Harm Reduction as a Strategy in Overcoming Excessive Self-Medication
While changing any behavior is difficult, especially one which becomes as pervasive as our alcohol use, there are any number of ways to go about, as well as ways to avoid going about it.
A currently popular buzz word approach is “harm reduction.” Simply put, this means reducing your use over time. Tapering off is the old term.
The ubiquitous “does it work?” question, here as elsewhere, is better asked as “can it work?” in which case the answer is yes.
Years ago we traded some ideas and clients with a Texas diet doctor who referred to the process as “better bad choices.” In his case he meant gradually modifying one’s diet over the course of a year, so instead of steak and potatoes seven night a week one went to four beef nights, two chicken nights, and one fish night. This then proceeded to two beef nights, two chicken nights, two fish nights, and one night all vegetables. The other portions in one’s diet also changed with less carbs, more vegetables, fruit and salad. I’m sure you can see how that would work.
The problem is that his patients, like our clients, tend to want immediate results with no effort and it didn’t happen. On average, his patients lost little or no weight for the first six months but then achieved steady, and sustainable, weight loss. The key word here, for him and us, is SUSTAINABLE!
Getting back to our clients and alcohol.
One of our earliest clients was a research psychologist who wished to reduce her chardonnay consumption from six bottles a day down to two. I know, sounds unimaginable, like the client who drank 36 cans of beer a day.
Nonetheless, our chardonnay person set up spreadsheets and tracked every glass every day and graphed and charted every trend and change and regression. But this is harm reduction at its most extreme. Was she successful in achieving her goal? She came in to see us periodically and I can say that the answer is “YES!” But it took four years.
The trouble with “harm reduction” is that it’s a little like AA – a great way to convince yourself you are doing something when in fact you are, again, postponing doing something.
Yes, you can put in an enormous amount of time and effort, as both our clients and the doctor’s patients did, and you may indeed achieve the result you want. BUT. What is going to happen during the months or years it may take you and how much health, family members, jobs, etc., will you lose in the process?
No, I’m not suggesting that harm reduction won’t work for you. I am suggesting that you take a cold hard look at yourself and answer whether or not this is a strategy you are willing to commit to, as our client did, or is it just another way of procrastinating under the guise of doing something? All of us, myself included, are awfully good at fooling ourselves into thinking we are taking action when we aren’t.
What is Your Idiosyncratic Path Out of the Maze of Self-Medication
Just as Harm Reduction does work for some who are committed to it, so do any number of other approaches. That’s a fact that Steppers with their “AA – The ONLY WAY!” dogma hate.
The reality is that what is going to help you probably won’t look like what has helped anyone else, at least not exactly. I certainly don’t recommend the muddling about method I used, successfully it’s true, because of the time it took, the cost professionally and personally, but, yes it “worked.”
A major result of my own hit and miss scramble was the idea that others shouldn’t have to waste years in a process that shouldn’t take more than a few months.
75+% of Mary Ellen’s and my clients have demonstrated this to be true.
“Ah,” you say,” but what about the other 25%?”
Fair question and the answer is, half of them didn’t want to fix the problem, they wanted to get a spouse, employer, judge, family or all of these off their back. You will not be surprised to learn that no one lasts long when the only motivation is placating someone else.
The others? The others want the painless, effortless, stress and destress solution promised by programs from Malibu to Center City to Atlanta and beyond. And I am equally sure you know that that’s a false promise. There is no such thing as effortless change. If there were we’d all be healthy, happy and wise.
For nearly 20 years Mary Ellen and I have worked with individuals for the reason that solutions are individual and groups, with their insistence on conformity, cannot provide answers to your own unique situation, circumstances, and motivations.
But we can.