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.