Is “Harm Reduction” Strategy Enough For Recovery?
If I could drink like a normal person, I would be drunk all day long . . . 1
In 2006 a self-help book titled “The Secret” hit bookstore shelves and immediately became a best seller. Its premise is that our thoughts directly change our world. The so-called Law of Attraction. The principle seemed revolutionary yet intuitive, something that deep down we always knew. People got excited. Millions of copies were sold. There was a movie. A lot of money was made. Except, there was only one problem – our thoughts don’t directly change the world. The real secret, everybody came to realize, is that the book was garbage. People came to their senses and forgot about it.
A corollary of The Secret called “harm reduction” now has arrived to the world of substance abuse recovery. Zealots claim that we alcoholics and addicts can have our cake and eat it too. They tout it in self-help books and on-line recovery forums. Their message is simple: believe in yourself, drink like a normal person, and you can be drunk all day long. They even publish success stories of their members who, not surprisingly, are drunk all day long. Their message has intuitive appeal to an alcoholic or addict’s mind. It’s the same type of guff that Bill Wilson foresaw back in 1939:
The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker. The persistency of this illusion is astonishing. Many pursue it into the gates of insanity or death.2
Sadly, many alcoholics and addicts today are pursuing harm reduction to the gates of death. Their illusion finds its origin in the unfortunate tendency to lump everybody suffering problems from drugs or alcohol into one basket. Some people today get sent to AA and NA even though they are not alcoholics or addicts. They can control their substance use and aren’t dependent. A host of problems follow. We have a population of people going to 12 Step meetings who probably shouldn’t be there and who don’t want to be there. Resentments arise. Certain harm reduction methods nevertheless may be helpful to these people. There is yet another population of people attending AA and NA, who probably should be there, but are unwilling to work the program. They suffer huge problems from substance abuse. They feel overwhelming guilt and shame over their inability to stay sober. Resentments arise in this population, too. They start blaming AA and NA for their problems.
We end up with two groups of bad attitude bears. Eventually they find each other and join together. From this unlikely union a marketing idea is born: offer harm reduction methods as an actual recovery program to alcoholics and addicts. The idea offers an aura of hope to desperate people. The promoters are profiting. The results are predictably dismal.
Harm Reduction Promotion
So, what is harm reduction? How do we recognize it if we see it? Broadly speaking, it refers to the universe of ideas and strategies intended to reduce the negative consequences of drug and alcohol use. As promoted to alcoholics and addicts, the ideology starts with the notion that everybody has a natural, universal desire to get high.3 “To get drunk, to get high, to get out of one’s mind has been a natural phenomenon throughout human history.”4 Since the dawn of time, drugs and alcohol have been used by almost everyone, on every continent, for many reasons, whether recreational, cultural, religious, dietary, or medicinal.5 Drugs and alcohol are great. They work.6
Proponents assert that “[p]roblems with alcohol and drugs are not diseases, crimes, or sins. They are health issues”7 that are personal to the user. So, if a person really enjoys drinking a fifth of booze every day and has no desire to change, for example, then it is not anybody’s job to try and change them.8 Five to seven drinks per day are considered “low risk” drinking, by the way.9 Nobody should be diagnosed or labeled an addict or alcoholic, either. To the contrary, the user is the expert, the only one who fairly can balance the benefits and risks. Only they can evaluate how to best fulfill their needs through these substances.10 Harm reductionists further assert that people always think rationally. They are the ones who can and should be able to examine – without harsh judgments – their own substance use and whatever trouble they may have gotten into because of it.11
Some of the harm reduction methods promoted by these advocates may be considered relatively “new,” like using clean needles to inject drugs, substituting pharmaceutical medications for a substance habit, voluntarily installing a breathalizer on one’s car, and kicking an alcohol addiction by smoking marijuana. Most of the methods have been around for a long time, however.
In fact, the methods most often suggested by harm reduction literature were familiar even when the Big Book was published. They include strategies like: drinking beer only, limiting the number of drinks, tapering off, never drinking alone, never drinking in the morning, drinking only at home, never having it in the house, drinking only at parties, taking a trip, not taking a trip, taking more physical exercise, reading inspirational books, going to treatment centers, and any number of other measures, ad infinitum. These methods are expressly identified in the Big Book as measures that are universally tried – out of desperation – and don’t work.12
Harm reductionists promote paperwork, too. Lots of it. Users are encouraged to cultivate their relationships with drugs and alcohol by writing all kinds of descriptions, plans, and calculations. The relationship must be nurtured and fine-tuned. Nothing can be overlooked. There are cost/benefit analyses, drinking goal worksheets, risk ranking worksheets, risk charting, drink charting, written drinking plan worksheets, rational emotive worksheets, and self-confidence enhancement worksheets. The paperwork is an evolving process that can change at any minute, depending the user’s needs or wants, so maintaining all of these worksheets and charts requires vigilance.
According to harm reductionist proponents, the results of these activities are great. Alcoholics and addicts are empowered to use. Websites and books offer full-throated endorsements for using drugs and alcohol. Users are expected to moderate, or quit, whenever they want. Time to throw off the shackles of past prejudices and fears:
You can be a daily pot smoker and a good parent; a weekend partier and a great teacher, lawyer, plumber, or gardener; dependent on heroin and a loving partner.13
Wow. For somebody trapped in the cycle of addiction, this sounds appealing. But, who takes care of the baby’s sudden emergency when we’re stoned? How does a hangover help us at our jobs? How do we love our partners when we’re too high to even think? Advocates insist that we keep a positive attitude. No guilt, shame, or remorse for past mistakes allowed! Believing in ourselves is what counts. Believing that we have the power of choice and the power to change is the essential ingredient for success.14 Better is better!
Harm Reduction’s Angst Against 12 Step Programs
As we alluded to above, a great many of the harm reduction group members formerly sat in AA and NA meetings. Many appear to dislike 12 Step programs, and the writers of their literature and administrators of their websites cultivate their resentments and cheer them on. Nobody bothers with the fact that they never worked the program. How can one get sober if they don’t do this? Inability to get sober can lead to shame and guilt, one reaction to which is anger. None of this matters to them, however. Nor does it matter when landmark scientific studies support 12 Step results, or when study after study is published that evidences particular points of the program. Their literature, frankly, puts flat-earthers to shame in trying to minimize and tear apart what in our 21st century is a well-supported, scientifically evidenced truth: 12 Step programs help alcoholics and addicts quit their addictions. Their resentments against AA really run deep.
An example may help illustrate this. It is common in the on-line harm reduction forums to find posts by people claiming that AA made them feel guilt and shame for their drug and alcohol use. Yet, what becomes apparent from reading these posts is that “attending” AA and “sitting in” their AA rooms means exactly what is said. Attending and sitting. Hundreds of proverbial frogs sitting on a log. No action. They not only failed to work the 12 Step program, most never ever made it through Step 1.
One entry, offered here as example, is by someone who pseudonymously calls herself Jaya Angel. She relates that she has been reading a book called The 30 Day Solution, which recommends doing a 30-day period of abstinence (Abs). While she likes the book, doing a 30-day Abs sounds way too much like AA to her. For years she attended AA and was never able to stay sober for even a month, which brought her only shame and low self-esteem. The book thus poses a dilemma, one that in her mind can only be solved by never trying to stay sober for 30 days again:
…I’ve been setting myself up for horrible failure this past week and a half trying to do this Abs-30 thing! I’ve set myself up for over-drinking, shame, embarrassment, guilt, and truly hating myself. I’ve set myself up into starting to believe again I’m an alcoholic! Do you know how erroneously sad that is? I think it even made my behavior worse when I drank because I wasn’t supposed to be drinking!!! The problem ISN’T that I CAN’T complete 30 days of voluntary abstinence from drinking! The problem is I SHOULDN’T!!!15
This poor woman clearly is living in torment. She is blind to her chronic intoxication and sees only the shame and guilt it brings. Her answer, then, is to stop even trying. She can’t lose a race that she never enters, after all, and somehow that idea sounds entirely reasonable to her. At all costs, she will not admit to herself that she is an alcoholic, the very essence of Step 1.
Others on Jaya Rainbow’s thread rush to comfort her, but the fact of her chronic drunkenness is never addressed. They are more than willing to indulge her fantasy, to the point of blaming AA and the medical community for her problems:
You really nailed it on the AA stuff for sure . . . . Forbidden fruit is enticing indeed. We are setting ourselves up for failure if we base our recovery on ‘clean’ time . . . The main problem being when the medical system blindly pushes us there. . . .It tells me about what is going on in those [AA] secret rooms. We are the survivors, we are the strong ones.16
Sad stuff. Note his suggestion that recovery shouldn’t turn on sobriety. He sounds sincere, too, even though he’s sincerely wrong. Some of us in early recovery also felt ashamed at meetings at first because we weren’t sober. There is a solution, however. Work the program.
When the Word “Recovered” Comes to Mean that You’re High or Drunk
These harm reduction on-line forums are littered with embittered souls who can’t stay clean or sober. Harm reduction advocates assure them not to worry. Better is better, even if you’re drunk. In this connection, we share some of the “success” stories from one of their books. The authors are all members of a popular harm reduction group. Amazingly, intoxication has become part and parcel of their “recovery”:
Stephen had “had enough of drinking.” He attended AA meetings for 90 days but then quit when he became suicidal. “I don’t drink a whole lot,” he says, of his drinking history of 8 beers per night, but it makes him feel “disconnected,” the same word he uses when feeling suicidal. Since adopting a harm reduction plan, however, he now has planned intoxification days. In fact, he candidly admits spending his entire weekends drunk. He drinks about two six packs per day on the weekends. From this, he confidently writes that “nobody is powerless over their decision to drink or not drink.” Really?
Jacqueline drank for four decades because “it’s not easy to stop.” Her therapist wanted her to go to AA but she “didn’t want to become completely abstinent” and didn’t accept the idea that she “had a disease.” Ultimately, she attended AA but cried hysterically and felt exhausted, so she quit. Then she tried harm reduction. She reports that “80% of the time my drinking is managed.” Her sober days are Mondays, Tuesdays, and Wednesdays, although she sometimes trades Thursday for Wednesday. As of writing her account, she reports continually “hearing” (presumably metaphorically) an evil voice on her shoulder telling her to drink, “whispering in my ear, just have a drink, it’s all fine, what’s one more?” We assume this voice is her alcoholic obsession buttering her up for another binge during the 20% time.
Emily is an older woman who always liked to drink alcohol and use marijuana. She began attending AA but reports that it was an extremely frustrating experience because she was a “chronic relapser” and thus felt guilty. The people at AA told her that she was failing because she was not “working the program.” After she got 2 DUIs, she quit AA and began a harm reduction plan. Following this plan, she “determined to make moderate drinking work,” but she discovered that her relapses were getting worse over time, and she started blacking out more. She realized that she can moderate her drinking only sometimes. When she can’t “bad things tend to happen, and they get worse over time.” So, she decided to try abstinence instead of moderation, joined two support groups, and began seeing an addiction therapist. As of the writing of her story, she still drinks, but she reports several months-long periods of abstinence. Her drinking today, which she does not quantify, still causes “problems,” which she describes as “minor” and happening “occasionally.”
The Simple Truth About Recovering
What are we to conclude from stories like this, which are offered as harm reduction recovery stories? These people inhabited AA halls, but they made no effort to work the program. This is an unfortunate occurrence that we have seen before. They harbor resentments against 12 Step Programs. They all drink. In fact, they all meet the criteria for alcohol use disorder under the DSM-5. How can we possibly say this is recovery? Their existence is hardly the kind of the life that we hope for our clients.
The book does contain 15 stories in total, and there are people who positively report moderating and quitting. We are pleased for them. The Big Book well describes such people who, when given sufficient reason, go on to moderate or quit. These are the people for whom the harm reduction methods may be appropriate. “If anyone who is showing inability to control his drinking can do the right-about-face and drink like a gentleman, our hats are off to him.”20 We agree.
But what about people who are alcoholics and addicts? Even the harm reduction people concede, if only sardonically, that “medical professionals, researchers, everyday people know that addiction is a disease that cannot be cured.”21 For such people – the rest of us – we do have the solution, and it isn’t harm reduction. If we spent even half the amount of time working the 12 Steps as others do chasing vain attempts to use like normal people, then we wouldn’t have to worry about the specter of substance abuse anymore. No more keeping track of charts and lists. No more counting drinks or the other. No more shame and disappointment. We don’t have to live our lives revolving around the disease anymore. We pick up the simple kit of spiritual tools laid at our feet by the 12 Steps. We follow the path of sobriety. By doing this, we find much of heaven. We are rocketed into a new dimension of existence beyond what we ever dreamed.22 By the grace of God, we are recovered.
We have been observing these harm reduction groups for some time. Our opinion is similar to the dozens of rehabilitation centers whose websites give online opinions about the question of 12 Step abstinence vs. harm reduction. We enthusiastically recommend and endorse 12 Step sobriety.
1. An old AA Saying.
2. Big Book of Alcoholics Anonymous, at 30.
3. Denning, P., Over the Influence, Chapter 2 (2019). Retrieved from Amazon.com.
7. Denning, P., Over the Influence, Chapter 1 (2019). Retrieved from Amazon.com.
8. Anderson, K., How to Change Your Drinking, 2nd Edition, Chapter 1, section 4 (2010). Retrieved from Amazon.com.
9. Id. Chapter 5.
10. Denning, P., Over the Influence, Chapter 1 (2019). Retrieved from Amazon.com.
12. Big Book, at 22 and 31.
13. Denning, P., Over the Influence, Chapter 1 (2019). Retrieved from Amazon.com.
14. Anderson, K., How to Change your Drinking, 2nd Edition, Chapter 1.5 (2010). Retrieved from Amazon.com.
16. Oddnes, Senior Member of HAMS vbulletin.net, 06-22-2016. 02:12 PM.
17. Anderson, K., Editor, Better Is Better!, Stephen’s Story (2019). Retrieved from Amazon.com.
18. Id., Jacqueline’s Story.
19. Id., Emily’s Story.
20. Big Book, at 31.
21. Anderson, K., How to Change Your Drinking, 2nd Edition, Introduction by Pat Denning (2019). Retrieved from Amazon.com.
22. Big Book, at 25.