Harm reduction or enabling? No easy answers.

If there were simple answers to the scourge of substance addiction, then society would be virtually paradisical. There would be little crime, little domestic abuse, rape would be rare, and our highways would be devoid of much vehicular mayhem. Everybody would get clean, sober and functional.

But, the problem with the ‘problem’ is that everybody has an opinion and in the recovery biz it’s often a case of that old Jimmy Durante cry of despair: “Everybody wantsta get into da act!”

That problem is, too many people with not a clue about the process of addiction or the realities of addicts’ lives, think they have an ideal solution. And, rest assured, opinions abound. Including many invalid opinions.

In this regard I find myself being highly conflicted. The trend of the moment via various health authorities is the process known as ‘harm reduction’ – not ‘harm elimination’, but merely reduction. You know, sort of like a philandering spouse suggesting that “Yes, I still am unfaithful, but not as much as I once was.”

Health authorities, by the way, are often populated by doctors, clinical sorts who bring all sorts of theories along with them. In my dealings with doctors as an addictions counsellor is that I’ve found that the average doctor knows unspeakably little about the nature of addiction. There are exceptions, of course, but that lies only with those who specialize in the field. Dr. Gabor Mate, whom I interviewed a little over a month ago knows a lot about addiction and addicts, and is also an advocate of harm reduction. As much as I respect his wisdom, we philosophically part company at that point. Harm reduction to me (and I could easily be wrong) smacks of enabling.

See, I’m old-fashioned enough that I have no idea whatsoever who or what a Miley Cyrus is, and I happen to believe in the so-called abstention model in dealing with substance. If some shit or other that you are drinking, smoking, injection is causing you or other\s grief, then you quit doing that – or not. If you do not choose to quit, then I guess you bear the consequences. But, I balk at the idea of helping you to keep doing what you’re doing if it is antithetical to the general weal of society.

I’m also old-fashioned enough to believe that people are much tougher and more determined than we give them credit for; especially if we demand that they be tough and determined and give them the tools and support needed to be tough and determined.

I only say this because over the years I have run into many people who have successfully kicked huge addictions are now leading fulfilling and productive lives. Was it hard for them? You bet. It was gruelling and brutal, and probably continues to be in certain regards. But, so is life. But, maybe it’s better to look at life face-on rather than escape via substance and artificial euphoria.

So, now that I have re-entered the counselling realm on a part-time basis, I am somewhat restricted in calling a spade-a-spade, a drunk-a-drunk, or a junkie-a-junkie. I can only suggest that there “might be a problem” and hope that the client has enough grip on reality to recognize that there ‘is’ a problem. As I have suggested before, if you have ever thought you ‘might’ have a problem with a certain lifestyle, then you ‘do’ have a problem. Those whose behavior is not problematic never think it might be.

So, while I might want to advise a client to get to AA or NA or some other abstention advocacy organization, I can merely suggest such a course as a possible option.

So, do I do much good? Is it of benefit to listen to a client with a significant alcohol problem who advises me that what he wants to do is really cut down on his drinking? My impulse is to say: “What you must do is cease drinking alcohol period, ASAP.” Even Dr. Mate agrees on abstention for boozers.

Such thoughts cross my mind because I have to go and deal with that alleged ‘problem’ drinker this afternoon. Nice guy, truly, who has lost his job, lost his home, lost his wife, lost his kids, but thinks he might be OK if he just limits his alcohol intake. Hmm.