I used to work with a guy who ate a half of a donut and let the other half sit on his desk for the rest of the day. It didn’t bother him, but it drove me crazy. I couldn’t concentrate on anything he said with that tasty pastry lying there.
One afternoon I tried it. I cut one donut in half and left the other in the box. I told myself I could do it, channeling my inner Tony Robbins. However, no more than five minutes went by and I was stuffing the other half in my face, and two more donuts after that.
The experience left me wondering: Are there two types of people in life — the compulsive kind who can’t do anything in moderation and those that can write an article with a donut a few inches from their monitor? Is there an island of other people in between? If so, how do I get there?
The Shifting Line in the Sand
As I have said before, I struggle with some of the absolutes that I hear in recovery groups. I fully understand why the philosophies are there — nuanced thinking can lead to relapses. For many people, a clear, concise line in the sand provides the distance needed from a manipulative disease. Complete surrender paves the path to peace.
However, given that black-and-white thinking has caused problems in my life, I try to tolerate ambiguity better today and attach a sense of curiosity to matters like this. Last week I spoke to
Dr. Elizabeth Drew, Medical Director at Serenity at Summit Doylestown, a Delphi Behavioral Health Group facility. She has over 20 years of experience in the health industry and is passionate about helping people deal with alcohol and other substance abuse, providing holistic addiction treatment, and ensuring clients achieve long-term sobriety.
“How do you know when you’re an alcoholic?” I asked her.
“There is a wide spectrum of alcohol use disorder,” she explained, “from the alcoholic whose body requires alcohol to function to the binge drinker who uses a glass of wine to deal with stress.”
According to Dr. Drew, it’s not uncommon for people to prove to themselves that they don’t need alcohol, only to start binge drinking again when stress resurfaces. Alcohol use can be as complex as the individuals drinking. That thick, black line drawn to separate alcoholics from normal drinkers might not be accurate, at least not all the time.
While defining who is and is not an alcoholic is fuzzy, Dr. Drew asserts that it’s always problematic to reach for a substance to treat problems, no matter if you are physically addicted or not. “People can binge drink and then get to a point where they simply decide that drinking is only creating more problems in their lives, so they stop. However, the risk is always there in the future to use drinking to treat stress.” So even if they are not an alcoholic by some standards of the definition, the risk for abuse in the future essentially categorizes drinking as problematic, much like an alcoholic.
In her practice, she sees many women in their 50s come in for help because their drinking has escalated. They make the decision to stop drinking, and their life returns to normal.
Harm reduction — say what?
The first time I heard about harm reduction — an approach to minimize the dangers of drinking or any drug use without requiring abstinence — I shook my head in disbelief. I envisioned the half donut on my co-worker’s desk and read all opinions suspiciously.
The HAMS Harm Reduction Network, Inc. says this about the concept:
In the broad sense of the word, Harm Reduction includes every strategy which helps to reduce harm including abstinence… However, harm reductionists are also realistic and pragmatic and realize that the attempt to force abstinence on everyone against their wills generally backfires and actually leads to an increase in alcohol related harms overall. Likewise, an attempt to eliminate all alcohol related harm by forcing perfect moderation on everyone will backfire and lead to an increase in alcohol related harms overall. The most effective strategy is to meet people where they are at and work with individuals on goals which they choose for themselves which can range from safer drinking to reduced drinking to quitting altogether. In the narrow sense of the word, those who seek to eliminate all harm by pursuing perfect moderation or perfect abstinence may be said to be pursuing a goal of Harm Elimination rather than Harm Reduction. Harm Elimination is not for everyone.
Very true, it’s not for everyone. But then again, neither is abstinence.
“People don’t like to hear they can never drink,” says Dr. Drew. “They want to go back to normal. Although there are only rare occasions that people can do that, making the choice not to drink for them feels more empowering than being told they can never drink again.” She sees harm reduction as a choice people make to abstain. “They recognize that alcohol isn’t producing any benefits in their life, that not drinking is going to be a better way.”
The difference between that approach and the one in recovery circles is that there is no first step — admitting powerless over the stuff. It is more of a decision to live another way, which gives the person more control and freedom.
I believe each way works if approached in the right way — abstinence and pledging powerless, and harm reduction or a thoughtful choice to abstain. What they have in common is that people begin to see that alcohol isn’t required for joy, and their lives can be meaningful and fun without booze. This is, after all, the message of Alcohol Awareness Month.