Harm Reduction Happy Hour

By Liz Melchor 09/25/17

Who am I to say the best way to deal with someone else’s drug or alcohol problem? But if I am honest, even with this new intellectual understanding, I still felt an internal nagging.

People sitting at a long table, talking and drinking.
Harm reduction does not moralize choices—what works for me is not better than what works for you.

I will admit to a knee-jerk reaction when I got the email invitation to the Harm Reduction Happy Hour. The event was a book signing for the release of the second edition of Over the Influence by harm reduction pioneers, Patt Denning and Jeannie Little. For me, a recovering alcoholic who had been sober for nine years, to celebrate a book, the subtitle of which was “The harm reduction guide to controlling your drinking and drug use,” at an event that traditionally revolved around alcohol seemed goading. Oh, you have an alcohol problem, we beg to differ, you can throw some back with us, let us show you how.

But the next day, when I got to the well-lit corner bar, I did not find sloppy drunks throwing their arms around my shoulders, telling me they had learned to moderate. Instead the room was filled primarily with treatment professionals—counselors at methadone clinics, therapists with private practices, trainers of motivational interviewing—many with the same sparkling water that I had in hand. When I would tell them I was sober, many said: Me too. And then they added: But that isn’t the only way.

And that was the thing—my initial disdain for harm reduction was based partly in my own misunderstanding. Harm reduction is not anti-abstinence. In fact, one could absolutely be in AA and be practicing harm reduction. This is because harm reduction is not a support group or an alternative to 12 steps. Instead, it is a treatment philosophy, based not on the idea that substance use is controllable, but on the idea that each person has an individual relationship with drugs or alcohol and is free to choose what that relationship looks like.

The first two people I sat down with, counselors at a local non-profit that provided needle-exchange, HIV, and Hep C services in the community, were engaged in a friendly debate.

“Look, abstinence is the best harm reduction,” one said.

“No, don’t say that,” his colleague said, sitting forward in his chair. “It makes abstinence an aspirational goal.”

The distinction he made was important because, as he made clear, harm reduction is not prescriptive. There is not one solution, there are individual solutions. And harm reduction does not moralize choices—no value judgments are attached—what works for me is not better than what works for you.

The introduction of the book Over the Influence lists some beliefs of the harm reduction philosophy. Included in these are that people have the right to self-determination, the right to real and unbiased information about drugs, and the right to freedom from society- or program-induced shame or guilt for how they choose to cope.

When explained in this way, I readily agreed. I believe strongly in individual choice and freedom. I believe in education and knowledge. I detest stigma. Who am I to say the best way to deal with someone else’s drug or alcohol problem? But if I am honest, even with this new intellectual understanding, I still felt an internal nagging.

My own experience validated sobriety. I had tried many alternative solutions: never drinking liquor, never drinking without a meal, never drinking on weekdays, but these were just exercises in continual failure. And looking back, I always wished I had come to sobriety much sooner than I had.

As I stood at the happy hour, sipping my seltzer, feeling the awkwardness of being alone in a room full of strangers that years ago I would have needed alcohol to tolerate, I tried to reconcile this tug of war between intellectually valuing the underpinnings of harm reduction but emotionally feeling that sobriety was the only real way.

An older man with kind eyes ushered me over and told me his story. He had gotten sober in 12-step programs and still attended meetings. And when he had started his career as a substance abuse counselor, he was all about abstinence. But now, he told me, he was certain never to wear his NA t-shirt to the office. He didn’t want to unduly influence his clients. He believed in harm reduction.

“What changed?” I asked.

I expected his answer to be theoretical, something about individual freedom, but instead it was practical. “When it was about abstinence, I just kept fighting them,” he said. “After a while, I realized, my client is a big boy. He knows what he needs to do, and I am going to walk with him.”

Hmm. I thought about my own therapist who I had been seeing for over a decade, including for a couple years before I got sober. She had walked with me.

I realized now that while my therapist had never named it aloud, she had taken a harm reduction approach with me. She had never demanded I stop using, and to be honest, if she had, I might have quit—not the booze, but her.

Together, in those years I was still using, we did a lot of the work Over the Influence described. We examined my own relationship with alcohol—the why, when, and where of my use—and my ambivalence about letting it go. And so when I finally came to sobriety, it was a considered choice—and my own.

A bit later, as the crowd was growing and Patt Denning was seated signing books and laughing with attendees, I found myself by the pool table talking to a clinical psychologist. Now in private practice, she had trained for years at the Center for Harm Reduction Therapy. She scoffed at the idea of telling someone they had to stop their use. “It is infantilizing,” she said.

But she admitted that many counselors and professionals still approach their clients in this way. It made her sad, angry even, because as is asked in Over The Influence, “Do you know of any doctor who would refuse insulin to a patient with diabetes because he won’t stop eating ice cream?”

“We are adults and make our own choices. It is about education, respect, dignity, and knowledge,” she said. She then became more emphatic, “It is not my job to tell you what you want.”

She was right. It wasn’t her job, and it wasn’t mine. My bias towards sobriety was based on my own experience.

But I had forgotten all my friends who pounded them back with me every day in college, and after graduation, with new priorities, found themselves naturally partying less and less. Or one girlfriend who quit her serious heroin habit when she broke up with a using boyfriend but continues to smoke a bit of pot a couple of times a month. Or even my grandmother, who gave up her two-pack a day cigarette habit one morning in her eighties because she just didn’t feel like it anymore. She quit completely spontaneously.

Their way was not my way. Their relationships to their substances were not the same as mine. And the thing about harm reduction is that it allows for all of it—the range of experiences and the range of solutions.

As I left the happy hour, I paused one more time to say goodbye to one of my new friends.

“I think harm reduction is misunderstood,” I told him as I hugged him in the doorway. “And to be honest, I didn’t get it either—but now, I am getting there.”

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Liz Melchor is a San Francisco-based writer and photographer. You can find Liz on Linkedin, Instagram and, Twitter.