The Stanton Peele Addiction Website, March 28, 2008. This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.
Heeeeeere’s Harm Reduction
Have you heard the term "harm reduction" used in re substance abuse and wondered, "What the hell is that?"
Thankfully, Bon Jovi guitarist Richie Sambora has explained it. Tuesday night, Sanbora was arrested for DUI in Laguna Beach, CA. Cops pulled him over while driving his Hummer all over the road with his girlfriend and 10-year-old daughter in the car.
Like most current substance abusers, Sanbora has been exposed to Alcoholics Anonymous and its abstinence uber alles philosophy. Last year, he entered rehab, and he has announced that he is continuing alcohol treatment.
As Sanbora's case illustrates, however, few people exposed to such treatment actually then abstain forever. George Vaillant, Harvard psychiatrist and AA board member, discovered when following up Cambridge Hospital patients he treated using the twelve steps, including mandatory AA attendance, that 95 percent relapsed.
(Nothing daunted, Dr. Vaillant continues to flack AA and the religiously-oriented steps. At a conference in Vancouver where we were both presented with lifetime achievement awards, I asked George publicly what he thought of harm reduction. He declined to answer.)
Harm reduction says - "You can try for abstinence, or not. But let's protect your life and the lives of those around you." Examples of harm reduction are clean needles for heroin addicts to avoid HIV infection, safe rides programs to prevent adolescent stupidity from turning into life-ending tragedy, and nicotine patches to feed drug addictions without causing lung cancer.
Sure addiction is bad, but who among us is perfect? We are all, in John Lennon's words, "doing what we can" to get better (or is that taking "whatever gets you through the night"). But in order to improve your life you need to avoid the very worst things various addictions can cause - death being chief among these.
What prevents us from adopting this philosophy is America's moralism about drugs, alcohol, et al. - a moralism that suffuses our treatment programs. The typical program says, "Quit using before you enter, while you're here, and forever after." Good advice - if only people weren't addicted. (For those of you who don't know, addiction means finding it very hard to cease a harmful habit.)
As Valliant and Sambora inform us, most people fail at this prescription. But when they do while in AA or following standard treatment, armed with no other principle than abstinence, they flail around harming themselves and others with no therapeutic direction to follow (except to return to treatment to try harder to abstain).
How does asking people to deal with a problem by instantaneously stopping it comprise treatment? Couldn't some of the time Sambora spent in rehab have been devoted to exploring ways for him to get around when he is intoxicated other than driving a several-ton vehicle through crowded streets with his child and lover in tow? The failure of therapy to help Sambora in this area is likely to have steep consequences for his parental rights.
Sambora could install a breathalyzer-ignition system. Or perhaps his girlfriend could be brought into treatment to learn effective ways to help him desist from such death-defying driving. Motivational interviewing in this case might include asking such questions as: "How do you feel about your daughter being put in harm's way? Under what circumstances have you done that? What realistic ways can you imagine to avoid such circumstances? What failsafe can you put in place to protect her when you've been drinking?"
But we're wistful and moralistic, not realistic, when it comes to addictive sins. God doesn't want us to be drunk so, for God's sake - don't ever, ever drink! Remember how Mark Twain (who saw many a Temperance lecture) described Pap swearing off the booze in Huckleberry Finn:
"Look at it gentlemen, and ladies all.... There's a hand that was the hand of a hog; but it ain't so no more; it's the hand of a man that's started on a new life, and'll die before he'll go back. You mark them words-don't forget I said them...."
So they shook it, one after the other; all around, and cried. The judge's wife she kissed it. Then the old man he signed a pledge- made his mark. The judge said it was the holiest time on record, or something like that....
In the night... [Pap] got powerful thirsty and clumb out onto the porch-roof and slid down a stanchion and traded his new coat for a jug of forty-rod, and clumb back again and had a good old time;... drunk as a fiddler,... [he] rolled off the porch and broke his left arm in two places and was froze most to death when somebody found him after sun-up.
The judge he felt kind of sore. He said he reckoned a body could reform the old man with a shot-gun, maybe, but he didn't know no other way.