and have not yet decided whether or not you wish to drink again then we strongly suggest that you do a Cost Benefit Analysis (aka a Decisional Balance Sheet) which compares the pros and cons of continuing to abstain with the pros and cons of drinking again. We also suggest that you write out a list of alcohol related losses and problems and a list of what you have gained as a result of abstinence from alcohol.

Some people are more likely to succeed in drinking again than others:

People whose drug of choice was not alcohol. If you went to rehab for heroin or some other drug which was not alcohol you were probably told that you were cross addicted to all mood altering drugs and that you must never drink again or you would relapse. The simple fact is that this is not true. You may well have noticed your rehab counselors using mood altering drugs like caffeine and nicotine all the time and not calling this a relapse. The fact is that if you try to use alcohol as a direct substitute for heroin and get as drunk as possible all the time instead of shooting heroin then you will certainly have alcohol problems. However, if you get your life together and become a whole new person with a whole new life there is no chemical reason in your brain why you should not have an adult beverage at times. Opioids are directly cross-tolerant with each other; they are only slightly cross-tolerant with alcohol. Other drugs like speed are not cross tolerant with alcohol at all.

We do, however, very strongly recommend that if you are an ex drug user who is choosing to drink in moderation that you track your drinks by charting. Keeping a drinking chart will help you keep your drink numbers under control and let you know if you are starting to slip out of bounds. If you find your drinking is showing a tendency to “creep” up more and more you might wish to opt to return to abstinence from alcohol. We also strongly suggest that you do your experimenting within the safety net of a HAMS group and that you write out a Cost Benefit Analysis.

Another group who may tend to succeed with drinking again are those who were sowing a lot of wild oats in high school or college and wound up in rehab or an abstinence program in their teens or early twenties. If you are now in your forties you might have matured a great deal and no longer be interested in being the wild man. If you now find that moderate drinking is appealing to you but the thought of being a drunk teenager throwing up on your date’s shoes at a party is repulsive to you then you may well find success at becoming a moderate drinking. Again we suggest that you do your experimenting within the safety of a HAMS group and that you chart and do a Cost Benefit Analysis.

If you had a long drinking career and a long history of alcohol related problems then the odds of returning to controlled drinking are greatly reduced. The longer the drinking career and the more problems the lower the chances of successful controlled drinking.

If you think that you have a shot at becoming a successful controlled drinker, then write down what it is that has changed in your situation that you believe will make you a successful controlled drinker this time around. If nothing has changed then it may well be excruciatingly difficult to try to use the HAMS harm reduction and moderate drinking tools to become a controlled drinker. Not only may you find that your odds of success are low, but you may also find that staying within the moderate drinking limits you have set for yourself is a form of torture and that abstinence is far simpler and more pleasant.

HAMS harm reduction strategies are not a magic bullet which can turn everyone into a successful controlled drinker. For many, many people abstinence remains the best choice. Abstinence is simple and clear cut and avoids the problem of shades of gray

And whether you opt to continue to abstain or you choose to drink again, always remember that you and no one but you are responsible for your choices.

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

  Copyright © 2012, The HAMS Harm Reduction Network

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To Abstain, or Not To Abstain

Choosing your goal:

The main choice is between an abstinence goal and a non-abstinence goal. Goals of safer drinking and reduced drinking are not really at odds with each other very much. You will have to be honest with yourself about successes and failures you have had with a goal of controlled drinking in the past as well as be honest with yourself about successes and failures you have had with a goal of abstinence in the past. It is worth writing down two lists—one of successes and failures with the abstinence goal and one with successes and failures with the non-abstinence goal.

If you are currently abstaining and are considering experimenting with controlled drinking, we suggest that you follow each drinking session the following day with a written evaluation of what worked and what didn’t.

We also suggest that yo write out a Cost Benefit Analysis of the pros and cons of adopting an abstinence goal and the pros and cons of adopting a non-abstinence goal.

Harm reduction is aimed at those who are unwilling or unable to abstain—it is not a magic bullet to allow successful abstainers to drink again as much as they want with no consequences.

If you choose abstinence as your goal then we suggest that many people may find it helpful to participate in an abstinence-based group as well as in HAMS. If HAMS is the only group that you use then you might find that constantly hearing others talk about controlled drinking strategies is a temptation to pull you away from your abstinence goal.

HAMS always supports abstinence as a goal. However, the evidence shows that the traditional notion of “hitting bottom” is erroneous. People often use alcohol or drugs to cope with trauma, and increasing the trauma increases the drug or alcohol use. The more resources that people have intact, the more likely they are to succeed in either a goal of abstinence or in non-abstinent recovery. Stripping people of all they own  in an attempt to force then into AA is less successful than doing nothing at all. After all, research tells us that the normal outcome of addiction is recovery without AA and without treatment.

Many people find that their first step towards abstinence is through harm reduction.

 Copyright © 2012, The HAMS Harm Reduction Network

 

 

The Way to Stop DUI Is to Stop People from Driving

The way to prevent fatalities due to impaired driving is to stop people from driving. This means building workable public transportation in every city in the US and penalizing people for driving instead of using public transportation in all ways possible. The way to fund public transportation is with prohibitively high taxes on gasoline as well as instituting toll roads everywhere as well as closing many city streets to private automobiles. We also need to pass a law against bars having parking lots and we should make the breathalyzer ignition interlock standard on every automobile in the US just like seatbelts.

In Japan in 1993 there were 525 drunk driving fatalities for a population of 124.7 million people. In other words, 0.000004210104 drunk driving fatalities per capita. Compare this to the US. In 1991 in the US there were 22,083 drunk driving fatalities for a population of 252,127,402 people. In other words 0.000087586672 drunk driving fatalities per capita.

In other words, there are 20.8039212 times as many deaths caused by drunk driving in the US than there are in Japan!

The reasons why are pretty damn obvious to anyone who has ever lived in Japan. Japanese bars do not have parking lots. The drunks are all on the subway and not in automobiles. In Japan public transportation is the norm for everything and driving is the exception.

In Japan only five percent of traffic fatalities are caused by drunk driving, in the US this number is fifty percent.

Isn’t it pretty obvious what we need to do to stop drunk driving in the US?

But don’t expect MADD to start campaigning for better public transportation any time soon. MADD is funded by DaimlerChrysler, General Motors and Nissan. Can you spell conflict of interest, boys and girls?

REFERENCES:

Mothers Against Drunk Driving: A Crash Course in MADD by David J. Hanson, Ph.D. http://alcoholfacts.org/CrashCourseOnMADD.html

Drunk Driving in Japan http://www.dui.com/dui-library/foreign/dui-japan

Copyright © 2012, The HAMS Harm Reduction Network

Project MATCH Proves That Harm Reduction Works And 12 Step Programs Don’t

It is rather amazing that the US government spent 35 million dollars on a project as flawed and fraudulent as project MATCH. Project MATCH purported to compare 12 Step Treatment with Cognitive Behavioral Therapy (CBT) and Motivational Enhancement Therapy (MET), but in actuality it did nothing of the kind. The first huge problem with Project MATCH was that the 12 Step Facilitation Therapy (TSF) used in Project MATCH bears no resemblance to any 12 step treatment programs available to the public and also no resemblance to the original 12 step program, AA. The TSF used by Project MATCH incorporated huge amounts of Harm Reduction and this is why it was successful.

In standard 12 Step Treatment Programs clients are kicked out of treatment if they relapse. If not discharged they are hugely shamed and degraded for their relapse. Project MATCH, on the other hand, told clients that they should value every one of their abstinence days and not beat themselves up for relapse. They were told that the total number of abstinence days was far more important than the number of consecutive abstinence days. They were not shamed, degraded, or kicked out of treatment for relapse. These are PURE HARM REDUCTION STRATEGIES which are not to be found in any 12 step treatment program you will pay money for in the US.

Imagine walking into an AA meeting and declaring that you were doing really great because you had abstained from alcohol for 20 days of the last 30. Anyone attempting such a thing would get a clear message from everyone’s subsequent “shares” that they were an alcoholic in denial and leading themselves down the road to death be thinking that they could control their drinking instead of surrendering to God.

Why did Project MATCH conduct such a fraudulent study instead of just looking at 12 step treatment as generally available in the US? The answer to this is quite simple. A huge controlled trial of standard 12 step treatment, CBT, and Psychodynamic Therapy called Project SHARP had already been conducted by Jeffrey Brandsma and his colleagues in the 1970s. What this study had shown us was that 12 step treatment programs are a resounding failure. Two thirds of clients assigned to the 12 step treatment groups dropped out. Only one third of clients assigned to CBT, Psychodynamic Therapy, or the control group dropped out. Clearly a therapy cannot be successful if it drives the clients away and they don’t complete it. What Project MATCH demonstrated was that even something is poor as 12 step treatment can be made successful if you add enough Harm Reduction elements to it.

A second huge flaw of Project MATCH was the lack of a control group. Even a high school science student knows that the results of your experiment are meaningless unless you have a control group to compare them to. Perhaps Project MATCH should have spent some of their 35 million dollar budget to hire a high school science student to do the project design for them. All studies of people with alcohol dependence show that a control group which receives no treatment at all always shows significant improvements over baseline. In fact, the NESARC study showed us that the natural outcome of alcohol dependence is recovery without treatment and without AA, albeit it can take up to 20 years for this recovery to take place. This study showed us that 75% of people with alcohol dependence recovered–and three fourths of those who recovered did so without treatment and without AA.

Moreover, it is essential to compare a treated group with a control group over a long period of time to show that the changes brought about by the treatment are permanent and do not disappear with the passage of time. In the Brandsma study at the three month follow up the treated groups showed significantly better outcomes than the control group on numerous measures including: number of times the subject stopped at one or two drinks, number of ounces of alcohol consumed over the 90 day period, number of drinking days in the 90 day period, and the number of times the subject abstained from alcohol for more than one day. However, at the one year follow up period there was only one significant difference between the treated groups and the control group: that was the total number of drinking days. All the other significant differences had disappeared by the time one year had passed.

Enoch Gordis, former head of the NIAAA, claimed that Project MATCH demonstrated that treatment worked, regardless of what the treatment was. This statement is eminently false. Without a control group and a lifelong follow up we have no idea if the treatments had any real impact at all. Moreover, testing treatments which are not available to the general public tells us nothing about the effectiveness or ineffectiveness of those treatments which are available to the general public.

Project MATCH proved that Harm Reduction works. However, I will bet that there is not a single 12 step treatment program in the United States toady where you will find the Harm Reduction strategies from Project MATCH incorporated into the treatment program. Rather than waste 30 thousand dollars on a treatment program that does not work and may well make you sicker than you were when you started, you can just stay home and read a good book about quitting or controlling your drinking. Or if you want a support group, SMART, HAMS and some others are free and are based on scientifically tested principles which are proven to work.

Or you could even go to AA if you like that kind of approach–it is not for me but some of my colleagues like it. At least it is free.

REFERENCES

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

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

NIAAA (1994).Motivational Enhancement Therapy Manual, 121 pp. NIH Pub. No. 94-3723..

NIAAA (1995).Cognitive-Behavioral Coping Skills Therapy Manual, 101 pp. NIH Pub. No. 94-3724.

Copyright © 2012, The HAMS Harm Reduction Network

Addiction Is Not A Progressive Disease

Addiction is defined as out-of-control substance use and the inability to stop. However, just because we are unable to stop today does not mean that we will be unable to control or stop our use tomorrow. THE HUMAN BRAIN IS NOT STATIC. The erroneous assumption that the human brain is static with regard to all things except substance use has led to unlimited nonsense in the world of substance use treatment. Our brains/minds change as we get older and more mature and when we reach a certain point we may decide to quit a problematic behavior because we have out grown it. According to the NIAAA more than half of people with alcohol dependence recover on their own without AA or alcoholism treatment.

http://www.spectrum.niaaa.nih.gov/features/alcoholism.aspx

There are more ex-smokers today than current smokers and the vast majority have quit on their own. The research also suggests that the majority of heroin addicts stop on their own when they are ready.

Substance use changes the brain, but so does everything else from prayer and meditation

http://andrewnewberg.com/

to driving a taxi cab in London

http://news.bbc.co.uk/2/hi/677048.stm

The normal outcome of addiction is recovery without treatment. The goal of treatment should be to speed natural recovery

Copyright © 2012, The HAMS Harm Reduction Network

Why Substance Use Should Never Be Called A Disease

There are three cases we can look at:

1) The case of recreational substance use where the only negative consequences are the result of the drug laws and not the result of drug use itself. In this case it is the drug laws which are sick, insane, and diseased, and not the drug users. We also include recreational alcohol intoxication in this category because we find the US governments definitions of moderate drinking to be insane, sick, and diseased. People who enjoy their drugs or booze without harming themselves or others need to be left alone. People who use substances recreationally are neither bad people who need to be punished, nor are they sick people who need to be treated, they are good and healthy people enjoying the exploration or alteration of their own consciousnesses. The province of the law stops at the surface of my skin.

There is a general agreement that moderate drinking of alcohol is not a disease. However, I also propose that recreational alcohol intoxication is not a disease: it is an entertainment. “Binge drinking” is a deliberately pejorative term intended to demonize recreational intoxication by associating it with out-of-control behaviors like drinking and driving or going on three day benders. However, there are many individuals who exceed the limit of 4 drinks per day (3 for a woman) and do not engage in drunk driving and do not go on multi-day benders which start with getting drunk in the morning. In fact, only a tiny percentage of people who exceed moderate drinking guidelines engage in these behaviors.

2)  There are people who want to change their drug or alcohol use because it is causing them problems which they do not like. We should definitely help these people on the path of safer use, reduced use, or quitting altogether. However, telling these people that they are diseased and incapable of changing their behaviors without a “higher power” or an AA group or some damn thing is not helpful. Quite the opposite, when people believe that it is impossible to change their behaviors because they are diseased, and when they believe that they are not responsible for their actions because their actions are the result of a disease over which they are powerless, then they do not change..Albert Bandura tells us that the people who are successful at changing are the ones who believe that they can change. Therefore we should tell people that they have bad habits which they are capable of overcoming with knowledge and scientifically proven techniques. Telling people that they are powerless and will drink and die unless they attend AA for life only turns them into lifelong AA junkies ready to relapse at the drop of a hat.

3) There are sociopaths and people with anti-social personality disorder who regularly drive drunk, engage in intoxicated violence, and generally do not give a f*ck how much damage or hurt they do to other people whether they are intoxicated or not. These are bad people who need to be locked up to insure the safety of the community. Personally I would like to see the breathalyzer ignition interlock be made a standard piece of safety equipment on every car driven in the USA.

CONCLUSION

The only people who benefit from calling substance use a disease are the treatment providers who want to charge insurance companies money and the 12 step groups who want to raise attendance numbers.

It is very unfortunate that the DSM characterizes behaviors as diseases or non-diseases on the basis of popularity rather than objective scientific evidence. Hence, when homosexuality was unpopular and stigmatized in the US it was a DSM disease, but when it became an acceptable lifestyle choice it was voted to be a non-disease. Likewise the APA refuses to recognized caffeine dependence because the majority of shrinks are unwilling to give up their morning cup of coffee and their sodas.

In a proper society of free men all vices are legal, including drugs, religion, gambling, alcohol, prostitution, homosexuality, etc. People have the right to choose their own vices and to avoid the ones which they do not like or find are problematic for them personally. We recognize that it is a great mental illness to impose one’s personal moral judgments on others rather than to respect their freedom to choose for themselves to engage in behaviors which do not harm others. This disease of Puritanical Busybodyism is what needs to be added to the new edition of the DSM.

 Copyright © 2012, The HAMS Harm Reduction Network

Guidelines for HAMS Meetings

This is a draft of the HAMS guidelines which will be put before the board for finalization.

We have found that the following guidelines are helpful for HAMS meetings, whether live, in a chat room, or by email:

1. The tone of discussion in HAMS groups is based on Miler and Rollnick’s Motivational Interviewing–adapted to a peer group setting. We avoid being confrontational and encourage people to share as much or as little information as they choose themselves. We let people choose for themselves how to use the group in a manner most beneficial to them. We encourage people to pursue goals which they choose for themselves, and do not attempt to choose goals for them. HAMS supports every positive change from safer drinking to reduced drinking to quitting altogether.
2. Generally telling other people what they ought to do is not nearly as effective as sharing how you solved a problem yourself. Therefore, in most cases it is better to use the first person pronoun “I” and share experiences than to use the second person pronoun “you” and give advice. Of course there are exceptions such as when advice is requested.
3. HAMS members are always expected to treat each other with mutual respect and never call each other bad names. Meanness of any sort will not be tolerated in HAMS groups and may be subject to disciplinary measures. When people fail to keep to their plans they are quite good enough at beating themselves up and require no outside help.
4. There is no rule against intoxication in HAMS groups; some people would never be able to participate in their first HAMS group if they had to be sober as a condition of coming in. However, members are expected to be well- behaved whether intoxicated or not. In the case of live HAMS meetings we encourage members to see that intoxicated members get home safely and do not drive drunk.
5. What HAMS members choose to do on their own time is their own business–this includes dating each other or drinking together. If you find it helpful to avoid drinking with other HAMS members then do so.
6. HAMS members cannot read minds or foretell the future. We respect each individual’s right to choose their own drinking goal and to pick their own tools and strategies to achieve it. We avoid the AA habit of saying “I used to be just like you” because we realize that everyone changes in their own unique ways as they follow their own unique paths through life.
7. It is up to each individual group how much time they wish to spend on humor and if they wish to discuss issues such as drugs or gambling in addition to alcohol. Some of us find that laughter is the best medicine and opt to mix humor with the serious business of harm reduction.
8. HAMS welcomes cross-talk, members are free to respond to what others have said. No one is forced to speak against their will, lurkers and observers are welcome. However we strive to make sure that everyone gets a chance to talk and that no one monopolizes the floor to themselves.
9. We respect the right of each individual to put together the components of their own plan which can include medications, supplements, psychotherapy, or what-have-you. Ultimately the decision to use or not use medications is between the individual and their doctor–we do not condone pro-medication or anti-medication browbeatings.

It does not matter how much or how little a person drinks, their drug of choice, their harm reduction goal, their race, color, creed, sex, gender, sexual preference and spelling ability. We strive to meet every person “where they are at”. If a person gets drunk every day and their goal choice is to quit drinking and driving but not to drink less–we support that. If a person drinks one glass of wine a week and thinks that is too much and wants to quit alcohol entirely–we support that. We support the individual in making any positive change which they choose for themselves. HAMS is here to encourage every success and to recognize every positive change, no matter how small. Small steps make for big changes.

REFERENCES:

Miller WR, Rollnick S. (2002). Motivational Interviewing, Second Edition: Preparing People for Change. The Guilford Press.

Copyright © 2012, The HAMS Harm Reduction Network

 

I Am…

It was recently pointed out to me that the statement “I am ___.” is the most powerful statement in the world. If you say “I am depressed”, I am powerless” or “I am an alcoholic” you are just setting up a self fulfilling prophecy.

AA likes people to be powerless because then AA can claim to be their higher power and the salvation without which they will die. AA empowers itself by disempowering its members. This is what makes the first step of AA dangerous. Never say that you are powerless.

This is also what makes AA members so vocal in claiming that AA is the only way. Since they have abandoned their personal self-efficacy to a group, they truly do believe that they will die if they have to rely on their own power instead of AA. This is what cults do and this is a basic brainwashing technique. It is very efficient at creating extremely vocal converts; however, it is not very good at helping people to stop drinking. In that area the success rate of AA is often found to be about the same as an untreated control group. Contrary to popular opinion, alcoholism is not a progressive disease and the normal outcome of addiction is recovery without treatment. Check out this link for verification:

http://www.spectrum.niaaa.nih.gov/features/alcoholism.aspx

The good news is that “I am ____” statements can be used for empowerment as well as disempowerment. Our newest HAMS exercise is to fill in the blank of the “I am ___” statement with something empowering like “I AM POWERFUL, ALCOHOL IS POWERLESS!”

Try it yourself today. What do you want to fill in the blank with? Repeat to yourself five times and that will help you to become what you desire!

Copyright © 2011, The HAMS Harm Reduction Network

Leaving AA

New blog up for people considering leaving AA

http://leavingaa.com/

 

Free Harm Reduction teleseminar with Kenneth Anderson and Beverly Buncher

Free Harm Reduction teleseminar with Kenneth Anderson and Beverly Buncher – Register now http://beverlybuncher.com/key-5-teleseminar-on-harm-reduction-little-steps-to-big-changes/

Although conventional treatments based on the 12 steps have helped millions of people, the NIAA (National Institute on Alcohol Abuse) tells us that less than 20 % of people with Alcohol Dependence will recover via AA or a 12 step treatment program. Even though the majority of people with an addiction will eventually recover, there can be a tremendous amount of damage on the way.

Harm reduction offers a means of engaging people in the recovery process who object to conventional treatment programs because of either the abstinence requirement or the spiritual component. Numerous studies have demonstrated the effectiveness of harm reduction interventions. Tonight Beverly’s guest Kenneth Anderson will be sharing with us the alcohol harm reduction strategies which he has written about in his book “ How to Change Your Drinking: a Harm Reduction Guide to Alcohol” and which are used in the HAMS harm reduction support group.

Join Beverly and Kenneth as they discuss:

1. how demanding perfection can backfire and leave people worse off than before

2. how people are more successful when they choose the way they change themselves

3. how becoming a safer drinker is better than choosing not to change at all

4. how people who find they cannot stand AA may do better with another approach – and there are plenty!