Two Approaches to Harm Reduction: Goal-Setting and Meaning
Let me begin with a disclaimer: I lead a dull life. A 69-year-old, I live alone in a rear house in Park Slope. It is less than 350 sq. ft. I am not allowed to divulge the rent by the Brooklyn Chamber of Commerce. Let’s just say, in most places, my rent would easily pay off a six-figure mortgage in short order.
Occasionally, I run into interesting people by dint of my line of work: I am a pioneer in nondisease, harm-reduction approaches to addiction. So people who are active in the field, often pioneers themselves, will sometimes hang out with me for a few hours.
That has happened this week and last, when I spoke and broke bread with four great leaders in harm reduction: Ken Anderson, founder and director of HAMS (harm reduction for alcohol); Roy Baumeister, co-author (with John Tierney) of the best sellerWillpower; Effie Nulman, harm reduction therapist extraordinaire and chair of the Drug Policy Alliance’s Youth Advisory Committee (of which I’m a member); and Marc Lewis, author of the just-published best seller, The Biology of Desire: Why Addiction Is Not a Disease.
Roy Baumeister is a social psychological researcher, and addiction isn’t his field. But we share an interest in meaning. Roy has distinguished between meaning and pleasure as motivations; I am interested in meaning as an antidote and preventive for addiction. Roy suggested that, when I question people in workshops and speeches about having quit a smoking addiction, that I ask them to write down, first, what the meaning of their addiction was for them, and then what meaning recovery had to them.
I was having lunch with Roy in midtown Manhattan after meeting with Effie Nulman that morning in Riverdale, where he lives, to discuss writing a book together. That book is tentatively titled, How To Use Drugs. The book has the joint purpose of showing how people successfully regulate their drug use, and to describe how continued drug use can be effective therapy, either through substitution (e.g., marijuana for narcotics), or through safer or moderated use of drugs.
Effie has been a harm reduction therapist for decades. He wishes many people in the arts—some of whom he has worked with—were more open about their personal use of harm reduction, rather than 12 step and abstinence approaches.
This week, I had dinner with Ken Anderson and Marc Lewis on the same night. Unlike the previous week, when I traveled from here to eternity, both Ken and Marc came to Park Slope. Well, Ken lives in Park Slope. Marc was in New York on a media tour for his book.
Ken is considering starting a treatment program. Although he is studying for a PhD in psychology, he doesn’t view himself as a therapist. His program is one of goal-setting, counting drinks, planned intoxication episodes, and getting the AA bug out of people’s ears telling them that they are bad or wrong for pursuing drinking and intoxication. Despite his not claiming to do therapy, Ken helps people with his calm manner and wealth of information. I know—I refer black-out drinkers to Ken for information, which they always find helpful.
And last is the delightful Marc Lewis. Marc is likewise not a therapist by training. His degree is in developmental psychology, although he has been a neuroscientist for 20 years. For Marc, the brain is designed for change. The term “chronic brain disease,” we agreed, is an oxymoron.
But lately, Marc has been working with a few heroin addicts from his home in the Netherlands (he himself was a narcotics addict 30-some years ago). When I spoke of goal-setting to Marc, he shook his head, as though he were hearing a bad cliché. “My goal for people is that they be happy, whether that means using a substitute narcotic, like Suboxone, or reduced use.”
Which set me to thinking: Marc’s approach is the opposite of Ken’s. And, unlike my and Roy’s discussion, Marc was focusing on the feeling side, rather than the meaning side. Effie and Marc, on the other hand, share a similar approach—both are looking for people to be content with their lifestyles.
As I said, I’m a meaning person, as represented by my book with Ilse Thompson,Recover! Stop Thinking Like an Addict. I think I share this approach with Andrew Tatarsky. That is, the addiction both has meaning for the person, and meaning and values are a bulwark and a beacon for people out of addiction: “I want to be a better parent; I am violating my own values; I want the people I love to respect me.”
At the same time, I very much appreciate Ken’s insistence that people drive the AA voice out of their heads, which holds so many pitfalls in terms of perfectionism, guilt, and self-blame.
Of course, what makes Andrew and me—and Effie, Ken, Marc, and Roy—harm reductionists is that we are nonjudgmental about the approach to substance use pursued as a route to contentment or meaning. It is time for us to remove that chip from our brain as a culture.
Oh, did you hear that D.A.R.E. has come out for marijuana legalization? In an op-ed, a D.A.R.E. spokesperson said: “People like me, and other advocates of marijuana legalization, are not totally blind to the harms that drugs pose to children. We just happen to know that legalizing and regulating marijuana will actually make everyone safer.” So we are going to have to come up with something other than the idea that drug use is a disease.
Stanton Peele, Ph.D., is the author of Recover! Stop Thinking Like an Addict. He is the recipient of career achievement awards from the Center for Alcohol Studies and the Drug Policy Alliance. His Life Process Program for treating addiction is available online. He last wrote about why studies are showing that drinking problems are on the rise.
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