Harm Reduction

Alcoholics Anonymous World Services (1990) “Comments On AA Triennial Surveys” Alcoholics Anonymous World Services (internal document). Brandsma, JM, Maultsby, MC, & Welsh, RJ. (1980) Outpatient treatment of alcoholism: A review.

HAMS Wholeheartedly Endorses Moderation Management Alternatives To Alcoholics Anonymous

When the vast majority of Americans hear the words “drinking problem” the first and only thought which pops into their minds is AA. Whereas it is true that AA has helped a large number of people become abstinent from alcohol, it has also become quite clear that AA is not a good fit for all problem drinkers. Brandsma (1980) has reported that forced AA attendance leads to increased binge drinking in a sample population. AA’s own “Triennial Surveys” (1990) report that only 5% of new AA members are still attending meetings at the end of one year. This number may be too low due to people moving to new cities, etc., but it is still suggestive that many new AA members soon leave. Moreover many people find that AA’s insistence on powerlessness, the surrender to a “Higher Power”, and the spiritual aspects of AA are offensive to their personal religious views.

Fortunately in the past three decades many alternatives to AA have sprung up which have proven helpful for those who were unhelped by AA. This article gives a brief summary of these alternative programs. None of them require a sponsor or a Higher Power or Twelve Steps.

HAMS

HAMS (Harm reduction, Abstinence and Moderation Support) was founded in 2007 to support any positive change individuals make in their drinking habits–including safer drinking, reduced drinking, or abstinence from alcohol. HAMS welcomes all drinkers who wish to make a positive change regardless of how much or how little they may drink.

The HAMS program is based on 14 elements. These are not steps. All the elements are optional and may be done in any order. The 14 elements of HAMS:

Hang out and interact with other Hamsters.
Deprogram from the disease model.
Track your use.
Take steps to reduce harm.
Take steps to reduce use.
Do a Cost/Benefit Analysis.
Choose/create your plan.
Address any issues which led to overdrinking.
Honestly report your progress/struggles.
Learn to have fun without booze.
Learn to cope without booze.
Praise yourself for every success!!
Tweak the plan.
Don’t be afraid to get back on the horse.
HAMS offers live support groups for its members as well as online support via and email group and a chat room.

HAMS is modeled on harm reduction programs for injection drug users which have had much success in curbing the harms of injection drug use. HAMS believes that alcohol is a drug and that strategies which work for other drugs will work for alcohol as well. HAMS encourages members to prioritize goals and to eliminate high risk behaviors first. HAMS is pragmatic in accepting that alcohol intoxication is a fact. HAMS is nonjudgmental in that it believes that safe intoxication is better than unsafe intoxication. HAMS members who choose abstinence do so because they feel empowered rather than powerless.

HAMS is based on research by Alan Marlatt (2002), the Open Society Institute (2004), and others which has demonstrated the efficacy of harm reduction approaches.

HAMS is organized around democratic principles–all members have a say in the governance of the organization.

HAMS has not as yet published a book–all the information about the HAMS program is available on the HAMS web site. HAMS recommends Patt Denning’s book Over The Influence.

HAMS rejects the disease model of addiction.

For more information visit the HAMS web site at http://hamsnetwork.org

MWO

My Way Out (MWO) was founded in 2005 by Roberta Jewell (pseudonym). MWO offers a great deal of information about medications, dietary supplements, hypnosis, relaxation CDs and more to fight alcohol. MWO supports both goals of abstinence and moderate drinking. Ms. Jewell bases the MWO program on her own experiences with the medication Topamax (Topiramate) which has been shown in clinical trials to be very helpful in reducing cravings for alcohol.

MWO offers online support via a forum and a chat room.

The MWO handbook is My Way Out by Roberta Jewell.

For more information visit the MWO web site at http://www.mywayout.org

MM

Moderation Management (MM) was founded in 1993 as a support group for people who wish to pursue moderate drinking as a goal. The MM handbook Moderate Drinking was published in 1994. MM sets moderate drinking limits of no more than 14 standard drinks per week and no more than 4 per day for men and no more than 9 per week and 3 per day for women. A standard drink is defined as a drink containing 0.6 oz of ethyl alcohol.

The MM program is based in its Nine Steps Toward Moderation and Positive Lifestyle Changes:

Attend meetings or on-line groups and learn about the program of Moderation Management.
Abstain from alcoholic beverages for 30 days and complete steps three through six during this time.
Examine how drinking has affected your life.
Write down your life priorities.
Take a look at how much, how often, and under what circumstances you had been drinking.
Learn the MM guidelines and limits for moderate drinking.
Set moderate drinking limits and start weekly “small steps” toward balance and moderation in other areas of your life.
Review your progress and update your goals.
Continue to make positive lifestyle changes and attend meetings whenever you need ongoing support or would like to help newcomers.
MM offers live support groups for its members as well as online support via and email group and a chat room.

MM strongly suggests that persons who fail to remain within moderate drinking limits, who do not complete a 30 day abstinence or who score 20 points or more on The Short Alcohol Dependence Data Questionnaire (which can be found on the MM web site) leave MM and pursue an abstinence based program instead.

MM is based on research by Mark and Linda Sobell (1973, 1978), Martha Sanchez-Craig (1995) and others which demonstrated that people who did not have severe alcohol problems could be taught moderate drinking skills.

The book Responsible Drinking (2002) has supplanted the book Moderate Drinking (1994) as the MM handbook.

MM accepts the disease model of addiction for alcoholics but not for problem drinkers.

For more information visit the MM web site at http://moderation.org

WFS

WFS (Women For Sobriety) is an abstinence-based program founded in 1976 by Jean Kirkpatrick. Ms. Kirkpatrick felt that the AA tactic of “breaking down big egos” was harmful rather than helpful to women. WFS assumes that women drink because they are disempowered and offers a program to empower women and make them strong enough to quit drinking.

WFS is based in the 13 Affirmations of the New Life Acceptance Program:

I have a life-threatening problem that once had me. I now take charge of my life. I accept the responsibility.
Negative thoughts destroy only myself. My first conscious act must be to remove negativity from my life.
Happiness is a habit I will develop. Happiness is created, not waited for.
Problems bother me only to the degree I permit them to. I now better understand my problems and do not permit problems to overwhelm me.
I am what I think. I am a capable, competent, caring, compassionate woman.
Life can be ordinary or it can be great. Greatness is mine by a conscious effort.
Love can change the course of my world. Caring becomes all important.
The fundamental object of life is emotional and spiritual growth. Daily I put my life into a proper order, knowing which are the priorities.
The past is gone forever. No longer will I be victimized by the past, I am a new person.
1All love given returns. I will learn to know that others love me.
Enthusiasm is my daily exercise. I treasure all moments of my new life.
I am a competent woman and have much to give life. This is what I am and I shall know it always.
I am responsible for myself and for my actions. I am in charge of my mind, my thoughts, and my life.
WFS offers both live meetings and online support via a forum and a chat room.

WFS accepts the disease model of addiction.

For more information visit the WFS web site at http://www.womenforsobriety.org

RR

RR (Rational Recovery) is an abstinence program which takes the stance that all individuals are capable of self-recovery–no support groups, treatment centers or therapists are necessary to overcome an addiction. All that is required is a mastery of AVRT (Addictive Voice Recognition Technique). A complete course in AVRT is available free-of-charge on the RR web site. More detailed descriptions of AVRT are available in books published by RR. RR claims that groups are not only unnecessary, but that groups are detrimental and become an addiction in and of themselves. RR has taken this stance since 1994.

RR was founded by Jack Trimpey in 1986. Between 1986 and 1994 RR operated support groups which in 1994 became the basis for SMART Recovery. During this period the RR handbook was The Small Book. In 1994 Trimpey announced that the discovery of AVRT had made support groups obsolete. SMART and RR went their separate ways.

RR offers a complete AVRT course online for free, books and DVDs on AVRT, and seminars on AVRT for which there is a charge.

The core of AVRT is identifying any desire for drugs or alcohol as outside the self. All desires for abstinence are identified with the self. AVRT says “I want to abstain, IT wants me to drink.” Anecdotal evidence from AVRT users suggests that it is highly effective for a number of people.

RR rejects the disease model of addiction.

For more information visit the RR web site at http://rational.org

SMART Recovery

SMART (Self Management And Recovery Training) is an abstinence program which teaches members how to use techniques from RET (Rational Emotive Therapy) and CBT (Cognitive Behavioral Therapy) to deal with their urges to drink or drug. SMART meetings are free of charge–but they are led by a trained facilitator rather than a pure layman. SMART concentrates at working on feelings underlying the urge to use.

SMART offers both live meetings and online support via a forum and a chat room.

SMART is an offshoot of RR which became an independent entity in 1994 as detailed above.

SMART concentrates on teaching its members The ABC Model developed by Albert Ellis as the basis of Rational Emotive Behavioral Therapy (REBT or RET).

The ABC Model is a refinement of the Stimulus Response Model. Ellis says that C, the Consequent Reaction (i.e Response) to A, and Activating Event (i.e. Stimulus) is mediated by B, the Belief System of the individual. When one changes one’s Beliefs about the Activating Event then one also changes one’s Consequent Reactions to the event. The ABC model is all about disputing Irrational Beliefs and replacing them with Rational Beliefs.

As a very simple example, if one has a bad day at work (A: Activating Event) one may believe that life is awful and that one might as well kill oneself (N: Beliefs) and one will have thoughts of suicide (C: Consequent Reaction). REBT teaches people to dispute the Irrational Belief and replace it with a Rational Belief such as “Today may have been hard, but tomorrow is a new day and I can start fresh”. When Beliefs are changed so are Consequent Reactions.

SMART rejects the disease model of addiction.

For more information visit the SMART web site at http://www.smartrecovery.org

SOS

SOS (Secular Organizations for Sobriety - Save Our Selves) got its start when Jim Christopher published and article titled “Sobriety Without Superstition” in Free Inquiry magazine in 1985. Christopher had given up alcohol with no help from a “Higher Power” and felt that others could do the same. SOS was formally incorporated as a nonprofit in 1990.

SOS meetings have no steps and no “Higher Powers”. The basis of SOS is the Sobriety Priority–the idea that abstinence from alcohol is the most important thing in life since if one fails to abstain one can accomplish nothing else. Members of SOS share tools for maintaining sobriety and mutual support at meetings. The following is an excerpt from Your Sobriety Toolkit, a brochure published by SOS:

No matter what - there is no valid reason on earth to drink again.
Here’s sobriety - there’s everything else - separate and prioritize sobriety.
Seriousness - this is nothing less than life or death.
Determination - there is no turning back, especially if it gets rough. You’ve gotten another chance at life. How many really have that chance? Sobriety doesn’t fix everything, but it makes it possible.
Information - retrain your brain; stimulate it with things related to alcoholism: books, audiotapes, videotapes, movies, pamphlets, brochures, meetings, plays, television and radio, newspapers and magazine articles, etc.
People - human contact is powerful. Try to meet people, at least one, and be sure to meet other alcoholics. Interaction fights the old patterns of isolation.
Honesty - this is the time to get things into the open. Get rid of the shadows and darknesses of the past. Put light on the dark things and they lose their power. Things can be dealt with reasonably when they’re seen as they truly are.
Listening - especially to people with long-term sobriety.
Take notes - anytime; but especially in early sobriety when memory can be tricky.
Meetings - be with people who want better lives and are taking actions to get what they want. Meetings are a good place to establish or re-establish social skills in a supportive environment. There is a lot to learn and feel in a meeting. You are not alone. You have not done the worst or been the most; there are always those who have ‘bettered’ you. Think about what you hear and see, but better yet is to feel what you hear and see at meetings.
SOS offers support via live meetings and an email group.

SOS accepts the disease model of addiction.

For more information visit the SOS web site at http://www.cfiwest.org/sos/index.htm

LifeRing

LifeRing split from SOS in 1997, was formally incorporated as a nonprofit in 1999, and adopted democratic bylaws in 2001. The clearest difference between LifeRing and SOS is organizational structure–SOS is hierarchically organized like a typical corporation whereas LifeRing is organized on the principles of democratic governance. LifeRing also differs from SOS in that SOS encourages abstinence from all mood altering substances whereas LifeRing only encourages abstinence from substances to which individuals are addicted. The LifeRing handbook is titled Recovery By Choice. The following is an excerpt from the LifeRing Sobriety Toolbox:

Change your self-image to a non-drinker/user. While this is much easier said than done, consider the benefits once it’s achieved.

1) You don’t feel sorry for yourself because you can’t drink or use because you don’t want to.

2) You aren’t jealous of people who do drink or use because that’s not you anymore.

3) You won’t relapse because, eventually, you won’t even get the urge.

4) You don’t have to attend endless meetings to stay clean and sober.

5) You don’t have to worry about never being able to drink or use again because you don’t want to anymore.

6) You avoid all the baggage associated with “alcoholic” (whatever that means) because you are a “non-drinker”.

How to get there:

The mind is a powerful thing controlling all our behavior. Consciously, or subconsciously, we all act on or reflect our self-image. Consider the come-from-behind victories won by Joe Montana and Michael Jordan. They knew they were going to win, their teammates knew they were going to win, and, I’ll bet, even their opponents knew they were going to win. Positive thinking brings positive results.

LifeRing offers support via live meetings, an online forum and a chat room.

LifeRing accepts the disease model of addiction.

For more information visit the LifeRing web site at http://unhooked.com

References:

Alcoholics Anonymous World Services (1990) “Comments On A.A. Triennial Surveys” Alcoholics Anonymous World Services (internal document)

Brandsma, J.M., Maultsby, M.C., & Welsh, R.J.. (1980) Outpatient treatment of alcoholism: A review and comparative study. Baltimore: University Park Press.

Christopher, James (1989) Unhooked : Staying Sober And Drug-Free. Prometheus Books.

Denning, Patt (2003) Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol. The Guilford Press.

Jewell, Roberta (2005) My Way Out: One Woman’s Remarkable Journey in Overcoming Her Drinking Problem and How Her Innovative Program Can Help You or Someone You Love. Capalo Press.

Kirkpatrick, Jean (1978) Turnabout: Help for a New Life. DoubleDay.

Kirkpatrick, Jean (1986) Goodbye Hangovers, Hello Life : Self-Help For Women. Ballantine.

Kishline, Audrey (1994) Moderate Drinking: The New Option for Problem Drinkers, See Sharp Press.

Marlatt, Alan (Editor) (2002) Harm Reduction: Pragmatic Strategies for Managing High-Risk Behaviors. The Guilford Press.

Nicolaus, Martin (2006) Recovery By Choice, Living and Enjoying Life Free of Alcohol and Drugs. A Workbook. third printing LifeRing Press.

OSI (2004) Evidence for Harm Reduction. Open Society Institute.

Rotgers, Frederic, et al (2002) Responsible Drinking: A Moderation Management Approach for Problem Drinkers, New Harbinger Publications.

Sanchez-Craig, Martha (1995) Empirically Based Guidelines for Moderate Drinking: 1-Year Results from Three Studies with Problem Drinkers American Journal of Public Health, Vol. 85, No. 6

Sobell, M.B. & Sobell, L.C. (1973). Alcoholics treated by individualized behavior therapy: One year treatment outcomes. Behavior Research and Therapy, 11, 599-618.

Sobell, M.B. & Sobell, L.C. (1978). Behavioral treatment of alcohol problems: Individualized therapy and controlled drinking. Plenum Press.

Steinberger, Henry (Editor) (2004) Smart Recovery Handbook. SMART Recovery, Inc.

Trimpey, Jack (1989) Rational recovery from alcoholism. Lotus Press.

Trimpey, Jack (1992) The Small Book (Rational Recovery Systems) (Revised), Delacorte Press.

Trimpey, Jack (1994) The Final Fix For Alcohol And Drug Addiction: AVRT, Addictive Voice Recognition Technique. Lotus Press.

Trimpey, Jack (1996) Rational Recovery: The New Cure for Substance Addiction. Pocket.


© Alcoholics Anonymous World Services (1990)


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