ŷ������

I found this book very wordy and detailed - and for that reason sometimes quite boring, but on the other hand I'm extremely glad I read it. Its repetitive nature helped drum into me the rather counter-intuitive idea of harm reduction.

The authors are associated with one of the few places in America, which does therapy based on harm reduction instead of full abstinence (although that is sometimes suggested as a solution too.)

They say that problems with drugs develop from three scenarios.
1. A person's unique interaction between the drug and its compelling qualities. Person A may find drug X hugely more attractive than Person B, and their propensity to end up having a problematic relationship with it might therefore be that much stronger.
2. A person's unique needs and characteristics - eg one person may be infinitely more prone to anxiety than the next person, and will therefore find a calming and soothing drug that much more attractive than someone who doesn't suffer with anxiety.
3. The environment, with its combination of stressors and sources of supports. Obviously someone in a happy relationship, with a supportive family and a satisfying job is going to find drugs less attractive than someone whose life is full of loneliness, insecurity and stress.

I think a lot of recovery organisations treat their participants with a sort of one size fits all recipe for recovery. 'Whatever your problems, come into our organisation, follow our tools and ideas, and we will transform you into someone who leads a better, (abstinent) life."

This approach with harm reduction is the opposite - it goes into the minutiae of each person's life, and works with someone's specific personality and situation. It also has a much more generous attitude towards moderating (harm reduction), than do most of the traditional recovery approaches.

I found the life stories given in the book (an amalgamation of various clients' experiences) to be particularly interesting. One woman is shown to have stopped taking heroin, and she now just uses weed at weekends, to allow herself to relax. That is seen as a good example of harm reduction working well.

The book also give a chart listing a continuum of alcohol and drug use. No use...Experimentation....Occasional.....Regular.. ..Heavy.....Abuse.. ..Dependence... ...Chaos. If you are dependent on a drug you will probably need medical supervision to help you slowly taper off. At least 50% of heavy drug or alcohol users "mature out" of their using as they grow up, without any outside help. If you're a chaotic user it may well be that you do have to practise abstinence with that particular drug, although you may be able to continue with one or two other substances that don't affect you so badly.

This book sees little difference between legal and illegal drugs - it's well known that cigarettes cause great physical harm and alcohol can be abused in ways similar to the abuse of many illegal drugs. (This is not the same as saying that all drugs should be available without restriction.)

Time and time again, the book returns to the needs of each specific person, as they work towards leading their best possible life. It also emphasises the success of harm reduction - which something we seldom hear about in our society. For people who have had a problematic relationship with drugs or alcohol, most of us have been brought up with the idea of addiction versus total abstinence. However there are now various organisations showing an increasing interest in the idea of harm reduction.

I've had both in my life. I gave up smoking some years ago, and I'm convinced that complete abstinence was necessary (and still is), in order for me to do that. On the other hand I've had eating disorder issues which I stopped five years ago. Obviously I haven't been able to stop eating, instead, by using various strategies, I practise harm reduction - and the results have affected my quality of life immeasurably. The book has also made me think about other areas in my life where I might practise harm reduction. I could develop strategies for less screen time for instance....

All in all I found this book an eye-opening and useful read.