Harm Reduction – Can It Work?
There are various takes on harm reduction – both on what it means and on what success looks like.
For the purposes of this post, I am referring to harm reduction in terms of changing one’s drinking pattern and/or stopping drinking all together before they develop the chronic, often relapsing brain disease of addiction (in this case, an addiction to alcohol).
When Should a Person Consider Harm Reduction
The short answer, “When their drinking causes drinking behaviors.” Drinking behaviors are what a person does when the amount of alcohol they have consumed changes the way their brain works.
This change in brain functioning is because of the way the body processes alcohol. It takes about one hour for enzymes in the liver to metabolize the ethyl alcohol (chemical) in one standard drink. Thus, if a person drinks four drinks, it will take four hours for the alcohol to be fully metabolized. This means that until the ethyl alcohol is metabolized, the chemical is interrupting the chemical portion of the brain’s electrical-chemical signaling. The latter refers to the brain’s neural networks, aka neural transmissions; basically the way cells in the brain talk to one another and to and from those in the rest of the body via the nervous system. It is this electrical-chemical, cell-to-cell “talking” that controls everything a person thinks, feels, says and does.
Thus, alcohol “sitting” in the brain (and other body organs) waiting for its turn out the liver changes the chemical portion of normal neural transmissions and thus changes a person’s behaviors, causing drinking behaviors. These include: verbal, physical and emotional abuse; illogical, insane-making circular arguments; physical assault; driving while impaired; unplanned or unwanted sex and blackouts, to name a few.
And it is the drinking behaviors that cause secondhand drinking (SHD) impacts for the people on the receiving end. These SHD impacts include:
- Deeply hurt feelings, losing one’s self-esteem, walking on eggshells.
- Having to deal with the fall-out of someone driving while impaired, whether that is death or injury or ticketed DUI, for example.
- Recovering from a broken arm after a brutal beating or from a sexual assault.
- Developing depression or anxiety, feelings of hopelessness or helplessness.
- Taking medications for stomach ailments or sleep disorders.
- Unable to concentrate at work or in school.
- Losing friends, dreading social events, trying to keep track of a constant stream of white lies and cover-ups.
Assess Your Drinking Pattern
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has a Single Question Screen to assess “at-risk” drinking:
- How many times in the past year have you had 4 or more standard drinks in a day? (for women)
- How many times in a day have you had 5 or more standard drinks in a day? (for men)
- A standard drink is defined as: 5 ounces of wine, 12 ounces of regular beer, 1.5 ounces of 80-proof hard liquor, 8-9 ounces of lager beers/ale and 3.3 ounces of champagne. Often drinks served in bars and restaurants or at social events contain more than one standard drink.
An answer of once or more is considered “at-risk” drinking.
Common “at-risk” drinking patterns include:
- Binge Drinking – defined as having 4 or more standard drinks on an occasion for women and 5 or more for men.
- Heavy Social Drinking – defined as routinely having more than 1 standard drink a day for women or 2 standard drinks a day for men.
- Alcohol Abuse – defined as regular binge drinking and/or heavy social drinking.
By comparison, “low-risk” or “normal” drinking is defined as:
- For women: No more than 7 standard drinks in a week, with no more than 3 of those 7 in any one day.
- For men: No more than 14 standard drinks in a week, with no more than 4 of those 14 in any one day.
Harm Reduction – Can it Work?
One of the reasons a person loses control of their drinking and another person tolerates drinking behaviors (secondhand drinking) is the assumption that drinking is either “normal” or “alcoholic.” Determined “not to be an alcoholic,” an individual may continue their harmful drinking patterns and their loved ones continue to tolerate their drinking behaviors, simply because they don’t understand there are actually three stages of drinking: use, abuse and dependence.
To the question, “Can harm reduction work?” Yes, it can – meaning a person can reduce their drinking to fall within “low-risk” limits – IF they are NOT an alcoholic. If they are, it is imperative they stop all alcohol use entirely. Additionally, for some people, harm reduction means stopping drinking all together just because they don’t want to continue drinking given the way it leaves them feeling about their behaviors or their health.
To further assess your drinking pattern and find tips for cutting down – aka harm reduction – visit NIAAA’s Rethinking Drinking website for more information.
Bottom Line
Societally and individually, we would not tolerate drinking behaviors if a person were sober, yet for some reason, we excuse them “because they were drunk” or “they’d been drinking.” And it is in that excusing that we harm our own safety, health and well-being if we are the one coping with secondhand drinking, and if we are the person whose drinking is causing drinking behaviors, we not only harm those we love the most, we potentially cross the line from alcohol abuse to dependence.
So, if you see your drinking pattern in this post, give harm reduction a try. There is every reason in the world to reduce your drinking pattern to fall within “low-risk” limits – for yourself and for those you love.
For more information, please consider my short eBook, Crossing The Line From Alcohol Use to Abuse to Dependence.
Lisa Frederiksen
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