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Kenneth Anderson Kenneth Anderson

Guess What? Harm Reduction Is a Common Path to Abstinence From Alcohol


Offering problem drinkers the option of moderation frequently works better than mandating abstinence—and many people who use harm reduction approaches do eventually decide to quit.

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In the HAMS program, you set your own goal and measure your progress. Photo via

When people hear the term “harm reduction,” their immediate association is likely to be needle exchange programs for injection drug users. But the strategies that succeed in needle exchange can also work for people who drink alcohol: “meeting people where they are at,” encouraging small and achievable changes and making safety paramount. Many people who find 12-step programs and abstinence unapproachable feel more at home with a program that offers a choice of recovery goals and an emphasis on self-empowerment.

The HAMS alcohol harm reduction program is one such program. Like Alcoholics Anonymous, it is a free-of-charge, lay-led support group. But it differs decisively from AA in that its members define their own goal of safer drinking or reduced drinking or quitting altogether. (HAMS stands for Harm Reduction, Abstinence and Moderation Support.) Founded in 2007, the program currently has approximately 1,300 members enrolled in its online group.

There is a common myth in addiction treatment that abstinence is the only workable goal, even if it has to be “forced” on someone. Otherwise, if offered a choice between moderation and abstinence, people will almost always choose to continue to use substances, generally with disastrous results. However, research by psychologist Martha Sanchez-Craig and others has shown that a choice-based approach can have significantly better outcomes than an abstinence-only one.

In the late 1990s, Sanchez-Craig conducted an experiment in which problem drinkers were randomly assigned to either an abstinence-only group or a group that was allowed to choose either moderate drinking or not drinking at all. Conventional wisdom would suggest that most of those in the choice group would choose moderation and would fail to achieve it; only those assigned a goal of abstinence would succeed. What Sanchez-Craig found was quite different. First, both groups had an equal number of successful abstainers. Second, the choice group had much greater reductions in overall consumption. Sanchez-Craig concluded that forced abstinence “fail[s] in promoting abstinence among clients generally, and [is] not very helpful in promoting moderate drinking.”

HAMS was inspired by Sanchez-Craig’s research. The program measures success in terms of reduction in alcohol-related problems, over alcohol consumption and successful and stable moderate drinking or abstinence. About 25% of those who come to HAMS eventually opt for abstinence. What follows are the stories of two HAMS members who used harm reduction as their pathway to abstinence.

There is a common myth in substance misuse treatment that abstinence is the only workable goal, even if it has to be “forced” on someone. Otherwise, if offered a choice between moderation and abstinence, people will almost always choose to continue to use substances. However, a choice-based approach can have significantly better outcomes than an abstinence-only one.

Joe’s Story: At age 14, I discovered the wonders of alcohol: the three-beer buzz, the drank-too-much-Southern-Comfort heaves and a heightened sense of boldness and extroversion. Within three years, I had two drunken driving accidents. Family interventions ensued, beginning with three years of sporadic AA attendance and culminating, at age 21, in a 28-day stay at a chain treatment center in 1986.

I spent the next 25 years in a cycle of 12-step recovery and relapse. After six years of not taking a drink, I stopped going to meetings, propelled by a life trauma. I moved back to a large city with a big music and party scene. For the next seven years I was moderately successful in my career, and active in exercising my love for musical performance. But the fact that my drinking steadily increased seemed to confirm what I had learned in AA about alcoholism as a progressive disease. By 2001, I felt that I couldn’t go on with my self-destructive daily drinking. I re-entered AA, launching another six-year stretch of no chemical usage (except for one line of cocaine at a friend’s musical session).

Around 2005, I began to look on the Internet for alternative methods of recovery. I learned that the limited research found 12-step therapy no more effective than quitting drinking on your own. Despite having met some truly wonderful people in AA, I concluded that the harms of increased drinking due to learned powerlessness (AA’s first step) and denial of self (AA’s second step) outweighed the benefits for me.

I left AA, resumed drinking a year later and latched onto HAMS and harm reduction. Over the next three years of continued drinking, I practiced certain HAMS safety techniques, like eating prior to drinking, pacing and charting my drinks, and setting small short-term goals. Most important, I practiced leaving the key to my car at home on nights when I went out to drink.

During the last years of my drinking, I had no accidents or grievous bodily side effects, although I did feel remorse about continuing to drink when there was little pleasure in the ritual. I finally made the decision to quit for good on Mother’s Day 2011. Since then I have indulged three times in having from one to four alcoholic beverages. I have had no binges or hangovers, nor have I had a feeling of reviving a thirst that only alcohol could quench. Also during this new period of abstinence, I fell in love and married.

Harm reduction enables people to recover from addictions. It offers a viable alternative for those who do not do well with traditional 12-step programs. It keeps people alive and helps them continue to take small positive steps toward successful and stable moderation or abstinence.

Frank’s Story: I was 17 when I got a DUI. By then, I’d begun drinking and experimenting with drugs regularly. After speaking with my parents, the police officer who arrested me, my family doctor, a psychologist and a psychiatrist, I began attending AA meetings.

Although I remained “sober” in AA for many years, I always had an inner conflict about what AA describes as your Higher Power. I made sincere, occasionally desperate and always failed attempts to find this spiritual force that supposedly would help ensure my “sobriety” and remove my “defects of character.” When I spoke in meetings about my struggle to square myself with the spiritual aspects of the program, I was told that I was “too smart for my own good.”

Two things ultimately led me away from AA. First, I noticed that the fewer meetings I attended, the better I felt. Second, I was asked to lead a meeting where I was expected to get up in front of the room and share my experience, strength and hope. I felt like a fraud: Everything I said was true to “the program,” but I didn’t buy it anymore.

I had gotten married, started a family and had a stable life…so I quit going to meetings. After 17 years, I ended up drinking again in reaction to a stressful life situation. As a confirmed atheist, I didn’t go back to AA. As my drinking got worse, I often “heard” the residue of self-critical messages from my years in AA. I resigned myself to the fact that I would probably end up drinking myself to death and could only hope to hang onto my life and my family as long as possible before the inevitable.

As my kids grew up, it occurred to me that if alcohol misuse is hereditary, they were likely to be similarly afflicted. I decided to do everything in my power to uncover alternatives to the disease/AA model in case they ever needed help. To the internet!

I found HAMS and quickly learned that despite not wanting to stop drinking, I did in fact desire to improve my circumstances. The HAMS approach was a breath of fresh air. Every positive change was a cause for celebration. There was humor at most meetings. The practical harm-reduction advice was easy to implement and not mandatory: I began alternating my alcohol drinks with water or nonalcoholic drinks, started walking, getting outside, making small changes. If I went on a binge or bender, I was welcomed back to the program when I returned, without pressure to repent.

Over a couple of years I rediscovered my will to live, even though I was still often drinking to excess. I had a better, healthier routine as well as goals and a plan. As I aged, recovering from hangovers got harder. I began using “hair of the dog” to get me through early morning activities. This quickly caught up with me, and after a short hospital stay long-term abstinence became my goal.

Harm reduction enables people to recover from addictions. It offers a viable alternative for those who do not do well with traditional 12-step programs. It keeps people alive and helps them continue to take small positive steps toward successful and stable moderation or abstinence.

It has long been said that “no true alcoholic can ever achieve moderation.” We now have the data to show that this is false. In recent years, the NESARC (National Epidemiologic Survey on Alcohol and Related Conditions), a federally funded study of a random sample of 43,000 Americans, found that of those who have recovered from alcohol misuse, half did so by abstaining and half by cutting back.

HAMS is agnostic: Those who opt for total abstinence are welcome to pursue this goal, or they may leave HAMS for an abstinence-only program such as SMART or AA. HAMS empowers people to recover by offering both support in defining their own goals and tools to reduce their risk of harm. Whether you are in AA, HAMS or another program, recovery is often a long, hard process. This is one thing we all agree on. Rather than fighting among ourselves over “the one true way,” we should work together, continuing to mature and embracing the concept that there are many paths to recovery.

Kenneth Anderson is the founder of HAMS Harm Reduction for Alcohol and the author of How to Change Your Drinking: A Harm Reduction Guide to Alcohol. He has worked in the field of harm reduction since 2002, including “in the trenches” doing needle exchange in Minneapolis. He served as online director for Moderation Management and as director of development at the Lower East Side Harm Reduction Center. He hosts a harm reduction podcast and writes a blog for Psychology Today called “Overcoming Addiction.”


7 Comments

7 comments on “Guess What? Harm Reduction Is a Common Path to Abstinence From Alcohol

    Dr. Kellogg

    Ken -Nice Job! – Scott

  1. Shaun Shelly
    Shaun Shelly

    Nice Ken

    My experience has shown similar results in engaging who use other drugs as well. We always respect the goals that the individual feels comfortable with, and regularly evaluate these goals to see if they are happy with them. It is not our role to impose expectations, but rather to facilitate conscious choice.

    Counselorchick

    What a great article. Thank you Ken!

    Arnold M. Washton, Ph.D.

    Excellent points, Ken. I’d like to add that alcohol moderation serves not only as a stepping stone toward abstinence, but also to lower some of the most formidable barriers to getting help for drinking problems regardless of problem severity. Countless problem drinkers (and alcoholics too) are turned off by the abstinence only disease model approach. I can’t tell you just how many of my clients have said that until they became aware of alternatives to standard abstinence-only programs, they had actively avoided getting help for many years while their problem only kept getting worse. Our moderate drinking program continues to attract numerous clients who fit this description. Offering alcohol moderation as an option widens the front door to treatment and encourages more people to step in.

    Jeffery porter

    I’m a 53 yr old alcohol ic. I just choose not to drink today. I’ve been in 14 inpatient tx successfully. I have achieved multiple years of sobriety that include 3 college degrees married and children. I choose to drink again to deal with a bad divorce. I also got 2 dui’s and lost my job. I’m 3 yes sober now. I’ve realize that total abstinence works better for me. I realize not only I was addicted to alcohol but also trying to control the outcome. To the own self be true.

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