Addictionland - Addiction Recovery Blog

Harm reduction is a way of helping the alcoholic manage their drinking.  For instance, if an alcoholic is prone to drinking and driving, maybe he should move close to a bus route or a subway line so that driving isn’t necessary.   Not drinking is, well, not drinking.  Harm reduction has its very strong proponents.

As for me, when working with someone, I’m always thinking not just about the harm I want to help them reduce, but about completely replacing harm with life.  No change that. Life: with a capital L.  This is much like the OCD client’s I have that are consumed with reducing risk in their life so they stop going out … it’s a wonder they even get out to see me.  The idea is to be free of the addiction.

When I think of the client who stops drinking at 26, gets a productive job, becomes supportive and loving spouse and father.  The ripple effects of all the people that this person touches in a positive way are literally infinite.  There is no comparison to that and if he had learned how to manage his drinking, and shrunk his life into a small flat near the bus line, working the system for what meager funds he could pull together to drink alone in his apartment until he died.  One is a giver of life and the other is a parasite on society and a downer even unto himself.

Are there times when I’ve engaged in harm reduction?   Yes.  Productively, I can see harm reduction as beneficial if it is seen as the pre-contemplative phase of recovery.  In other words, it is something that is useful once they have become a nuisance to themselves and society but before they are ready to throw in the towel.  In those cases I will help with harm reduction.  Having said that, it is something that I do with trepidation, because addiction is very unpredictable.  Just because an alcoholic moves near the subway line so that he won’t drive drunk, is not guarantee that the once drunk, he/she won’t rebel against the who system and drive anyway.  Or like one young man I worked with who fell alone in his apartment, bashing his head on the corning of his stereo and bleeding to death.  Ultimately, the concept of managing addiction or alcoholism is very arrogant.  Sadly, sometimes, as a professional, it is the only tool I have.  While I will use the tool if that is the only place the client will meet me, it is, in essence, a lousy tool.

Sobriety is such a blessing with so many rewards - rewards that are measured in reunited families, careers that never would have been, in spiritual enlightenment that is bigger than any of us – when I am backed into the corner of harm reduction, I feel so impoverished, a little like Dr Kevorkian.

The typical picture painted of alcoholism is the staggering, drooling drunk-- usually a pathetic, affable person making a scene of some sort.  

I've come to understand that this does not capture the true essence of alcoholism.  It merely paints a picture of the alcoholic who has found a temporary solution (alcohol).   The spiritual malady has been sedated, the resentments and fears that eat their insides daily have been put to sleep.  Drunkeness provides relief from alcoholism.

To see true alcoholism, watch the sober, untreated alcoholic.   They are coming out of their skin, perhaps because they are doing all they can to fight a physical compulsion to drink, or maybe because they've been without a drink for a week or a month or a year and are battling daily mental urges to drink.  Impatience, irritability and edginess mark their day, they often appear forlorn and lonely, and any happiness often appears disingenuine and affected. For me, I often felt like my head might explode at any given moment, and I often wished for it.

This is why we drink:  this condition becomes unbearable.  It's often a choice between a bottle of vodka and a three state killing spree.  And we choose vodka, thankfully. When we hear it said that certain dry alcoholics should just drink, this is what drives it:  that person creates less havoc, misery, and destruction when they are drunk than when they are not.

Abstinence does not treat alcoholism, it aggravates it.   It's an untenable, in-between state for the hopeless alcoholic-- they either return to drinking or they find a spiritual solution to their spiritual problem.  

Don't ever tell me my worst day sober was better than my best day drunk.  Utter nonsense.

Cross-posted at Thump.