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Tom Moon, M.F.T. Uncategorized Harm Reduction in Alcoholism Treatment

Harm Reduction in Alcoholism Treatment


Q: I spent my twenties and most of my thirties getting loaded. It was crystal meth that finally brought me to my knees. I haven’t used that in a year, and I’ve succeeded, so far, in cutting back on alcohol and marijuana. But I haven’t stopped completely, and I really don’t want to. I have friends in recovery who tell me that unless I make a commitment to total abstinence from all drugs and alcohol, it’s only a matter of time before I completely lose control again. Is this true? I won’t deny that I’ve been an alcoholic and an addict for years. But are there alcoholics who can learn to control their drinking?


A: Many people only use the word “alcoholic” to refer to those who have permanently lost the ability to control their drinking, and for whom the only solution is lifelong abstinence. If that’s what the word means, then, obviously, the answer to your question is “No” by definition.  But others use the terms “alcoholic” or “addict” in a more general sense to describe anyone who gets into trouble with mind-altering substances. If the word is used in that sense, then the unambiguous answer to your question is “Yes.”


In 1992, the National Institute on Alcohol Abuse and Alcoholism conducted one of the largest surveys of substance use ever, sending Census Bureau workers to interview more than 42,000 Americans about their lifetime drug and alcohol use. The research showed that many people in their late teens or early twenties drink or use drugs heavily, often despite serious adverse consequences. At that point in their lives, most people who know them would probably describe them as addicts or alcoholics. But if we look at these same people ten or twenty years later, the majority are drinking in a moderate, non-problematic way. As young people take on more adult responsibilities, they often “mature out” of self-destructive substance use, and most of them do it without going into rehab, or therapy, or attending 12-step meetings. In other words, learning moderation is the rule, not the exception. Most substance abusers have all the inner resources they need to overcome their problems, and most of them do it without becoming completely abstinent. This doesn’t mean that everyone can do it, or that maturing out of addiction is an automatic process that just happens as people get older. Mature people know how much effort and struggle is involved in emotional growth. But the process of outgrowing substance abuse is so common that probably anyone reading this column either knows someone who has done it, or is someone who has done it.


During the 1980s, when I worked in addiction treatment facilities, the idea that some problem drinkers could achieve moderation was heresy. But in that same decade a sea change in our understanding of substance began as the new “harm reduction” movement started to challenge our preconceptions. Harm reduction proponents reject the presumption that abstinence is the only possible goal for all problem drinkers or drug users, and focus instead on helping patients reduce the harm that substances cause in their lives. They acknowledge that total abstinence is the only realistic option for some people, but also contend that, for others, moderation is an achievable goal. They respect the right of their patients to decide their own goals, and argue that it’s unethical to push a one-size-fits-all treatment plan for everyone who has a substance abuse problem. If you want to learn more about the harm reduction option, you might begin by reading Over the Influence, The Harm Reduction Guide for Managing Drugs and Alcohol, by Denning, Little, and Glickman. This book is a standard reference in the field.


So can you do it? Of course I can’t know the answer to that all-important question. I suggest you find a therapist in your area who practices harm reduction therapy and meet with her/him for a few sessions. The best way to avoid the potential trap of self-deception or wishful thinking is to share your struggles with a trained professional who thoroughly knows what you’re doing, and can help you assess what the most realistic options are for you. Good luck!


Author: Tom Moon