Alcohol Abuse and Harm Reduction
By: Edward W. Wilson, Ph.D., MAC
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Outside of the U.S. the concept of “Harm Reduction” is frequently the first step in addressing problems related to alcohol abuse, dependence or addiction. The concept is easy to understand: any reduction in a problem behavior is progress. Put together enough reductions and the problem will be eliminated or at least moderated.
While the concept is easy to understand, and the results frequently positive, the Harm Reduction model is opposed by most of the alcoholism treatment industry in the U.S. because it doesn’t support their discredited “disease” model. Most of the so-called alcohol rehab providers are wedded to a single 12-Step Minnesota Model that holds that alcohol problems are the result of an ill-defined disease whose only alternative is abstinence and a process of life-long recovery.
Research and most people’s personal experience, of course, supports the Harm Reduction model. According to the 2001/02 U.S. National Epidemiologic Survey on Alcohol and Related Conditions, for example, more than one-third (36 percent) of U.S. adults with alcohol dependence (alcoholism) that began more than one year ago were in full recovery a year later (according to the National Institute on Alcohol Abuse and Alcoholism).
The fully recovered individuals show symptoms of neither alcohol dependence nor alcohol abuse. They either abstain or drink at levels below those known to increase relapse risk. They include abstainers (18 percent) and low-risk, moderate drinkers (18 percent) and medium risk, but not dependent, moderate drinkers (12 percent).
One-quarter (25 percent) of the individuals with alcohol dependence are still dependent and 28 percent are in partial remission (that is, their use has moderated but is still above health enhancing levels).
Overall, the results are clear – almost 58% of those classified as alcoholics managed to moderate their drinking!
How does this fit with the “progressive disease” model? Obviously, it doesn’t. But again, what we have all observed time after time doesn’t fit with that model either.
After all, we all know people who have simply quit drinking or moderated their use for any number of reasons. Many others maintain the same level of drinking for decades, whether that level is healthy, abusive, or dependent. And, yes, we all know individuals whose use has progressed to addiction and who appear to suffer from something akin to a disease. But generalizing from this last group to the other 95% of the alcohol consuming population doesn’t make any sense – nor does it make for services that are either desirable or effective for most people.
It’s no wonder that most people are unwilling to look for help until their alcohol related problems are far advanced. Who wants to be diagnosed with an incurable, progressive, and demeaning “disease” whose only antidote is said to be life-long “recovering?”
Frankly, the biggest current alcohol problem in the U.S. is belief in a model that discourages people from getting help at the onset of their alcohol abuse. That’s when it’s still a symptom rather than a cause, and usually amenable to correction and a return to healthful moderate levels of consumption.
The best time to address alcohol problems is sooner, not later, and when moderation is still, by far, the likeliest outcome. Look for help from those providers who treat you and your situation, not some created “disease,” and who will help you discover the best outcome for you, not sentence you to punishing, pre-ordained, and counter-productive rituals.
For real help and information visit the Harm Reduction (www.hamsnetwork.org) and Moderation Management (www.moderation.org) websites.
©Copyright 2008 by Edward W. Wilson. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.
Click here to contact Edward and/or see his GoodTherapy.org Profile