Back when I was training in the challenging arena of addiction in Los Angeles in the eighties, with pretty much every chemical known to man available if you knew where to go, and an abundance of cocaine, marijuana and alcohol on virtually every street corner, the term harm reduction hadn’t been invented. We clinicians were entirely focused on abstinence. With Baltimore hosting the tenth National Harm Reduction Conference (October 2014), times have certainly changed.
I’m going to be honest. My personal declaration of success is abstinence. It’s absolutely clear to me that I’m not the kind of alcoholic who could moderate their drinking. Had I been given the option of moderation, offered what we’ll call a harm reduction model, I doubt I’d be here now. I was lucky enough to know instinctively that abstinence was my best shot and my last drink was really that, my last drink. So, as you may imagine, I’m pretty passionate about the benefits of abstinence, with almost twenty-six years of it informing who I am and how I enjoy my life. And, having said all of that, I’m also clear that abstinence is not for everyone. For me, a resounding yes; for everyone, not necessarily.
The journey to this perspective has been paved with heart-searching and turmoil to say the least. I remember hearing colleagues in the nineties talk about their work with the homeless, the recovering abused, sex workers, military vets – those whose lives have been devastated in one way or another. Colleagues would explain patiently that for these populations it just wasn’t feasible to be abstinent. They witnessed distress so palpable, a need to escape the pain so undeniable, that of course their clients relied on numbing with some substance to simply get through the day. The goal was to reduce the amount they used, gradually over time, so that perhaps abstinence would become a goal at some point, but not the goal from the outset. Instead, the goal was to reduce the harm alcohol and other drugs effected in their lives. At the time I would shake my head silently inside, reflecting on those I heard in twelve-step meetings coming from similar circumstances who had managed to get and stay completely clean and sober. I’m still in wonder at their ability.
I think I’ve developed compassion, tolerance and wisdom over these years. Now I cross paths with people who are clear they want the freedom to be able to drink alcohol or use recreational drugs occasionally. I do believe there are some who can be successful at this kind of moderate approach. In some ways I take my hat off to them. Wow, how amazing to be able to have just one line, just one hit, just one toke, just one drink. I can’t even imagine that possibility for myself! And it makes me wonder if, in fact, such folk are made of the same stuff as those of us for whom abstinence is the only way we’re going to stay sane.
I remember working with someone years ago, let’s call them Lou, who came to me shamefacedly admitting she’d had too much to drink at the office Christmas party and ended up in bed with her manager. Some environments may have tolerated such a slip, but not this one. She was pressured out of her job with little recourse. As we explored her history, she came to realise that alcohol and other drugs had played a significant role in a number of “difficult” scenarios. Lou believed that recreational drugs featured with specific people at specific times in specific places and she was determined to avoid them, with immediate effect. I felt cautiously optimistic. I thought alcohol would be more difficult to avoid, she agreed wholeheartedly, so we agreed an experiment in limiting the number of drinks. The first couple of weeks went well. The next few, not so much. Eventually, she returned to all out drinking and slipped back into the environment providing other drugs. At some point she didn’t turn up for a session; I never heard from her again. I often wonder what became of her. I wonder if I did right by recommending moderation when in my heart I knew abstinence was likely the key. Then I said to myself “well, it wasn’t time.” I could tell you all kinds of stories about people like Lou who consult with someone like me four, five, six times before getting so sick and tired of their lives they make a commitment to definitive change and become successful. Another story for another day….
Then there was Max (not his real name). A high achieving professional, he came to me filled with dread. He knew he needed to quit drinking and just didn’t know how. Not for him harm reduction. We moved directly to a clear plan of abstinence. We unpacked his routines, his relationships, his moods, his activities and put as much structure in place as could be imagined to support him quitting. He happened to love Diet Coke. Not something I’d recommend for a variety of reasons, but, as a replacement for alcohol to get started? Absolutely. And he was successful. Hallelujia he was successful. With the support of his family, work, self-help, he’ll be celebrating more than a decade soon and it gives me immense satisfaction to know I played a part.
Just one more story. Remembering someone I’ll call Don. An occasional toker who also loved fine food and wine, he was stopped by the police under the influence and got off with a caution. In relief and gratitude he decided it was time to take responsibility and avoid any further calamity. My approach was similar. We unpacked every last detail of his life to understand the role alcohol and marijuana played – as part of his identity, his experience, his freedom of expression – and he determined he had the wherewithal to drastically cut down and stay in charge of his use. And he was right. We worked together for a while and then he was one of those delightful clients who kept in touch, returning annually for a “checkup” and to report his success. What was the difference? Perhaps his drive and commitment to establishing enormously successful businesses, selling them, starting over; his desire to set a clear example to his growing kids; perhaps a new found passion for mountain biking? We’ll never know, I’m just glad I can report on someone who was able to reduce the harm. Yay for Don.
If anything you’ve read here resonates and you’d like to have a confidential conversation with me, don’t hesitate to contact me straight away. I promise to get back to you as soon as I can.
**After writing this blog post I came across an article on Oprah’s website about Moderation Management and wanted to share it here given its pertinence.