Some of My Views on Alcohol Usage and Harm Reduction:
Let’s Make Friends With the Elephant in the Room
—by Jim Nolan
You’re Going To Have To Do Some Thinking On Your Own
People, including alcohol treatment professionals, look at alcohol use differently. Some hold the idea that alcohol use/abuse/addiction is a “brain disease”, and they cite really smart science people who support that point of view.
I do not find the “brain disease” model all that useful or compelling. I can cite an equally impressive array of writers and scientists to stack up on my side. Yeah, that’s the way this field goes—You might as well get used to it—you’re going to have to do some thinking for yourself…Lots and lots of really smart people have not come up with a definitive answer.
In addition to being a licensed Psychologist and a Licensed Professional Counselor, I am a “LADAC” (Licensed Alcohol and Drug Abuse Counselor), and some other LADACs will disagree with this article like crazy. Again that’s how this field goes. It’s pretty clear that, despite claims by each side that they are supported by “science”, alcohol issues are not really yet hard “science.” Just because somebody cites “scientific studies” does not mean that their conclusions amount to indisputable science, let alone proof or truth. Anybody who says otherwise does not understand the scientific method, they have an agenda and they are selling something that does not exist.
Ultimately, you’re going to believe what you’re going to believe. There will be lots of support for whatever you choose to believe, as there will be lots of support for opposing points of view. That’s just the way it is, and it is not going to change anytime soon.
Strep Throat As A Contrast
Strep throat is strep throat, and nobody argues about it much. You test positive or you don’t. If you do, you get antibiotics, and the conversation, for most people, is over. I have had strep probably 15 times, and each time I was prescribed Amoxycillin or something similar, and each time I got better. For me, it’s not a very complicated topic. I don’t understand it, but somebody does, and they have treated it successfully for me EVERY time, no exceptions.
Alcohol use and abuse refuses to be that simple.
Simple Answers Usually Have To Ignore a LOT Of Information
Alcohol “problems” fall along a continuum. So-called “Alcoholism” or “Alcohol Abuse” are not clean diagnoses. It’s almost never like “You have it or you don’t.”
People who say it IS—well, they like simple answers, and I cannot really take them seriously. You have to make up your own mind how you want to think about it.
Complicated answers make a lot of people nervous, and they do not want to feel nervous, or uncertain. They want “alcohol abuse” to be strep, and it simply is not, so they pretend it is, and that makes them feel better. I don’t blame them. I wish I could believe that too.
When you think you know the answer, you stop asking questions. That’s dangerous. Lots of people ask “What is the meaning of life?”, but few ask “What is six plus eight?” because they’re pretty sure they already know. When people decide they completely understand alcohol abuse and addiction, they start getting dogmatic and stop asking questions, and they assume it is the same for everybody. Good luck with that point of view..
There are “addicts” to virtually everything who just stop the behavior. Often it sucks to stop, at least for a while, but they do. (Watch this video https://www.youtube.com/watch?v=PY9DcIMGxMs for a mind-blowingly different point of view on drug addiction, particularly heroin.)
People with “cancer of the brain” (brain disease) rarely “just stop” having cancer. You don’t just decide to stop having strep. It doesn’t ordinarily work that way. (Although I am open to the point of view that it is possible…that’s another article!)
But if often does work that way for substance or process abuse and “addictions.”
A lot of people who abuse the hell out of alcohol, or heroin, or what have you, DO just stop. They just stop. They just do. Can everybody “just stop”? In theory, yes, but practically speaking, it seems not. At least they DON’T, whether they “can” or not.
The point is, there is a powerful BEHAVIORAL piece here. You stop doing the behavior. Maybe you get support, and maybe you even go inpatient. Maybe you have a spiritual awakening, or you pray your heart out. Maybe you have major withdrawal symptoms. But the way you STOP, ultimately, is you stop the behavior. You stop by stopping.
Another Option: Harm Reduction
What is Harm Reduction?
Let me ask a few rhetorical questions.
Would it be better to smoke twenty cigarettes a day or five cigarettes?
Would it be better to drink 7 days a week or 2 days a week?
Better to have 9 drinks or 3?
Better to be 70 pounds overweight, or 20?
Better to get regulated doses of Methadone or Suboxone from a clinic, or heroin from some dude on the street?
You get the point.
One situation is less dangerous, less problematic, more preferable than the other. It can lead to fewer and less profound consequences. If you disagree with that, you probably shouldn’t have read this far. You clearly have a point of view that I do not share, and we are not going to find much to agree on.
If you do a “problematic behavior” less frequently, to a lesser extreme, you are better off. Your consequences are likely to be fewer, less frequent, less severe.
Problems with Harm Reduction
Those who believe alcohol abusers have a brain disease and can’t drink at all of course will argue that the person with the “problem” shouldn’t drink at all, ever. Alcoholics Anonymous holds that point of view for those they consider alcoholics.
One issue here is that people who hold that point of view tend to think it applies to anybody and everybody who ever over-indulged, abused, or got into trouble because of alcohol.
Problem is, that’s not true. At least I (and anybody who works with a Harm Reduction model) do not believe it. Never did, never will.
People have successfully cut back on problem behaviors of all sorts, including alcohol consumption, forever. Forever. Since the beginning of time. We all know that for some people, Harm Reduction does not work, has not worked, and is a bad idea. We also know that a REALLY low percentage of people are successful using Alcoholics Anonymous. I won’t quote a DEFINITIVE estimate, not only because that would be oxymoronic, but because the estimates vary a lot. But they are generally way the hell under 50%, and often under 10%–but look them up yourself. In short, AA does not work for most people. For others, it saves their life. That is great. But— we have to think about those for whom it does not work. Which is most of them. Harm Reduction is a legitimate alternative.
Nothing works for everybody every time. Anybody who believes one size fits all is off their rocker. Sorry. There’s just too much reality out there to keep believing that.
So exactly what population does Harm Reduction work for? I don’t know.
Exactly WHO will succeed by using AA? I don’t know.
Why should we be open to alternative views of substance and process abuse and addiction? Because historically, we have done a really crappy job at helping people with these issues. That’s why. Because looking for the Silver Bullet is not the way to go. Because one size does NOT fit all.
I have an open mind. I am not an expert on anybody, or anybody’s relationship with alcohol, or weed, or internet games, or shopping for shoes, or gambling on the NFL. I am just holding space, staying out of judgment of people who are struggling with these problems, and trying to help.
So that is a little bit about where I stand on the topic of alcohol, alcohol abuse, and addictions. Maybe you agree, maybe not. Maybe you find this conversation useful, maybe not.
If you do find it useful, please feel free to contact me. I take many insurances and would be happy to consult, so you can see if it might be useful for us to work together. If, on the other hand, you want to fight about it all, please don’t bother. I don’t want to hear about it. Go ahead and be helpful in your way, and I will be helpful in mine. But I have no interest in getting into arguments with points of view I have heard a billion times. No thanks.
Hope this was helpful!
Pass it along to a loved one if you think they might find it helpful too…
And here are some other Harm Reduction resources to use as well:
Jim Nolan, PhD