In 1945, AA co-founder Bill Wilson addressed the American Psychological Association’s annual meeting in New York, and received a standing ovation. As he sat down, he was amazed because this group had soundly criticized AA. Bill turned to the president of the APA and said, “I’m surprised that they’re applauding my theories.” To which the president replied, “I don’t think they’re applauding your theories. They’re applauding your results.”
So it has been. Most of us have been impressed by the millions of lives that have been transformed from many addictions using the disease model and a 12-step approach to recovery. Now there comes (what its proponents claim is a new) theory about treatment for alcohol and drug dependence—harm reduction. This new clinical approach is a response to the asserted black and white and abusive thinking of adherents to traditional addiction treatment.1 Harm reduction theory posits that:
Viewing drug and alcohol problems as a disease takes away the control and self-determination from those who have problems with drugs and alcohol. The disease model says the only cure is total abstinence—a cure that eludes 80% of alcohol and drug users. For most drug users, totally giving up all substances leaves them with intolerable pain. They may need to quit one or some drugs, but not others. Requiring people to quit the drug that they are using before therapy or help will be giving them means denying the care that they so desperately need. Most people who have drug and alcohol problems end up moderating their use rather than quitting. Moderation is the best way to reduce harm.
We have demonized certain drugs, like marijuana, that are more harmless than certain drugs we don’t, like alcohol. The result is that some people go to jail for their drug abuses and don’t get the treatment they need.
You don’t need to be an addict all your life. All you have to do is learn and grow and eventually you may even be able to return to moderate use of your drug of choice. These authors write that, in contrast, “Harm reduction means taking control… It means looking closely at the role drugs or alcohol play in your survival, your ability to function, your capacity to cope with the pain you suffer and your enjoyment of life’s pleasure. It means looking at drug use in pragmatic terms—as a means to an end—rather than as a disease or as a moral weakness.” 2 They, therefore, advise alcohol and drug users, “If your decisions lead you to quit, either now or later, fine. If you don’t quit, that’s fine too. As long as you make any change that reduces harm, you’re practicing harm reduction, and you’re moving in a positive direction.” 3 Harm reduction theorists believe that drugs can be a healthy way of coping with pain as long as they don’t cause harm to the user or others. Believing that many alcohol and drug abusers experienced some kind of abuse trauma in childhood, drugs and alcohol were the ways these trauma survivors learned to cope. To just take away their coping “tools” would be to expose them to more harm than their ongoing use would do. They see it as discriminatory and judgmental to deny some users treatment because of their inability to totally abstain.
Practicing harm reduction means getting more educated about the effects of drugs and making healthy decisions about their use, to help him or her make better, intelligent decisions. Proponents of harm reduction believe that traditional drug and alcohol treatment has been an abysmal failure. Instead of “Just say no,” they believe in “Just say know.” When a person is educated, he or she becomes his or her own best expert and directs the course of treatment. “In fact, your wisdom is best. Only you know your pain,” and, “Only you know whether you can quit heroin, pot, and cigarettes.”4 These authors also believe that each person has a “relationship” with alcohol and drugs, and the nature of it will vary according to a person’s biological, psychological, and social makeup. It is up to each person to know the nature of this relationship and what harms and benefits are the result.
Harm reduction proponents would decriminalize all drugs. It is unfair, they argue, to discriminate against the heroin or LSD user when the harm of alcohol (which is legal) can be much worse. Denning, Little, and Glickman provide a chart of the possible psychological, medical, and social benefits of many drugs that have been considered only a problem.5 For example, nicotine is said to create relaxation, reduce anxiety, enhance focus and concentration, and reduce any psychotic symptoms. Nicotine can also be used favorably as a group social activity. LSD, according to these authors, can be used safely and can create interesting spiritual journeys. It can also expand reality and enhance insights. Socially, LSD can create experiences of shared and expanded consciousness. I know that after I read this section, I was tempted to take up my pipe again and to try some drugs that I had never tried before (smile).
As a recovering addict myself, I find harm reduction theory to be frightening— it is just plain wrong. The words “justify, deny and minimize” come to mind. It is a classic case of a bad solution attached to a fair analysis. There are some harm reduction beliefs that can serve as helpful reminders. I say reminders because the black-and-white thinking that harm reduction theory reacts to is not consistent with the current state of addictionology. Many of the concerns that harm reduction theory states have been, and are being, addressed.
First, not all people who come to see us with problems of alcohol or drug use are addicts. There is a difference between drug problems, drug abuse, and drug dependence or addiction. In every individual case, a clear assessment must be made.
Second, treatment should not be denied, and is not denied, to someone who can’t stay sober. This failure is not a matter of will or discipline, but often reflects unhealed emotional trauma. Treating this trauma should be provided even if the person can’t remain abstinent. This can be a tough decision, because it is hard to work on trauma when a person is still “using” as a way of covering up the pain. Also, we should never neglect the danger that continued use puts the person in. Hospitalization may be the only responsible course of action. Third, each and every person is different. At one level, only the addict knows his or her own life and must be involved in care decisions. We know that in any psychological or medical care, if a person is motivated to be healthy internally rather than externally, the prognosis is so much better. We can’t batter a person into getting well, or shame a person into health. Likewise, we can’t encourage them enough if they truly don’t want to get well. Do you remember Jesus’ question to the paralyzed man at the pool of Bethesda (John 5), “Do you want to get well?”
Finally, harm reduction reminds us that the alcohol or drug is not the deeper problem. Drug use is usually the dysfunctional way people cope with their pain. Virginia Satir, the great family systems therapist, was fond of saying, “The problem is not the problem. Coping with the problem is the problem.” All of us who treat addictions must not demonize alcohol or other drugs as being the evil villain that creates all difficulties. We should be quick to get at the real root of the issue. Addictions of all kinds are ways that people cope with pain. To think that stopping an addiction, like alcoholism, is the answer to all problems is absurd. As Christians we must get at the real cause of the pain.
This brings us to the major problem with harm reduction theory. The fact that harm reduction theorists believe that LSD and other hallucinogenic drugs can produce spiritual consciousness should give us a clue. There is no understanding of Christ at the core of this theory. Christian addiction counselors know that the real cause of our pain is our alienation from God. The concept of unmanageability or powerlessness over a drug or behavior is really one way of understanding original sin. Adam and Eve said to God that they needed some knowledge so that they could be involved in the control of their own lives. They didn’t trust God and didn’t surrender to his authority.
That is the real problem with any addiction: we don’t surrender control to the One who can heal us. Paul clearly describes the law of sin and death in Romans, chapter 7. In verse 15 he says, “The good that I would, I do not. Rather the evil that I hate, that is what I do.” In harm reduction theory, each individual person becomes his own expert, the master of his own universe. The counselor’s job is to assist, guide and encourage, but never to direct, and certainly not in a spiritual way. In the words of a wise AA slogan, however, “My own best thinking is what got me here.” All recovering addicts who I have known understand that even in the beginning stages of alcohol or drug use, their thinking was impaired.
Modern addiction theories also know that addictions interact. They travel in groups, so to speak. For addicts, this means that if you give up one addiction, you are very likely to take up another if you’re not careful. We know, for example, that 50% of all sex addicts are also alcoholics. It is clear that underlying pain can lead to various kinds of coping. I have found that the more trauma in a person’s life, the more likely that he or she will have multiple addictions. The formula is simple: more pain=more coping mechanisms. Therefore, to say that a person could stop one drug while still continuing to use another is dangerous. Mature recovering addicts know that they need to practice recovery in “all areas of their lives.” (Step 12)
Finally, there are many days when I myself get tired of the label “addict.” It doesn’t really define me completely. I am also a husband, father, neighbor, church member, and worker (to name a few of my identities). Therefore, I don’t find my identity in being an addict. I find it in Christ. On my own, I know that I am not very far from being lost again. Knowing that I suffer from addictions keeps my mind focused on the real and lasting answer. The way to heal the pain that I have experienced in life is not to search in drugs for a false answer or idol, not even if it is only for a time while I heal. Instead, it is to look as quickly as I can for God, thanking Him that He is alive within me.
_Mark R. Laaser, Ph.D., is an internationally known author and speaker. He serves as Executive Director of Faithful and True Ministries and as Director of the Institute for Healthy Sexuality of the American Association of Christian Counselors. Take help from telephone counselor .
_Endnotes 1 Most of the information for this article about harm reduction was taken from the book by Pat Denning, Jeannie Little, and Adina Glickman, Over the Influence, NYC, The Guildford Press, 2004. 2 Ibid, p. 3. 3 Ibid, p. 3. 4 Ibid, p. 33. 5 Ibid, pps. 66-68.
