‘Reduction’ philosophy fails to solve the problem

If you have followed this column the last three years, then you know my position on “harm reduction.” For those of you out there that know nothing of “harm reduction,” in a nutshell, it goes something like this. The treatment community in this area has appeared to have thrown “abstinence” out the window and adopted “harm reduction.”

Clients, in treatment, are now being told by counselors and rehabs that instead of using cocaine when they have a craving, that smoking a joint is permissible, because it is not as strong as the drug of choice. Furthermore, for alcoholics, instead of drinking 12 beers, cut down to six, and practice “controlled drinking.” All of this sounds like it is rational thinking in treatment: trust me, it isn’t.

Years ago controlled drinking and harm reduction were tried in treatment. They never worked and will not work in the present day. Why? Because of the pharmacology of alcohol and other drug addiction.

When someone, anyone, crosses over from abuse of alcohol and other drugs into dependence, allowing them to keep using simply keeps them sick. Treatment is designed to help clients get better and self- actualize and get on with their lives. I have no idea how using another drug besides one’s drug of choice gets someone better.

As one of my clients that has 12 years sober stated, “Man, I’d like to be getting treated today. I’m really joking because if I was craving cocaine, when I was smoking it, and some counselor told me I could smoke weed instead, it would only lead me back to the coke and my problems would begin all over again. The lecture that you gave us on a drug is a drug, is a drug, finally made sense to me, because I tried harm reduction and it’s a joke. As the Big Book says, ‘if given the opportunity, many will take the easier, softer way.’ “

These thinking patterns have repeated themselves over and over for those that got and stayed sober. Another client followed up with … “the great fear,” namely learning how to live without alcohol and other drugs. I say other drugs because alcohol is as much a drug as heroin, cocaine, meth, fentanyl and other drugs. About my first year writing this column, I wrote an article on “lab rats” and their addiction to alcohol. Rats, in and of themselves, will not drink alcohol. In the experiment I witnessed as a young counselor, these rats were put in a maze and allowed to go through the maze to a turning point.

On one side was food, and the other side, alcohol. Both sides had levers to be pressed for food and alcohol.

These rats were to travel down the maze and turn right to the food.

Ninety-eight percent of them did because as I stated, they have an aversion to alcohol. Then a certain segment of them were injected with “THIO’s” I won’t spell it, but simply put, the chemicals found in the brains of alcoholics and drug addicts when they die.

These cannot be tested for when they are alive. Thus, after injected, the rats would travel down the maze, stop, smell the alcohol and go left, away from the food. Now, if I hadn’t seen this, I would never have believed it. The rats would go to the lever that had the alcohol and start pressing it until they either passed out or died. In treatment we call this “loss of control.” The other rats would continue to go down the maze and continue to press the food lever without any problem.

I know what many of you who are into harm reduction would say, “rats are not humans.” They may not be, but the behaviors of loss of control are.

In studying the pharmacology of addiction, I’m all for medicating those that cannot stay abstinent and stay sober. Allowing clients to continue to use is ludicrous. If a client is on, say, suboxone, then the only drug he or she should test positive for is suboxone. We have clients testing positive for cocaine, meth, marijuana while taking suboxone. Tell me, what’s wrong with this picture?

I’ll give you a prime example. St. Michael’s Rehab, which is downstate near New York City, houses 100 men and 100 women. The main goal of their treatment is abstinence. Clients are tested weekly, some daily. If they are on suboxone or getting “the shot” that curbs cravings, and other drugs show up, they are asked to elevate their treatment or find another place to live. This may sound cruel, but professional “enabling” someone to stay sick is not a part of this program.

The waiting list for men and women who want this treatment is in the hundreds, with abstinence, self-help being the goal. Sponsorship, meetings (AA, NA), volunteer work are a must. Consequences for poor behavior are ever present. I have sent clients to St. Michael’s and they swear by it. So, I have asked myself, “what is OASAS thinking, (the Office of Alcohol and Substance Abuse), by sanctioning harm reduction instead of abstinence?”

The coin says “to thine own self be true.” I would not work in any rehab that sponsors harm reduction. To the young supervisors and counselors who feel they have found something, you haven’t. What you have done is thrown the baby out with the bath water. Good luck, you’re going to need it with this irrational-type thinking.

Mike Tramuta has been a counselor for more than 30 years. Call 983-1592 for more information.


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