Alcohol Harm Reduction Defined
HAMS defines Harm Reduction for people who use alcohol as follows:
Anyone who works to drink more safely is said to be practicing Harm Reduction even if they do not choose to reduce the amount which they are drinking.
Anyone who works to reduce the amount they are drinking by any amount is also said to be practicing Harm Reduction.
The term Harm Reduction can be used in either a broad or a narrow sense. In the broad sense of the word, Harm Reduction includes every strategy which helps to reduce harm including abstinence. Harm reductionists are always supportive of successful abstinence as a means of eliminating harm. However, harm reductionists are also realistic and pragmatic and realize that the attempt to force abstinence on everyone against their wills generally backfires and actually leads to an increase in alcohol related harms overall. Likewise, an attempt to eliminate all alcohol related harm by forcing perfect moderation on everyone will backfire and lead to an increase in alcohol related harms overall. The most effective strategy is to meet people where they are at and work with individuals on goals which they choose for themselves which can range from safer drinking to reduced drinking to quitting altogether. In the narrow sense of the word those who seek to eliminate all harm by pursuing perfect moderation or perfect abstinence may be said to be pursuing a goal of Harm Elimination rather than Harm Reduction . Harm Elimination is not for everyone.
HAMS views Harm Reduction as a hierarchy; it is more important to reduce immediate harms than eventual harms, and it is more important to reduce major harms than minor harms.
HAMS encourages members to concentrate on eliminating severe high risk behaviors such as drunk driving before worrying about lower risk behaviors such as drunk dialing acquaintances.
However--anyone desiring to make any positive change is welcome at HAMS. Motivational Interviewing is a technique which HAMS members may use to help newcomers understand the importance of the hierarchy of Harm Reduction.
Harm Reduction As A Goal
Some people may use harm reduction as a means to an end goal of abstinence or moderation. Some may choose harm reduction as a lifetime goal in and of itself. HAMS supports each individual in their chosen goal and makes no judgment as to whether one goal is more legitimate than another. All behaviors have positive as well as negative payoffs: only the individual can judge which behavior is best for him/herself. HAMS merely encourages you to THINK.
Alcohol Harm Reduction Strategies
1) Safe Drinking--Plan Your Intox Day
If you plan to get intoxicated on a given day take all necessary steps to insure that you do not harm yourself or others. Planning ahead can save lives.
1.1) Driving, phoning, etc.
If you habitually want to drive after you start drinking just make sure that this is impossible before taking the first drink. Give your car keys to a spouse or trusted friend before ever taking the first drink. Or somehow lock them away in such a manner that it is impossible to get at them until after you are sober. Do it before the first drink. If you are drinking outside the home then make sure to take public transportation there so that your car is not available to drive home with.
If you have a tendency to make embarrassing or problematic phone calls after you have started drinking, then make sure to unplug and lock away your telephone before you ever take the first drink. The same if you send weird emails when intoxicated--turn that computer off and hide it away first. Try to find a non-problematic habit such as listening to music while drinking to distract you from those things which might cause yourself or another person harm.
If there are any things which you tend to do which cause harm when you are intoxicated--make them impossible to do before you begin drinking.
1.2) Drinking At Home
The statement that "drinking alone is a sign of alcoholism" is a myth--because "alcoholism" is a myth. Drinking alone at home can be much safer than going out and drinking in public if your intent is to get intoxicated. If you are alone there is no one else to worry about getting into a fight with. Moreover, there are no worries about getting lost on the way home or getting rolled or attacked or being tempted to drive. Drinking constantly whether alone or in company can be problematic because it can lead to physical dependency, but for some people drinking alone can be smarter than getting intoxicated in public.
1.3) Go Out With A Friend
Going out drinking with a friend who you can trust to watch your back is safer than going out drinking alone. The back watching can and should be mutual. However, beware of companions who will egg you on into crazy behaviors. Not only can you help keep each other awake on the subway ride home--predators who prey on drunks are more likely to go for people who are alone.
1.4) Carry Condoms
Male or female, straight or gay, ALWAYS carry condoms when you go out drinking. It is a good habit to always carry condoms period, whether drinking or not. When people drink their inhibitions are lowered, and people who would never have sex with a stranger when sober may suddenly decide that this is a good idea when drunk. So have a condom handy and use it.
As Alan Marlatt tells us, mindset is of major importance to one's behavior when drinking. Go into your intox day with plenty of planning ahead and a determination to be safe and this will help you go far towards reducing harm.
1.6) RU21, etc
Some supplements such as RU21 claim to reduce the negative impact of the byproducts of alcohol metabolism. These may be worth taking as they may limit the amount of damage done to your organs by heavy drinking, and may also help to ameliorate your morning after effects.
1.7) Take Your Vitamins
Alcohol causes vitamin loss. Replace them and safeguard your health.
1.8) Avoid Impulse Drinking
Drinking in reaction to anger is particularly likely to lead to a bad drinking episode. Unplanned drinking episodes are also fraught with danger.
2) Reduced Drinking--Count and Schedule
2.1) You Have To Start Somewhere
If your goal is reduced drinking then you have to start somewhere. If you have drank daily for a long time you may wish to start by doing just one abstinence day. Note: If you have been drinking heavily for a long time you may need to taper off gradually to get to the first abstinence day in order to avoid potentially dangerous withdrawals.The first day of abs in a long time with none is always a great achievement. One is better than none, and better is always better. Going from drinking 14 drinks a day to 13 drinks a day is also an improvement. Better is better. Switching from drinking straight booze to beer or wine is also better. Remember that you have to start somewhere and no change is too small to count. And any change for the better no matter how small is your first victory!
2.2) Add Abstinence Days
If you have done a few abstinence days then your abstinence muscle is getting strong--it is time to start scheduling abstinence days. Daily drinkers who want to reduce use should start by scheduling at least one abstinence day per week--although there is no limit on the amount you may start scheduling. You may choose to jump right in and schedule six abstinence days a week--or you may want to jump right into an abstinence period of 2 weeks or 30 days or even more. You know better than anyone else what you are ready for and what you want to do.
2.3) Schedule your intox days
Schedule your intox days so that they do not interfere with important things like work or school.
2.4 Choose Your Harm Reduction Plan
Choose which and how many days each week you wish to abstain (try for at least one--although more is generally better). Choose which and how many days each week you wish to drink moderately (this may be zero if you don't like moderating). Choose which and how many days you wish to get intoxicated. This is the skeleton of the Harm Reduction Plan. Flesh this out by deciding where and under what circumstances you will do mods, abs, or intox--and you have a full fledged harm reduction plan.
2.5) Buy Only When You Drink
This strategy is not for everyone, but some people who primarily drink at home choose not to have alcohol in their house on abstinence days--they buy it only on the days when they intend to drink. Some people with blue laws in their states even use Sunday--the day on which booze is not sold--as their sober up day--on purpose.
2.6 Avoiding The Eye-Opener
If you sometimes tend to drink the morning after then it is good to have a plan to avoid the eye-opener. One thing which can help is to buy only what you intend to drink and finish it that same night--it may be too much effort to go out and get more the next day then.
2.7 Reduce Daily Intake
Instead of reducing the number of days you drink per week (or month) you may choose to reduce the number of drinks you drink per day. Or you may choose to do both.
3) Avoiding Blackouts
Blackouts are no fun. People's behavior often changes for the worse during a black out and the do things which fill the with remorse when they are told of them the following day. However, most people can avoid blackouts by using the following tips.
3.1 Eat Before Drinking And Be Well Hydrated
If your stomach is full alcohol will enter your bloodstream much more slowly than if you drink on an empty stomach. Being well hydrated before you drink alcohol will help you to drink more slowly. Blackouts are caused by a rapid peaking of Blood Alcohol Concentration (BAC). Both these strategies will help prevent this rapid peak. The reasons why they work are given in detail in the section on moderation.
3.2 Slow The Pace
Slow the pace of your drinking by switching from straight booze to wine or beer or by alternating real drinks with non alcoholic drinks. This helps stop blackouts.
3.3 Beware Sleep Deprivation
If you drink when suffering sleep deprivation you are much more likely to have a blackout than otherwise.
4) Rank The Potential Harms
Things which may immediately kill yourself or someone else rank as such as drunk driving or drunk chainsaw juggling rank as MORE harmful than things which may eventually have a bad effect down the line such as bone loss from failure to take your vitamins. When you are sober stop and take the time to rank which of your drinking behaviors have the greatest potential harm to yourself or someone else and make it a priority to eliminate those FIRST.