Could Harm Reduction Actually Treat Real Alcoholism?

Could Harm Reduction Actually Treat Real Alcoholism?


There is a place in Ontario, Canada that is actually testing out a managed alcohol program for struggling alcoholics.

Pacific Standard says that “…managed alcohol programs, or MAPs, are treatment facilities that provide homeless alcoholics with housing and small amounts of booze.”

So what happens is that the homeless alcoholic can check in to this MAPs facility every hour of the day and get their “pour,” which is a small amount of booze. So they keep drinking slowly throughout the day and avoid binging.

The program has attempted to collect data and measure outcomes, which they claim are very encouraging. Some of the things they are noting are less police contact, less hospitalization, less violence, and so on.

So obviously this is not going to be an ideal program for every kind of alcoholic (or drug addict, for that matter). If you are a “functional alcoholic” who works at a job and lives in a home, then switching over to a managed alcohol program does not make a lot of sense. You have a job and you have a home, now you just need to find recovery, which is likely going to be abstinence based. You are not in a position to use something like managed alcohol programs.

Harm reduction and programs such as MAPs might still have some useful value to people, but only if they are in a position that really requires something so extreme. Picture someone who is living the woods, or sleeping on park benches, as the ideal candidate for this type of harm reduction.

It feels like a defeat in some ways to say “yes, I know that I am alcoholic, but the best that I can hope for at this point is to avoid binging and just keep myself mildly intoxicated each and every day in a controlled manner.” This is very similar to the idea of methadone maintenance for a struggling opiate addict. They have essentially chosen to take a more formal and controlled dose of opiates every day, rather than to struggle with an abstinence based approach. Are they “getting high” every day. Yeah, they sort of are, no real question about it. But are they getting smashed, trashed, and completely wasted? No, and that is the whole point of harm reduction.

For someone like myself, this would have been a disaster. I have too many resources at my disposal to make a harm reduction approach work. In other words, my bottom is not low enough for harm reduction to be viable. I would get my “daily pour” and decide that, because I am working hard at a job making real money, I deserve more than 2.6 fluid ounces of beer every hour (or whatever the MAPs program puts me on).

So I think that we need to consider the client before we jump on the bandwagon and declare that harm reduction is the solution for everyone’s problems. It just doesn’t make sense for a large group of people who are struggling to find recovery.

My question would be this: Can a person who is in the MAPs program, who is drinking steady amounts of alcohol every day, find a way to achieve real personal growth in their life? Can they figure out how to become more emotionally mature, learn new coping skills, and improve who they are and how they react to the world? Because that is the real test of recovery, in my opinion, if the person is actually growing and learning and evolving or not.

Can the MAPs participant look at other areas of their life, such as their physical health, and make significant lifestyle changes while they are self medicating with alcohol every day in a maintenance kind of way? Is this realistic, or does the fact that they are dependent on their “daily pour” keep them stuck from making significant lifestyle upgrades?

My main concern for people who are using any kind of maintenance for addiction is that their personal growth may stall out completely, because they are “partially medicated.”

So you are taking methadone, for example, or you are getting your daily pour of alcohol in the MAPs program. Are you still trying to improve your life in different ways, or are you content to just coast along and exist, letting life continue to happen to you, without really trying to improve yourself or your life in any significant way?

I think there is a complacency trap here. If a struggling alcoholic can find stability in a program like MAPs, that is obviously a good thing. But if they get into a program like that and it robs them of any chance at personal growth or self improvement, is that really desirable?

In other words, would it be better to allow someone who might be a candidate for MAPs to fall even further in addiction, so that they may one day hit bottom and be truly ready for an abstinence based program?

I personally went to treatment 3 times. All 3 of these treatment centers were teaching an abstinence based approach to recovery. And so the first two rehabs I obviously failed at and I was not able to maintain abstinence. I could very easily have said “well, I guess I am just not cut out for abstinence based recovery, I may as well try something different.” But instead, I finally hit an even lower bottom and I became willing to give traditional treatment another chance. And this time, it worked. I was able to finally grasp the idea that chasing happiness in the short term and trying to medicate my way to happiness was not working for me.

I don’t believe that I would be living the same quality of life today if I had entered some sort of harm reduction program instead. Does that mean that everyone should avoid harm reduction? Not necessarily. But I think that we need to carefully consider the idea that such harm reduction programs might lead people into complacency as much as it “helps” them.

My hope for most people reading this is that they give abstinence based recovery a fair chance. I never thought that complete abstinence could work for me, but then I finally hit bottom, and the rest is history. My life is so much better today.