Abstinence = Harm reduction

The views expressed here are my own and may or may not be the same as any organization I am affiliated with. 

I received an email from my Twitter account (https://twitter.com/greys_recovery) recently telling me I had been added to a list of "harm reductionists." I barely know how Twitter works, I don't know what it means to be on a list but I don't dispute that what I write is consistent with the Harm Reduction model. What surprises me is that people still make a distinction between "abstinence" recovery and "harm reduction" recovery. 

An abstinence goal falls under the umbrella of harm reduction. I've heard abstinence called "the ultimate harm reduction" though I'm iffy on th "ultimate" part. As I've said repeatedly before I think abstinence is often mistaken for recovery, chemical dependency treatment professionals often treat people like abstinence is recovery but few if anyone, 12 step to whatever I am argue that abstinence alone is all that it takes to begin and maintain a recovery from chemical dependency. What people often mean when they contrast abstinence with harm reduction is 12 Step vs well, anything else, but the language in the AA Big Book and what I've heard said around the tables for 7+ years is in inconsistent with a harm reduction model, if you remove the spiritual aspects of 12 step work the difference is even harder to spot. 

1) The 12 step community have their own word for abstinence only people in recovery

If you sat in on a few given 12 step meetings you will hear someone use the term "dry drunk." This is a person who has quite drinking (or stopped using their drug of choice) but has made no other changes to support recovery. The dry drunk can be anywhere from a day to many years sober. Basically they are a person who gave up their primary coping skill and replaced it with nothing. The dry drunk is painted as a  tortured and miserable soul, always losing his temper and blaming others for his woes. Basically all the problems of an alcoholic with none of the fun. But does the dry drunk really have all the problems of an alcoholic? Imagine there are fewer trips to the ER, fewer trips to jail. The dry drunk is probably not the most popular person  at work but there probably isn't a lot of sick days. There is probably very little cirrhosis of the liver among dry drunks if they can manage to keep from relapsing, but that's the rub, the dry drunk's quality of life is such that they seem at high risk for relapse or self harm. 

2) Abstinence is usually a long term goal 

There are a small percentage of people who have their last drink or use one or more days before they enter treatment for chemical dependency. Whether you make a distinction between a "lapse" a "slip" and a "relapse" there is, for most people in recovery, some substance use between the time they decide to change and the time they meet their goal of total abstinence. The number of people who enter treatment and maintain complete abstinence for 10 years is less than 1 in 10. Of the remaining 9 the extent of that use and the damage it does to their health and their lives  varies greatly. Most get some benifits from trying to achieve a goal of complete abstinence even if they never maintain the goal permanently.

3) Abstinence or *Abstinence 

Even in AA abstinence has never meant staying off everything. The Big Book is pretty clear that you should still take the medicine prescribes to you. Addictive substances were and are routinely consumed at AA meetings all over the world. One might argue caffeine addiction is fairly benign, but up until recently most meetings were filled with tobacco smoke. Even today tobacco is smoked outside openly before and after most meetings with little or no concern that those who partake are not really in recovery. Would they give the same deference if they were smoking marijuana? What of a methamphetamine addict who occasionally has a beer after work? There is still much debate on how risky it is for people addicted to one substance to recreationally use another but the evidence seems to show it is possible for example to be in recovery from alcohol and still smoke weed.

Both camps seem to agree that abstinence alone isn't enough to heal someone from addiction just as exposure to a substance alone doesn't make you an addict.  

 

My New Problem With Old Words

My New Problem With Old Words

The views expressed here are my own and are not necessarily shared by any employer or educational institution I may be affiliated with...but they probably should be.

There is a movement to change the terms used when talking about addiction both professionally and in the media. I support this movement, I believe its premise to be correct. Words are powerful and positive and negative words have positive and negative effects on my clients and on myself as a person in long term recovery. This is not in my opinion, political correctness out of control. This is about improving outcomes for some of the most vulnerable people in our society. This is treatment on the largest imaginable scale and while all change is difficult and change on this scale is even more so, I find resistance in surprising places.

The most ambitious goal of this movement is to eliminate the words "addiction"  and "addict" from professional vocabulary. In theory this shouldn't be too hard, "addiction" is nether a scientific term nor is it a medical or psychological diagnosis. The main reason for this is there is no agreed upon definition of the word. Calling someone an "addict" never made any sense if you follow the disease model. A person suffers from cancer, a person is not a cancer (outside of the astrological meaning) Someone is never called a cancer due to a medical diagnosis and being called an addict is never a compliment. At this point you may wish to ask "If you think these words are so terrible Ken, then why have you used them in every Grey's Recovery post?"

It's a fair question. The truth is it bothers me. I can name several reasons for my choice of words, but the biggest and simplest reason is so that people understand what I'm talking about. The term "Substance Use Disorder" is what I use in clinical notes, but nobody knows what I'm talking about outside of the mental health field. Even in my professional life, in individual sessions and groups I use the word "addiction" and refer to people in general and to myself as "addicts." I get tired of constantly educating clients about terminology and getting diverted from what I see as more important topics. Also I don't want to seem judgmental or paternal by constantly correcting clients language.

 The second reason is something of an excuse, but the first is just laziness. I predict this change will be a long time in coming, longer perhaps than similar changes spurred by the civil rights, women's rights and the LGBT rights movements. In those movements it was the marginalized and oppressed population which demanded then drove the chance in terminology. In my experience so far it is the people in recovery from Substance Use Disorders who have been the most resistant to this change. Myself included. I've identified as an alcoholic or addict for eight years, I've found comfort and community in this Identity. But I think it's time now for a new identity. With that I would like to introduce myself. My name is Ken and I am a father, a husband, a chemical dependency counselor, and I am in long term recovery. 

That's enough change for today.

"I freed a thousand slaves I could have freed a thousand more if only they knew they were slaves." Harriet Tubman