Posted by: Sam | 2009/06/26


I have a drinking problem. I don' t drink every night and I' m a high-functioning person but I binge drink at times. I realize it is a problem and is not okay and I want to do something about it. My shrink has told me a little bit about the harm reduction model. How does it work?

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I hope that I can respond succiently with the information that you have provided, but keep in mind that this reponse will have it's limitations as I have not formally assessed you. <br><br>The fact that you are not drinking everyday would probably indicate that you are not yet at a phase of chronic alcohol dependence (but could well be on your way). We refer to binge drinking as Alcohol Use Disorder (as opposed to Alcohol Dependence Disorder)- in lay terms, it sounds as though you have crossed the line in terms of problem drinking (psychologically speaking - in other words, alcohol already probably has an emotional function for you - which is a big red light). <br><br>Harm reduction is often regarded as a controversial social policy, it alludes to the reduction of risks - for example, if you cannot get someone to stop using a substance (for whatever reason) - then one tries to reduce the risks involved - for example 'controlled drinking' (which I am goind to discuss later), needle exchange programees - based on the philosophy of harm reduction where intravenous users can obtain hypodermic needles and associated injection equipment at little or no cost. These programmes are called ‘exchanges’ because many require exchanging used needles for an equal number of new needles. In addition to sterile needles, syringe exchange programmes typically provide other services such as HIV and hepatitis C testing, alcohol swabs, bleach and sterile water, aluminium ‘cookers’, containers for needles and many other items. Government resistance to these programmes is strong, because they are sometimes believed to encourage non-injectors to use drugs. Public objection to such initiatives, especially in more conservative countries, has at times been heated. The decriminalisation of cannabis and other traditionally illicit substances (such as in Portugal) - is also a harm reduction tactic.<br><br>Now getting back to alcohol - one gets two schools of thought in the field - namely the 'total abstinence model" (which is what most rehabilitation centres try to advocate, as well as AA and CAD), and the 'controlled drinking model' (which in SA, Alkogen traditionally advocated/s) - now interestingly enough, one does not hear of many advocating controlled heroin or other drug use - which in principle should also apply to most perhaps all psychoactive substances.<br>The philosophy between many 'controlled use methods' or harm reduction tactics is that if one can rectify metabolic imbalances (through mineral and vitamin suppliments) - then one's body will no longer have an 'alcohol hunger' - so in other words, one will be able to (theoretically) be able to use within norms, as the biochemical imbalances have been rectified. This in all good and well, and I think it is good to look at mineral/biochemical imbalances, but what the theory fails to take into account is the psychological component of the alcohol abuse/dependence (in other words the emotional/psychological component) - which is (arguably) the largest and hardest to overcome component of a dependece (on anything - be it alcohol, cocaine, heroin, gambling, food addicitons, sexual addiction - 'addictive disorders' if you like). The total abstinence model advocates that for whatever reason, the individual in 'allergic' to psychoactive substances (be it biochemical, psychological, genetic predisposition etc) - so it is better and safer to completely eliminate it from one's life - ie a lifestyle change (similar to an individual who is alergic it milk or is a diabetic).<br><br>In my opinion, harm reduction tactics should only ever be used in cases where the prognosis to recover is poor or the motivation to make changes is very poor. It does not seems as though you meet either of these categories - perhaps you should consider going into some type of rehabilitation programme and/or goining a support group such as AA - it might be a (pleasant) eye-opener for you.<br><br><br>In response to MDK comments:<br><br>I please note that I was not referring to SA goverment per se, but rather governments generally speaking - I concede that this might be easy to miscontrue in the initial response. I am well aware that NEP is mentioned in the 1998 SA National Drug Master Plan, you however mention that 'it dropped out of the new (2006) plan without so much as a discussion' - and I wander if you would agree that this stems from numerous factors, one perhaps being the conroversies surrounding NEP - and perhaps more prominent factors such as limited resources, other competing priories, and perhaps that the IV rate is not (yet) as high as in many other counteries). Just some thoughts to add... you also mention that all drugs cannot be treated as the same, but simultaneously state that Portugals harm reduction tactics of decriminilsing the so-called 'harder' drugs as well has been successful (which I am not arguing about). I am, however, curious - would you be in favour of controlled drinking theory then ? Is alcohol safer than the so-called 'hard' drugs? One final word, the comments are made from an academic and therapeutic/practical background.

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Our users say:
Posted by: MDK | 2009/06/28

More " Expert"  lies. Government does not strongly resist harm reduction strategies. The National Drug Master Plan of 1998 expressly mentioned them and made provision for needle exchanges programs! (p19) It dropped out of the new (2006) plan without so much as a discussion. That no plan is ever implemented is another story altogether.

Portugal is the poster child for the success of harm reduction where the decriminalisation of small quantities of small drugs has led to an actual decline in consumption. The facts are difficult to argue with, so it' s best to use scare tactics.... " now interestingly enough, one does not hear of many advocating controlled heroin or other drug use - which in principle should also apply to all psychoactive substances"  Why heroin? The BIG SCARE drug. If " they"  legalise one drug then HEROIN should be legalised because it is the same in PRINCIPLE? No one ever said that each drug should be treated the same. That would be stupid... like this expert. Even more interesting is that the expert keeps going back to " models"  rather than experience and what really works.... since he doesn' t really know! In " lay terms"  he' s full of shit...

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