HAMS: Harm Reduction for Alcohol

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What Is HAMS?

HAMS is a program of personal empowerment to help you to beat any problems you have with alcohol or other substances. HAMS is peer-led and free-of-charge.

Can you change your drinking habits? HAMS says "Yes you can!"

Can you be a safer drinker? HAMS says "Yes you can!"

Can you cut back on drinking? HAMS says "Yes you can!"

Can you quit drinking? HAMS says "Yes you can!"

You can do any of these if you choose to.

What Does The Name HAMS Mean?

This is what the letters H A M S stand for:

H is for Harm Reduction - reducing the risks associated with your drinking

A is for Alcohol Abstinence - some people find that quitting drinking is their best choice because the costs of drinking outweigh the benefits of drinking

M is for Moderate Drinking - some people find that they can reduce their drinking to the HAMS moderate limits and eliminate all harms from alcohol in this way

S is for Support - HAMS support groups will support you in your choice of goal no matter which goal you choose

Who Decides What Your Drinking Goal Should Be?

You and only you can decide whether your best drinking goal is Harm Reduction, Alcohol Abstinence or Moderate Drinking. No one in the HAMS group will ever tell you what your goal ought to be. However, a live or online HAMS group can be an excellent place for you to "think out loud". Talking about the advantages and disadvantages of the various goals with the group can help you to decide which goal is best for you. Another tool which can help you to decide is a Cost/Benefit Analysis--a tool we will discuss in more detail in a later chapter.

Who Is HAMS For?

HAMS is for anyone who has ever had a problem with alcohol or another substance. Our greatest area of expertise is alcohol, but you are welcome no matter what your Drug of Choice is. And it does not matter how much or how little you drink, if you want to make a change in your habits then you are in the right place.

Does HAMS Require The Acceptance Of A "Higher Power"?

Absolutely not. There is not one shred of clinical evidence that people who believe in God are any less likely to have problems with alcohol than those who do not. If you find that your religious beliefs are a help in dealing with your alcohol problem then by all means use them as a source of strength. Likewise if your atheistic or agnostic beliefs are of help to you then by all means use them. HAMS encourages each and every member to find what helps them as an individual and use it.

What Is The Basic HAMS Process?

1) Make a plan and write it down

2) Track your use with a calendar

3) Review your progress (we suggest weekly)

4) Enjoy success - or - tweak the plan - or - change the plan

We discuss the basic process of HAMS in more detail in a later chapter.

What Does The Term "Harm Reduction" Mean?

Harm reduction is a pragmatic and compassionate philosophy which accepts the reality that people will always engage in high risk behaviors such as alcohol intoxication or drug use,

Alcohol harm reduction seeks to reduce the negative consequences of alcohol use and alcohol intoxication on both society and the individual drinker by informing individual drinkers about the differences between high risk drinking and low risk drinking as well as teaching them strategies to avoid drinking risks.

Alcohol harm reduction seeks to promote harm reduction by offering support and encouragement for every positive change in individual drinking behaviors.

Alcohol harm reduction recognizes that many people making a small but significant change in behavior can have a vastly greater effect in reducing harms to society than a small number of people making a very large individual change in behavior.

One very clear cut example of how this harm reduction works is the seatbelt law. It would be truly wonderful if we could make everyone in the world a perfect driver and eliminate all human error and all traffic accidents. But in the real world this is impossible. Even though most people are basically good and try to obey traffic laws most of the time there is still such a thing as human error and traffic accidents do happen. However, thanks to a little harm reduction device known as a seatbelt countless lives have been saved. HAMS is like seatbelts for alcohol.

Another very clear-cut example of harm reduction in action is needle exchange for IV drug users. Communities which have both needle exchange programs and abstinence based treatment programs have far lower rates of HIV transmission than those with abstinence based treatments alone. The very small behavioral change of using clean needles can have a major impact on a community.

Alcohol harm reduction always recognizes the dignity and fundamental worth of the individual. Alcohol harm reduction programs are democratic in nature with users having a say in the operation of the group and self-determination over their own drinking goals.

Alcohol harm reduction seeks to live in peaceful coexistence with abstinence-only based programs.

Alcohol harm reduction does not view alcohol use or alcohol intoxication as either morally wrong or the symptom of a disease. Alcohol harm reduction recognizes that some people choose to use alcohol or to become intoxicated for fun. Alcohol harm reduction recognizes that some people sre unwilling or unable to abstain. Alcohol harm reduction views the negative consequences as bad rather than the drinking of the intoxication itself.

Am I An Alcoholic?

At HAMS we have found that for people to label themselves as "alcoholics" is not only unhelpful, it is absolutely detrimental to making a positive change.

The simple truth is that you are what you believe. If you believe that it is possible for you to quit drinking then you will find it easy to quit. If you believe that you can control your drinking then you will do much better at controlling it than if you believe that you cannot.

However, if you believe that you are powerless and out of control then you will act powerless and out of control. If you believe that one drink means one drunk then it will become a self fulfilling prophecy.

The bottom line: Labeling yourself an "alcoholic" won't help you to practice safer drinking, to cut back, or to quit. So why lower your self esteem by calling yourself a bad name?

How Has The Concept Of "Alcoholism" Changed Since 1939?

When AA co-founder Bill Wilson described what an alcoholic was in AA's "Big Book" it is clear that he was describing people like himself. Bill W was like the Ray Milland character in the movie "Lost Weekend": every time he drank he drank compulsively and could not stop until he had full blown Delirium Tremens seeing snakes coming out of the walls and having seizures and serious blood pressure spikes which can lead to death. Moreover, Bill compulsively returned to drink in spite of these withdrawals. But how many people actually undergo this alcoholic pattern of drinking defined in the AA "Big Book"? According to the eMedicine web site 1 only about 0.3 % of the population undergo this kind of withdrawal.

However, according to the NIAAA 2 (National Institute on Alcohol Abuse and Alcoholism) 8.5% of the population now meet the criteria for Alcohol Abuse or Alcohol Dependence--i. e. "alcoholism". Moreover the NIAAA defines binge drinking (drinking more than five beers at a time) as a form of Alcohol Abuse, i. e. "alcoholism" 3 . According to the CDC (Centers for Disease Control and Prevention) over 30% of Americans have engaged in binge drinking as defined by the NIAAA 4 . Today one hundred times as many people are classifiable as "alcoholics" as were in 1939 when the "Big Book" was published. This is illustrated graphically in Figure 1.

alcoholics defined

Has the amount which Americans drink changed drastically in this time period? No it has not--it has remained around 2 to 2.5 gallons per capita from 1860 to the present. (Appendix 1 discusses alcohol consumption per capita from 1860 to the present in some detail.) The actual fact is that drinking per capita has been dropping the last couple of decades. What has changed drastically is not the amount that Americans drink, what has changed is how Americans--particularly Americans connected with the alcohol treatment industry--view drinking and drinkers.

When Is A Behavior A Disease?

In the United States a behavior is a disease if the majority of members of the APA (American Psychiatric Association) vote that it is a disease. A behavior is not a disease if the majority of the APA vote that it is not a disease. It is as simple as that�no scientific criteria involved. The official listing of behavioral diseases in the US is contained in a book called the DSM (Diagnostic and Statistical Manual of Mental Disorders) The current edition of this is the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). The fact that a majority vote decides whether or not a behavior is classified as a disease can lead to some interesting situations.

The first edition of the DSM was published in the 1950s. In the 1950s in the US homosexuality was considered highly immoral and the APA chose to list it as a disease in the DSM. Whether this was considered a means of destigmatizing homosexuality or not I do not know--however, in reality labeling a behavior a disease does not destigmatize it but in fact increases the stigma. The result was that countless homosexuals were brought into treatment against their will to change their sexual orientation. It was also the case in the 1950s that heavy drinking was a behavior considered well within the norm. Mental health professionals only judged those who suffered from full-blown, snakes-in-the-walls Delirium Tremens to be alcoholics. The NIAAA (National Institute on Alcohol Abuse and Alcoholism) would not be created until 1970 5 .

In 1973 the APA voted that homosexuality was no longer a disease, instead it was just an alternate lifestyle. Boom just like that it is no longer a mental illness.

The 1970s, 80s, and 90s also saw the rise of a new Puritanism which was dead set and determined to stigmatize recreational intoxication. Today anyone who chooses to engage in recreational alcohol intoxication is at risk for being labeled diseased and having the big red letter A for alcoholic stamped on their forehead to stigmatize them for the rest of their lives.

We at HAMS disagree with this. We do not judge homosexuality, recreational intoxication, or other high risk behaviors to be either diseased behaviors or immoral behaviors. We recognize these as lifestyle choices and we encourage everyone who engages in a high risk behavior to practice good harm reduction whether that behavior is homosexuality, recreational intoxication, or skydiving

What Is "Maturing Out?

Stanton Peele 6 points out that as people become older and more socially stabilized the majority either curtail their high risk behaviors or eliminate them entirely. This phenomenon is referred to as "maturing out". HAMS believes that with appropriate information and support groups even more people can mature out of high risk behaviors at even earlier ages.

Isn't "Alcoholism" A Progressive Disease?

No, no, no, no, and no. As we saw above the vast majority of people who are currently classifiable as "alcoholic" because of their binge drinking or because of DSM-IV-TR criteria actually mature out of these behaviors on their own. Only one in a hundred binge drinkers ever progress into full-blown, snakes-in-the-wall, life-threatening withdrawals.

Isn't 12 Step Treatment Harmless At Worst And Beneficial At Best?

Many people have reported that their drinking or drug use became worse after attending AA or a 12 step treatment program. AA may be good for some people, but there are some people who are definitely allergic to AA.

Aren't Abstinence Programs Superior To Harm Reduction Programs Because They Eliminate Harm?

This would be true if abstinence based programs were 100% successful, however they are not. The problem with abstinence based programs is that all too often they backfire and lead to drinking behaviors which are far worse than they were when the person first entered treatment. If you or a loved one are succeeding with an abstinence based treatment then by all means go for it--we have no wish to dissuade you from what is working. However, if it stops working for you then please remember that harm reduction is always here as a safety net.

How Is HAMS Alcohol Abstinence Different From AA Alcohol Abstinence?

12 step programs teach people that alcohol is "cunning, baffling, and powerful" and that they are powerless and that their only hope is to be rescued by a "Higher Power" such as God or an AA group. Each day is only a daily reprieve from Hell.

Alcohol Abstinence in HAMS rests on doing a cost/benefit analysis and coming to decide that not drinking is better than drinking. We teach our members that they are powerful because they are human and that alcohol is powerless because it is an inanimate object. Our members kick alcohol like they would kick any bad habit and instead of forever teetering on the brink of Hell, after about a year they just forget about the fact that they ever had a bad habit. The thought of drinking no longer comes to mind.

Isn't Alcoholism Genetic?

The relationship between alcohol use and genetics is by no means so simple and clear-cut as the relationship between genetics and the color of Mendel's peas. We will devote an entire chapter to this topic later in the book--for now we will just take a quick glance at it.

Briefly put, it appears that there are dozens of genes which can have an influence on whether one chooses to be a heavy drinker or an abstainer. One thing we know for sure--there is NOT and "alcoholism" gene. What this means is that the trait of heavy drinking is totally unlike the trait of color in Mendel's peas. With Mendel's peas exactly one gene controls the color. With the trait of heavy drinking it appears that there are dozens of genes involved.

The good news is that no one is genetically foredoomed to themselves to death. We all have the power to choose to drink in a better way of to quit.

Is There Such A Thing As An Alcoholic Personality?

No. We will discuss this in more detail in a later chapter.

Should I Tell My Doctor That I am Having Problem With Alcohol?

This is a difficult question with no simple answer. On the one hand your doctor can help you with medications to help ease withdrawal symptoms as well as medications to help you cut back on drinking or abstain. On the other hand if your doctor puts a diagnosis of Alcohol Dependence in your chart this can prevent you from getting health insurance and even from getting a job. Moreover some doctors might refuse you medical treatment unless you agree to get involved with a 12 step program. And there are ways for you to taper off alcohol on your own as we discuss in a later chapter. So you will have to decide for yourself whether it is to your advantage to tell your doctor or not.



1 Delirium Tremens: Overview - eMedicine

2 NIAAA - Five Year Strategic Plan Introduction

3 NIAAA Newsletter WINTER 2004 Number 3

4 Health Behaviors of Adults: United States, 1999�2001

5 Important Events in NIAAA History

6 Peele, Stanton (1999, 1995). Diseasing of America : how we allowed recovery zealots and the treatment industry to convince us we are out of control. San Francisco : Jossey-Bass,.

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