For the holidays, have a little...harm reduction?

As most Points readers are probably aware, “harm reduction” is the practice of implementing scientifically based measures for minimizing the negative health consequences associated with substance use. The philosophy is closely aligned with public health goals, and it’s often contrasted with drug control strategies that seek to prevent substance use entirely. An article in the journal Addiction traces the emergence of the concept to 1973, when the World Health Organization recommended harm reduction as an alternative to drug control strategies that focus on “the prevention of non-medical [substance] use per se.”

Points has noted elsewhere that the concept of harm reduction is most strongly associated with HIV prevention practices for injection drug users—specifically needle exchange or sterilization programs—and with medically supervised drug maintenance treatment for heroin addicts. Lately, though, corporate interests have joined public health advocates in promoting harm reduction for a variety of other substances. Want to drink? Just drink responsibly. Craving a smoke? Try nicotine gum or electronic cigarettes. High-fructose corn syrup? It’s just like sugar—fine in moderation.

There are even season-specific harm reduction initiatives, specially designed for the holiday excess that lasts from Black Friday until New Year’s Day. In selected areas across the country, if you get tipsy, AAA and Budweiser will transport you and your car home for free. E-cigarette manufacturers are offering Christmas specials.

This expansion of the harm reduction concept means that it is no longer designed to apply only to a narrow population of heroin users or confirmed “addicts.” Harm reduction, broadly conceived, raises age-old philosophical questions about what constitutes The Good Life and about the kinds of temperaments that are worth cultivating.

Thinking along these lines, best-selling author Gretchen Rubin divides the world into two groups: abstainers and moderators. In one of the most heated discussions on her self-help blog, Rubin explains that she is an “abstainer.” Without copping to the mildest addictive tendency, Rubin writes that she finds it easier to give up treats like sugar cookies and alcohol entirely than to indulge just once in a while. In contrast, “moderators” get grouchy if they make certain pleasures off-limits. They can indulge in their preferred substances occasionally without experiencing guilt, obsession, or escalating usage.

You might say that moderators are natural harm reductionists. They are the people who experience the benefits—health and otherwise—of moderation in all things. And often, they don’t understand why abstainers would find it more gratifying to give up simple pleasures.
Alcoholics Anonymous traditionalists are among the most articulate defenders of the abstemious approach. Here, from chapter 3 of the AA Big Book, is the archetypal alcoholic’s account of his attempts to adopt less harmful drinking habits:

Heaven knows, we have tried hard enough and long enough to drink like other people! Here are some of the methods we have tried: Drinking beer only, limiting the number of drinks, never drinking alone, never drinking in the morning, drinking only at home, never having it in the house, never drinking during business hours, drinking only at parties, switching from scotch to brandy, drinking only natural wines, agreeing to resign if ever drunk on the job, taking a trip, not taking a trip, swearing off forever (with and without a solemn oath), taking more physical exercise, reading inspirational books, going to health farms and sanitariums, accepting voluntary commitment to asylums—we could increase the list ad infinitum.

In addition to displaying teetotaler humor, this list of failed attempts to control a drinking habit suggests that strategies used to moderate alcohol consumption are tricks that inevitably lead down a slippery slope of alcoholism. But it also sounds an awful lot like the failed diet resolutions that about half of the population makes every New Year: Eating low-fat carbohydrates only, eating no carbohydrates, limiting the number of servings, limiting the size of portions, never eating out, eating only pre-packaged meals, never snacking during business hours, eating only organic foods, going vegan—we could increase the list ad infinitum.

Before and after the New Year, the market is filled with substitute substances and easy behavioral tips. A variety of industries employ the guise of moderation, using tag line variations on the adage that you can “have your cake and eat it too.”

Of course, unlike the harm reduction techniques promoted by public health professionals, these substitute substances and behavioral strategies aren’t based in science. They might even distort our collective perception of what moderation actually looks like. This suggests what AA’s founders intuitively knew: if you sell certain forms of harm reduction to abstainers, it will mainly make them crazy.

Whereas prohibitions were once driven by morality, today we live in a so-called risk society—in which we supposedly make calculated choices about our consumption and behavior based on projections about the likelihood that our habits could bring about harms or benefits. That enlightened freedom comes with a downside. The nostalgic idea that it was easier to live in a time when social roles and prohibitions were clear is supported by psychological research that suggests it’s less emotionally taxing to make one decision rather than a series of smaller deliberations.

“Life was so much easier when I knew which behaviors would lead to ruin.”

So, for the holidays, try a little harm reduction. But if that doesn’t work out, remember what the Victorians knew: abstention as its virtues, too.

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