Harm reduction vs. abstinence?

The following is a guest post, composed by Julia Hammid. I’m grateful to Julia for her thoughtful and sensitive reflections…..

Judging by the volume and intensity of the discussion around Harm Reduction (HR), both here and in many other venues, it seems to be a flashpoint for identifying some of the core issues driving policy, research and personal opinion in regards to addiction (even as the term addiction is still being defined). In the spirit of promoting an illuminating and productive conversation around addiction, recovery and treatment, here are some of my thoughts on HR. Just for the record, I am in favor of HR as a concept, though I may not agree with every version of how it’s provided.

So, why the brouhaha around HR? Doesn’t it just describe a broad variety of strategies to counteract the damage of addiction, short of complete abstinence? The question is not so much whether HR should exist. It’s going to exist no matter what we say. The question is whether or not we like it and support it. For example, we dispute whether the powers that be should fund programs that provide clean syringes, safe spaces to use, and even the (uncontaminated) substances themselves.  In my mind, HR includes a lot more. In fact, I would claim that most, if not all, recovery includes some form of HR, even if complete abstinence is the goal.

cigaretteWhile addiction includes a vast array of substances and behaviors, abstinence can only be applied to selected substances, mostly illegal ones. How are we to define abstinence from addictions that are not measurable with a blood test? And even where abstinence is the only goal, where HR is most controversial, those who are abstinent from the identified substance often end up substituting or relying on (dare I say becoming addicted to?) other substances or behaviors, which fly under the radar. For instance, there’s a joke around AA about being addicted to the donuts and coffee that are ubiquitous at meetings.

I am not saying that addiction cannot be overcome or that one thing is always replaced by another or that any of the above is bad. I am just saying that I think, with few exceptions, recovery is always a continuum and always includes some form of HR, in the fullest sense of that term. More often than not, there is a period of shifting of drawingbraindependence from the target bad thing to other less harmful (or simply legal and more easily obtained) things. Even seemingly positive things can be pursued with some of the same desperation that the original addiction carried, including socially approved addictions such as, coffee, sugar, TV, running, the internet, or even “dependence” on therapeutic treatment, religion, etc. I  know some people who are so immersed in their 12-step community that their whole lives revolve around meetings, the literature and the people they know in that community. I’m not saying that’s a bad thing. I’m just saying that it should be recognized as a form of HR.

To some, HR connotes state-supported addiction. But that is nothing like the actual goals of HR proponents. The controversy is kept alive by discrepancies such as these. In contrast, I think the word “abstinence” carries its own social and psychological baggage and may misrepresent what the opponents of HR are arguing for. Abstinence is not a term I personally find appealing. For me it connotes ascetic monks trying to rise above earthly existence by denying themselves much of what makes life worth living. Abstinence puts the focus on what one is not doing, rather than looking forward to what is truly worthwhile. In some ways, full blown addicts are abstinent from life, foregoing all its richness in pursuit of their addiction. Most agree that abstinence from a particular drug or behavior is far more precious.

A story was shared in response to a post on this blog, about a relative being instructed to just apply a cool cloth  to the addict’s forehead and in a few weeks they would “be good as new.” As any recovering addict will tell you, it puzzledmantakes a lot more! And much of what it does take I would classify as HR. Even if you quit the identified addiction, there are still a mountain of other issues that need to be addressed, such as recovery from the trauma that may have been driving the addiction, employment, reputation, how to create/repair a life, a family, a community. From the addict’s point of view, support for those tasks is as essential as stopping using.  And much of that work can begin while engaging in “official” HR services.

Society sees addiction as a drain on its resources (unproductive individuals sucking up services) and a source of harm to others (crime, disease, embarrassment, etc.). So, from society’s perspective, fully abstaining from the addiction removes all the above negative consequences. But from the perspective of addicts (and those who are able to step into their shoes, whether family or treatment providers) it’s not at all that simple.

Abstinence and recovery are not one and the same. As opposed to simply stopping using the target substance, “complete” recovery is as varied as are humans. Life is, by its very nature, imperfect, and applying definitions of things such as addiction, abstinence, sobriety, and recovery to real people will always be approximate.

The core arguments I’m hearing are about who pays for what services and strategies, what the authorities endorse, and what is socially and ethically acceptable.  We can, and should, argue about specific programs, policies and laws, but trying to agree on one “correct” way to recover from addiction ignores the valiant struggles and triumphs of so many who have recovered, one way or the other. I was bulimic for over 15 years (many years ago), which was as intractable, self-abusive and life threatening as addiction to any drug. And I am quite certain it would have killed me had I continued. As with other less clear-cut addictions, recovery for me is a continuum, one which involved plenty of what I would certainly call Harm Reduction.

Julia Hammid

PS. I (Marc) highly recommend this Time article by .  It is just excellent, and it provides some very dependable statistics that argue for the value of various Harm Reduction programs and policies.

37 thoughts on “Harm reduction vs. abstinence?

  1. shaun shelly February 21, 2014 at 5:56 am #

    “Abstinence puts the focus on what one is not doing, rather than looking forward to what is truly worthwhile.” – a very good point. In my treatment setting we emphasise that moving away from chaotic substance use is not about what you aren’t doing, it’s about what you are doing.

    • William Abbott February 21, 2014 at 9:50 am #

      The problem with this, as is the case with so many things in psychology is it is very poorly defined .Poor definition is the bane of science. GArbage

      Who can argue that reducing harm isnt a wonderful thing ? Within certain contexts and not in others

      What are we talking about here then?

      And in my opinion , abstinence is a vital component of any recovery from any truly addictive behaviour , for at least a period of time in early stages

      Long term- optional and choice.

      nuff said

    • Toti May 10, 2016 at 9:38 pm #

      Abstinence Is doing what addicts cant do

  2. Mark Brady February 21, 2014 at 6:52 am #

    I think it was Einstein who suggested we might need to use a different degree and quality of thinking to address personal and social disorganization than the thinking that delivered us to this day.

    In her schools and in the book, *The Woman Who Changed Her Brain* Barbara Arrowsmith-Young makes that leap in my experience (http://www.youtube.com/watch?v=o0td5aw1KXA). Instead of devising all kinds of Harm Reduction “Workarounds” to address traumatic disorganization, she instead has used her own brain to find and create practices that strengthen and integrate areas that function less than optimally.

    Much as Pat Kuhl’s research at the University of Washington suggests – increasing numbers and connections of neurons in babies by teaching them a second language when the language window is open – shows a subsequent increase in impulse control and immune function, Barbara Arrowsmith-Young has accomplished something similar.

    Noticing that many dyslexics have difficulty reading an analog clock, Barbara designed a computer program to teach students to first learn to read a clock with a single hand on it – straight up is 12 o’clock, straight down is 6 o’clock, etc. Next comes two hands. then three, all the way up to … 12 hands! Once students have mastered a 12 handed analog clock, their brains have been significantly altered for the better.

    That’s just one example of going healing integration rather than designing a Harm Reduction, incremental workaround strategy.

    A lot of the ways we come up with to address a challenge often are forced to evolve from how we decide to frame the challenge.

    • Marc February 22, 2014 at 9:22 am #

      Welcome to the blog, Mark. But I don’t really get your point. Barbara A-Y’s techniques, like the one you cited, do indeed work incrementally, not suddenly. The whole idea of training up skills bit by bit seems entirely consistent with what we know about the brain and entirely consistent with the philosophy of harm reduction in addiction. Why do you see these as either-or?!

      • Mark February 22, 2014 at 9:48 am #

        Hi Marc, It may have come across as either/or in what I wrote, but the point I was trying to make is that indirect approaches, at least in the way Barbara has been successful, seem to have generalized to other dimensions/behaviors. I can readily imagine how the circuitry involved in learning how to read an analog clock, after not being able to, could activate ancillary inhibited circuitry in the brain that have very little to do in the least with telling time. What’s your best sense? ~ Mark

        • Marc February 22, 2014 at 10:12 am #

          Yes indeed, indirect approaches can be very powerful. But isn’t that the credo of Harm Reduction?

          I guess I just don’t see any dichotomy here. I think Barbara’s approach (by the way, I’ve met her: lovely woman…and read much of her book) is very consistent with the harm reduction strategy. It’s about going at things according to where the person is at, rather than in some classical all-or-nothing way, and that’s almost a core tenet of the HR movement as far as I can see.

  3. Brenda Conlan February 21, 2014 at 7:24 am #

    I am so glad I read this – thank you. Your comments were illuminating and inspiring. Addiction feels like a tired old subject – much of the information available is repetitive and doesn’t keep my attention very well…so nice to see some new sentences on the subject!

  4. Richard Henry February 21, 2014 at 8:04 am #

    Hi! Marc
    As you know I have been reading you post for quite sometime know, and really enjoy your perspective. I hope you continue to share your view for many years to come, and write many more books in helping bring to light many areas of concerns we both share. I also have a Blog on the Dr. Phil web site called Harm reduction, in trying to share my perspective on things through the eyes of an addict. Harm reduction I think is crucial for many who seek to bring balance into their life. It gives them the chance to see the big picture without being trapped into complete abstinence. For some it is that abstinence that becomes their focus without balance. Many from the outside are like children in thinking if their is a problem just quit, but it is never that easy. For me winning is gaining control and regaining my right for choice, this gives me the freedom to do what ever I want, its like “I won” and I Am no longer dependant on any outside influences, and am rewarded with balance in the whole of my life, and in every part of it. When people ask me, and that is one of the first things people ask, when I say I have overcome my Addiction is “How long have you been sober” and I say Long enough to know better, and short enough to resist…
    Regards Richard

    • Marc February 22, 2014 at 9:25 am #

      ….as in: resisting temptations? Or resisting the question?

      As you note in your book, Richard, you were really deeply immersed in “the life”. I can imagine that putting all that behind you was really like changing worlds, though it may have taken a while to get off the ground.

      • Richard Henry February 23, 2014 at 9:03 am #

        I would say “both” resisting the question because it takes so much out of me sometimes, and people generally don’t believe a person can turn back the clock and have a fresh start. The majority of society believes once’s an alcoholic always an alcoholic and i’m say “Not” I was a full blown alcoholic for 20 years, dependant everyday, morning and night. To call my self just a heavy drinker was an understatement. I could have taken what I see as the easy way out and say i’m, somehow allergic to it, and never pick up a drink again, but I said “Not” and took back my right for choice. Today if I choose to have a couple beers with my son, that’s my choice, and by regaining control, I think I have come above and beyond the norm, I fought back and won…I can say however alcohol is really not part of my life anymore and my last outing was like 8 months ago. I choose to be sober today and am loving it. So yes I can “resist temptation” and yes, resist the question… to educate everyone who asks me how long have you been sober, becomes tiring… I do believe you need substantial sobriety before you can see your way clearly and each substance of abuse has it’s own time lime, I do believe a person can choose a life of moderation in any and all substances, and areas in their life. The risk must be evaluated and considering all the reward verses consequences. I better stop here…hahaha… See Marc it’s hard for me to keep it short, and convincing people to see my side of Addictions can take all day…
        Respect Richard

  5. Lovinglife52 February 21, 2014 at 10:20 am #

    Even if abstinence is the ultimate goal, (which it was in my case), very few will succeed at stopping completely straight away. A period of harm reduction can often help somebody get some perspective on their recovery. Many who work the 12 step method, relapse several times and often binge, after feeling they have failed. This can have very bad consequences. They do not see any of the sober time that they managed as a sucessful period of moderation.
    I think we have to be more practical about recovery and less idealistic. We need solutions that will help many and encourage people to keep up the struggle against addiction, that many find overwhelming at times.

  6. fredt February 21, 2014 at 11:08 am #

    It is the addicts choice, harm reduction,the hard way vs. abstinence, the easier of the two ways. Harm reduction is the addict’s unwillingness to give up the substance, or the perceived benefits of the substance. These people are still in the contemplation stage. First they will need to replace the perceived benefits of using somehow.

    • Al February 21, 2014 at 6:43 pm #

      Fred I beg to differ with you.Coming from this completely willing addict, all I can do is ask you if there was something you were not able to do. No matter how you tried. Perhaps stopping someone you loved from walking out on you, or lose weight, or even stop opiates/ Have you ever tried to stop opiates? In the beginning they help with whatever pain you saw your Doctor for and if you are lucky enough to find a way out further down the you realize that it rook the very essence of who you are. I woke up the other morning and I clearly saw the difference for the first time. I am starting to be Me again. I am Al again. My old ways and feelings and beliefs are returning. For the better I might add. And it took HR to get me to this point. Yes it was my choice. I choice not to be catatonic and emotionally wrecked. Physically beaten down. Yes the HR has benefits. That I would say is very good and helpful. what good is something if it does not provide benefit. But its not the benefit you might think. Its like I am swimming between two islands. One the island of Addiction’s hell and the other the island of my life without drugs and my kids and my soul and my health and my entire existence (because I really lost my existence). Its too much to swim. My boat has a hole that I cannot fix and the current was too strong because trying to swim the lengths before nearly drowned me, numerous times. So someone was kind and professional enough to give me an oxygen tank to help me in the whirlpools and undertows. Yes while I am breathing that oxygen, I do feel its helping me. But I will not always be in the water. One day I will swim long enough that I will hit shore. And my heart just melts at the image of me talking off that mask and tank.

      I also did not like the way you say “these people.” I am not outside of your community. You could very well have the same problem as me. And I am positive that someone you know, in your family or your work, is in fact an addict. We are not the fringe of some morally or ethically superior world that you live and the “other than addicts” live. We are all in the same community.

      Rest assure I am in a stage of contemplation but NOT contemplating on whether or not I want to be clean! I contemplate on other things now. Things I want to think about. Its a grand freedom, believe that.

      I wish you could have finished your last sentence. instead of quitting with “using somehow”. What do you really think the replacement of the perceived benefits is or should be? You must have had something in mind.

      Take care,
      An Addict named Al

      P.S. I think you got the two ways wrong. Did you mean that HR is the easy way and abstinence the hard?

      • fredt February 21, 2014 at 7:10 pm #


      • Marc February 22, 2014 at 10:15 am #

        Al, I think he meant what he said: that taking a detour from the path to direct abstinence (as I think he sees HR) is actually an obstacle, not a benefit. Seems that Fred’s in no mood to debate it, but….this does highlight a core difference in perspective.

        • Al February 22, 2014 at 10:26 am #

          Marc, (and Fred) I tend to see “whatever” as a sign someone does not want to engage. My kids say it all the time. I was happy all the next day after writing my comment. Because I DID want to engage and I DID engage.That was my first really intentional response to another with a differing view. I might add It was a little less caustic than I used to be (even prior to my addiction). No harm no foul. I do want to know what his thought was nearing the end of Fred’s writing. Thank you for providing a safe place to discuss this. I do believe lives are affected by the views of even people who do not make policy. Thank you, Al

          • Marc February 22, 2014 at 10:43 am #

            I love to engage too. And yes, it can be liberating. But some debates get wearisome… For all we know, Fred’s been thinking about this for a long time.

            But yes, this is a safe place for….whatever….

            • Al February 22, 2014 at 2:55 pm #

              Yes. Whatever. Fred: I really would like to read your view. I mean that really and I am not being snarky. I like to know all sides of this subject because I am living it. And I learn more about my own situation from both sides of it. Thanks

            • Gary April 9, 2014 at 8:10 am #

              Just wanted to make a personal comment with respect to “Addiction”. I don’t believe I was born an alcoholic but! and alcoholic was born, in my opinion, with my very first drink of alcohol. It was like a wow moment even despite the negative consequences.

              In the case of “Harm-Reduction” this is not a new term but one that has been high-lighted in hopes, I believe, of getting people into treatment or reaching out for help sooner and has always been part of the continuum.

              Some scholars in the addiction and/or mental health field like to debate rather or not addiction is a disease or learned behaviour. Addiction usually disrupts a persons life which causes a “dis”- ease and it appears the only way to find comfort or calm is to use.

              My experience is not caught in the symantics or definition and is much more simplified. That which causes a problem is a problem and the focus is on the problem regardless of how big or small. Long before I had a drinking problem I had a “thinking problem” about drinking. This problem manifested itself once I ingested alcohol. The brain is very accomodating in that it will adjust even to toxic foreign substances which in return can cause other diseases in the body.

              Human beings are complex and can be influenced by various factors that are biological, psychological and/or environmental. I believe in many respects that we see the world the way we are and not the way the world is. There is the world and then there is my world.

              The word change can be intimidating if I feel that I have to change the whole structure of my being. If I believe that who I am is someone who is an addict or alcoholic then how can I change that which I am? The fact is, once I understood that change isn’t about changing who I am, for that will always remain, its really means clearing the debris in order to see that using was never who I was.

      • Chris February 22, 2014 at 10:57 am #

        Speaking only for myself, I would find moderation much harder than abstinence. Count drinks and then stop when I reached the limit? Not my forte. I think I could pull it off (but, given the difficulty of my struggle to stop, I’d hate to be wrong). I love the taste of a cold beer at the end of a hard day, but not enough to drink just one or two and stop. Wine with a good meal? Oh yeah! but why stop with a glass or two when the bottle is open and there are three or four more in the wine rack. I’m not very good at moderating anything. It requires too much effort and attention. I struggled for decades to walk that very fine line between enough and too much. Over the years I became less and less adept at perceiving the line. For a couple years before I quit there was no such thing as enough. Far easier for me to side step the struggle altogether; I abstain.

        But I accept others might find the opposite to be true for them. Whatever works.

  7. Suzy February 21, 2014 at 5:08 pm #

    Thanks for sharing your thoughts, Julia. Anne Fletcher’s “Sober for Good” shows data on how the people she studied recovered, their methods varied widely, and she concluded that there are about as many paths to recovery as their are people in it. If I remember correctly, 49% recovered via AA and the rest of the 51% via other means. AA is not the only way.

    I agree that addiction is a continuum or even a spectrum disorder. There are some commonalities but also many differences. Insisting that one or the other has to be the same for everyone is a setup for frustration. Meeting people where they are is so important. I appreciate you sharing your thoughts on these points.

  8. Janet February 22, 2014 at 8:56 am #

    My grown son, who has come in from the cold after years of heavy drug use said, “Whether you are using or not, you can become a better person.” He has been honest that he is not completely abstinent. But he speaks the truth which was unavailable in the past. For him, for me, this IS recovery. The unbearable hurting has stopped. We are healing from the inside out. Who knew??? Thanks, Julia, for a great post. And for everyone else who contributes. Thank you thank you.

    • Al February 22, 2014 at 10:06 am #

      Janet, I feel so happy for you and your son. I agree with what he said about being a better person. I will keep you all in my thoughts. Thank you for sharing that.

  9. Denise February 22, 2014 at 9:33 am #

    Marc/Julia, I think this is a brilliantly conceived and written essay about the relative nature of addiction, recovery, abstinence, and Harm Reduction. One question I’ve often considered (and I haven’t read the other comments yet so forgive me if I’m repeating anything) is considering that I have been “maintained” on Suboxone for several years, can I rightfully label myself “recovered”? I’m pretty sure I can say “I’m in recovery” as that implies a process. But then I wonder, since I am dependent on this drug/medication, should I be doing something to get off of it. My doctor (who I believe to be progressive and sincere) explains his prescription of it by comparing it to say, Prozac, and not because he believes if I stop the Suboxone I’ll return to abusing prescribed meds and/or illegal drugs. He believes that since my brain was altered earlier in life because of opiate use, that giving me a bit of opiate each day is necessary. I accept this, to some extent. On the other hand, I feel “addicted.” Perhaps even more significant is that Suboxone or no, I still grapple with the impulse of addiction, i.e., at times, wanting to “get high” and/or engaging in non-substance addictions (such as shopping) with control. Bottom line, I’m on the continuum, as we all are. I just can’t help but think I should be working toward reaching the far end of it.

    • Al February 22, 2014 at 10:16 am #

      Denise, I can understand where you are coming from completely. I do not have years of non use, just about 6 months. I have the same feeling that I am not totally “clean”. and that my recovery will not begin until some further point in the future. However, as Marc said to me, its developmental. I believe it was Julia who worte I am already there. Others whom I’ve spoken to said that feeling or thought is from the part of me that would have me believe I am not worthy of better, or I don’t deserve a happy sober life. Its more about confidence and self-esteem. More than likely its something from way before we even started using. One of the foundations that led to us choosing the path to addiction in the first place. We just have to accept and love ourselves on the very deepest of levels. I too “grapple” from time to time. Whether it be an extra sleeping pill or shopping a new windfall to death before it had time to get warm in my pocket, I say I feel addicted as well. But I think we need to give ourselves the time for that thought or feeling of being addicted is replaced with a new mantra, I do not know if its safe to say the same amount of time it took us from the first use until the the last time? There is that saying that when you walk 17 miles in the woods you will probably walk 20 miles to walk out. Makes some sense to me. I wish you luck. You sound great. And rest assured, there is at least one addict who is feeling and thinking the same as you. so it might be more common than we think.

      • Denise February 22, 2014 at 10:29 am #

        Thanks, Al. I wish you luck too. Sounds like you’re on the path and heading in the right direction. I think the goal is to embrace the journey and not focus too, too much on the destination. If you really need/want to get there you will. In the meantime, sounds like you’re doing great! And yes, there are many of us around going through similar stuff. And we’re fortunate enough to have Marc (and others like him) to share their own process and knowledge.

  10. Julia February 22, 2014 at 2:28 pm #

    I’m so glad that my words have inspired this conversation. That’s really all I wanted to do, make it a conversation rather than an argument about what’s the right, or best way to deal with addiction. I think defining our terms more clearly is helpful. But mostly just sharing stories both from inside the addiction and outside or it (either looking back having recovered or as someone who is close to an addict) to remind us that no matter what we call things, the lived reality is ultimately individual and undefinable.

    I understand why the term Harm Reduction was coined, as a way to put an affirmative label onto something that would otherwise be lumped together with full blown addiction. We need to have names for things and what we call things matters. I like what Denise says above, that “[she is] on the continuum, as we all are.” But when it comes to setting up programs and paying for them, that’s where the politics comes in starts setting up boxes we have to fit into.

    I’ve always had a problem with putting myself into any of those boxes, But I’ve matured enough to realize that even if I don’t do so willingly, someone else will see me in one box or another. So I’d better take as much control as I can of which box I am in. Maybe even create my own box!

    In some ways, that’s what the Harm Reduction proponents have done. What’s funny to me is that it’s nothing new. As Denise above attests to, there are plenty of instances of sanctioned “crutches” being provided for people trying to “recover” from another addiction. Who decides when and which crutch is deemed less harmful or more acceptable by the authorities and current social norms? What do we call Methadone treatment? Or sugarless, non-fat food products for that matter???

    Here’s my favorite answer to the question of what is the most effective treatment for addiction. I wish I could give credit but wherever I read it years ago is lost to memory. Anyway, some treatment provider, who was also a recovered (heroin, I think) addict answered by saying something like, “There are basically two options for the addict: they either die from their addiction or they grow out of it.” How anyone does that sort of growing (whether addiction is a part of it or not) is kind of what life is about.

    Thanks again Marc for furthering the conversation in so many ways! Julia

    • Al February 22, 2014 at 3:04 pm #

      Very well put Julia. Even though I am an addict. I am also in recovery, Suboxone is but a tool I use to maintain as my brain catches and my mind clears out and my feelings are more manageable and finally my behaviors are more CONSTRUCTIVE. My toolbox is growing. Suboxone is just one tool. It deals with some nasty sensations and symptoms but it does not make me think or feel differently. To examine my thoughts and beliefs is very difficult at times, as they were prior to taking any drug. Iam totally against, at least for me, Suboxone as the ONLY tool in recovery. You cannot just take your dose and sit back and watch it work. It will end in failure that way. I cannot prove that statement but it is what I intuit. In that sense my addiction, as bad as it was, actually is the impetus of a better human being. I like your quote and it sounds perfect, even if it is coming from some long ago and far away recess in your mind. Thanks, Al

    • Marc February 23, 2014 at 4:35 am #

      Julia: Bravo!! You’ve helped us all bring some murky issues into some kind of perspective, and that’s about all we can hope to accomplish through this kind of communication. I’m very pleased at the level of our dialogue. Thanks!

  11. Jan February 22, 2014 at 3:38 pm #

    The central dispute around harm reduction seems to me to be the concern about “allowing or condoning” drug use vs. requiring abstinence to be in drug treatment. I wrote our agency’s Harm Reduction Philosophy 15 years ago because I saw that requiring abstinence meant that drug addicts were barred from help unless they stopped using. That struck me as tremendously unjust not to mention ineffective with all kinds of people. Abstinence must needs be a personal choice and never ever a requirement for treatment. Sadly, the vast, vast majority of substance abuse treatment programs terminate treatment for using. What sense does this make??? When treatment is severed, where does a person go for comfort from that failure? How is that a better answer than keeping the treatment door open?

    • Marc February 23, 2014 at 4:38 am #

      That is a very succinct expression of the central logical conundrum here. When you frame it this way, it’s no conundrum at all.

  12. Liz February 22, 2014 at 6:39 pm #

    Thanks for this! I like the proposed conceptualization of all kinds of recovery as “harm reduction.” I don’t want to characterize myself, and others who have struggled with addictive behaviors, as individuals that have an “addictive personality,” because I’m afraid that relegates us to ultimately succumbing to the power of our addictions. However, developing an addiction is certainly influenced by underlying brain chemistry (and affected by our environments). While we can strengthen or weaken certain pathways in the brain, we cannot fundamentally change our personality types. As someone who also struggled with disordered eating, I’m pretty sure there is NO way I will ever stop caring about food intake. Even if I did manage to find a way to remove food completely from my thoughts, there would probably be something else I would be micromanaging or obsessing over. My brain is fundamentally geared to do so. Sometimes it serves me well (I can memorize like a fiend, and I’m very good with following and executing detailed instructions), and sometimes it’s maladaptive. I just try to practice greater insight and awareness to mitigate the negative effects my personality can have on my daily life. I suppose I will always be working on some form of “harm reduction,” but it feels like continuous self-improvement. I’m okay with that.

    • Julia February 23, 2014 at 9:29 am #

      Hi Liz, Thanks for chiming in. Just to add to your already very enlightened perspective on what recovery from food-related disturbance looks like.

      As I’ve gotten more and more distance from my own immersion in that obsession, I have come to observe my attitude towards food and eating as a kind of barometer.

      When I notice that I’m obsessing or feeling impulses I recognize from when they used to lead to the behavior, I take it as a signal that I’m feeling stressed, sad, lonely, etc. and turn my attention to what to do about it. I kind of think that everyone has some sort of “go-to” mode when they are in such states. Mine just happens to manifest around food. I can also tell when I’m feeling really comfortable, happy or safe when I can engage with food related activities without any “charge.” So it’s become quite useful actually.

      These days I’m more and more alarmed at the food-related hysteria I see around me that is accepted as normal or even admirable. I mean people who obsess about eating only the “purest” foods, organic, non-GMO, gluten-free, etc., etc. I do think the food system is out of whack and I think I eat pretty healthily (one side benefit of having been obsessed is being more knowledgeable than the average consumer) but it seems sad to me to be so preoccupied with such matters.

      What truly nourishes me are relationships, community, nature, satisfying work, creativity and all the rest. Not that I don’t still struggle at times to find those things. But I try to see those struggles not as a sign that something that’s wrong with me, just as my version of what every human being confronts as we grow through our lives. Easier said than done, of course! Glad to be here, Julia

  13. Richard Henry February 23, 2014 at 11:46 am #

    Stigma and Harm redution
    October 28, 2013 at 10:13am
    Fighting addictions or substance abuse is hard enough with out all the stigma that goes along with it.

    Contrary to popular belief that the abstinence program based recovery is the only way, has only added to the hardships of many who are trying to quit. The stigma put on people who fail this type of program is that they are a failure and can’t quit. This only adds to their troubles and does nothing in helping them through their recovery.

    We don’t all get it the first time… many of us who suffer, have a deep dark hole to fill, and it takes many programs, many tries to fill that hole. Harm reduction for me was key in filling that hole, I had to keep putting good in with no results, it took many, many times to fill that hole till it over flowed where I could see the good.

    Change and growth… Change is inevitable, growth is optional.

    I am not where I once was, and I am no longer an alcoholic, I have changed and I have grown. Having a drink on an occasion for me today is not failure, but choice. I am no longer bound to the chains of my past addictions. My transformation is a proven success that harm reduction works.

    This once an alcoholic, always an alcoholic, may work for some in holding on to their sobriety, but it didn’t work for me.

    You don’t know what you don’t know! and I can’t blame people for not knowing total abstinence, is not the only option. My hope however is that people learn from my wisdom and the results of my recovery, that it works.

    The best experience is in someone else’s. I not only talk the talk, but walk the talk…

    It’s no longer trail and error, you choose the life you live, and today i’m living the life I choose.

    We all have had failure, we have all experienced dark times, it’s those dark times that the brightest light comes from…

    God bless everyone for he has blessed me…


  14. NN February 24, 2014 at 12:39 am #

    Hi Jan,
    You said, above, in part,
    “Abstinence must needs be a personal choice and never ever a requirement for treatment. Sadly, the vast, vast majority of substance abuse treatment programs terminate treatment for using. What sense does this make??? ”

    That is an excellent point, and it’s not just termination of treatment that may
    be involved, essentially some programs make abstinence a prerequisite for

    Lance Dodes (psychiatrist at Harvard Med School), in “Breaking Addiction”
    makes a similar point. How odd, for any other affliction, for a doctor to set
    a prerequisite to *start* treatment. Would a skier with a broken ankle be told,
    “You must give up skiing–make a pledge– before we set that ankle”?

    True, you might not get a lung transplant if you openly keep up smoking; but lungs are in short supply and that treatment is VERY expensive. Pain and anxiety can be treated for a few cents a day.

    My main point, here, though is to put in a word for 12 step groups, whatever their other limitations or ‘cult-like’ aspects: The ones I’ve seen in the “S” field have been extremely accommodating to relapse. I believe this attitude is inherited from the better angels in AA, but I have no first hand evidence. I have seen people turn up after a year in relapse. There were no recriminations, not were they told they’d been terminated for violating abstinence.

    The histories of some alcoholics, as told in the “Big Book” often seem to support my view that the best of the groups are almost infinitely forgiving, and very rarely
    ‘terminate.’ I’ve only heard of that for obstreperous, threatening or assaultive behavior.

  15. Waylon February 28, 2014 at 9:05 am #

    I am beginning to get as much out of these comments as I am the actual posts! Thanks all for sharing your views/experiences. I really enjoy reading them.

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