Harm Reduction: Is It A Mystery Or A Myth?

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entertainment and information only. So let's keep it in that light, alright? Have a good time, learn something, and then get the real help that you need from a professional. Harm Reduction I just want to drink like everybody else and have one drink. Sure, I binge, I pass out every once in a while, but I can get down to one. Harm reduction. That's got to be the answer. Harm reduction. Is it a mystery or a myth? How come I can't seem to do it? But if I tried hard enough, I'll bet I could.

So I'm going to go see a professional and have him tell me, yes, you can drink just one drink. You can engage in harm reduction. That'll work. So is it a mystery? How do you do it? How is it happening? Or how is it not happening? Or is it truly a myth? You can't really just get back down to one once you've crossed that line and you've become an addict. So today's discussion is about harm reduction. The mystery or the myth? Today's discussion is a frank discussion about harm reduction.

That question gets asked of me all the time in my private practice here at the world headquarters of Doc Jacques, your addiction lifeguard. And it's an interesting question because it means that somebody somewhere is thinking that they can engage in harm reduction. And that's why they came to see me. However, the problem with that is that one is never just one. That's what my clinical experience tells me. Can you have one? Sure, you can have one now or maybe one today.

But see, once that drug of your drug of choice hits your system and starts to sit in there, it really gets to you. And you can't stop. And I'm going to tell you, 20 years of doing this work, 100% of my clients have at one point or another tried harm reduction because they tried that as a self-help method to get past their drug of choice. Unfortunately, addiction... It's very, very much a binary process on off ones and zeros. Yes or no. You either are or you aren't. And that's kind of how it is.

And that really doesn't sit well with a lot of people because they want to be like a normal person. And it's interesting, too, because the very second question that I get is, well, what am I supposed to do if I can't drink, especially from people who have carved out their entire existence around the idea of using their drug of choice. All your friends drink or they smoke pot or they shoot up, they snort cocaine.

So then all of a sudden the question becomes, well, what am I supposed to do if I can't use? What am I supposed to do then? I'll tell you exactly what you're supposed to do. You're supposed to not use. That's how that works. Because if you don't use at all, There's zero chance that you're going to go headlong into uncontrolled usage, which is what the problem was in the first place.

So if somehow you're thinking that I can abstain and then I can go into one or two drinks like everybody else, it really is kind of, at that point, just a myth. And it's... not something that I wish I could come up with some kind of data that showed differently. And you can certainly find information out there on the worldwide interweb that would tell you, oh, yes, no, you can use harm reduction. I can find lots of literature that says that harm reduction is a valid approach to treatment.

I can certainly find that. The problem is that finding the information and then seeing the outcome of when that actually occurs or how it occurs over the long term. And that's part of it too, is I don't know how much of the literature supports the long term controlling of alcohol in particular, I guess is what we're kind of talking about here. for harm reduction, but reducing harm. But see, it's a spectrum disorder. That's the issue is addiction is a spectrum disorder.

So you've got the different stages, early, mid and late stage of usage. And certainly if somebody is in the very early stages and they're drinking, you know, they're binge drinking once or twice a year, are they gonna be able to reduce harm by changing the amount that they're drinking? Well, probably so, yes. But that's early stage. And how do you know where you are on that spectrum? You've got to have a clinician determine that.

So, and again, people that come in to see me, they get to me, it's bad. That's why they're here. They've tried other things and they're seeking out now an expert who can help them get into recovery or they're being forced into it or whatever the case may be. But that's kind of where it goes. And so they are now at the point where it's a crisis. Well, if you're in crisis, you know what? So maybe it's just my segmented population sample of people that come to see me that have this.

But I also hear this from other clinicians and I have a lot of friends who are clinicians and they tell me the same exact thing. People come in, they want to do harm reduction, but they're in this phase in their addiction where that's just not even possible.

And those friends that I have, when we talk about it, it always makes them laugh because we always have stories of people who come in and they want to engage in harm reduction rather than practice abstinence so they can move towards actually being sober. And it's a bumpy, rocky road for a long time until they finally realize they can't really do that. And so now you have that problem of, you know, well, what am I supposed to do?

Just... forever be trapped in addiction or whatever so myth or mystery harm reduction is it a real thing yeah it's a real thing it's just how effective is it for long term recovery and can you get sober engaging in harm reduction to me It's kind of like the difference between lighting a fuse on a bomb and it's a very short fuse and it immediately goes off. Or maybe the explosive device doesn't even have a fuse, just has a pin. And you pull the pin, boom, blows up.

Or you push the button, boom, it blows up. It's immediate contact. But for me... As a clinician, it is a myth. And I think it's similar to lighting a very, very long fuse that's going to burn for a very, very long time sometimes before eventually then you get to the point where now you're starting to lose things because of your drug of choice. And so lighting that fuse, does it make any sense to light the fuse and wait for it to burn?

Or are you going to just stand there and watch it burn all the way up until it explodes? It gets to the explosive and boom, then you got an explosion. That's crazy. And so if I light the fuse and I say, yeah, but you know what? That bomb is a long way off. See, the fuse is burning. There's no explosion. Is that a mystery? Are you confused by that concept? That, yes, there's no explosion because it's just a fuse. It's not the bomb.

So in my analogy, the metaphor of the bomb, the bomb is when you've lost things. Your life has just been blown up. And it blows up because you lost your job, your wife, your money, your freedom, your health, etc. you know, your license, something, you know, license to do anything. It's just any number of things. That's the bomb exploding. Now you've blown up your world, and there's really not much left. And so you standing there watching the fuse saying, look, nothing's happening.

No, it's eminent danger. So the fuse is a mile long. It doesn't matter. It's just a fuse. So... Is it possible for you to engage in this stuff and harm reduce and find a way so that you don't have the bomb going off? Yeah, don't light the fuse. That's how. I mean, it's really, it's that simple. Don't light the fuse. So mystery or myth? To me, it is a mystery. It's a mystery as to why anybody would buy into that.

The myth being that you're really, what you're saying is addiction doesn't apply to you. It applies to other people. It just doesn't apply to you in particular. And that, my friends, is a complete myth. So what should we do instead of harm reduction? And that is the problem that I run into with people who are firmly entrenched in the idea that harm reduction is possible and is the way to do things. It's the idea that I have to stop.

So I'm going to go back to what I keep telling people over and over again in these podcasts. I tell them in my office. I tell them in my conversations when they inquire about addiction. It's very, very simple. You are going to have to stop using your drug of choice, but you're going to have to find some other coping mechanism. So harm reduction, it's interesting. The focus is the harm is the drug of choice.

So thus the term harm reduction, but the concept of it always focuses on the drug of choice. That's the harm. That's not the harm. And that's the issue that I have with this. And this is why this is just a complete myth. Harm reduction assumes that the harm that is happening is because of the drug of choice. If you overdose from a drug of choice, what killed you? What kills the person? Is it the drug of choice? I maintain it's not the drug of choice.

It's the thing that was driving them to use in the first place. So I have a reason for drinking. And here is the quiz. I'm cheating because now if anybody listens to this and they come and see me, they're going to know the answer to this question. First question I ask people, are you an addict, yes or no? And they may be hem and haw and they don't want to be and they'd rather not embrace that idea.

So they'll say no and then we talk about it and then they finally realize that, oh, okay, well, I meet the criteria, diagnostic criteria for having addiction. Okay, are you an addict, yes, no? Well, okay, yes. All right, fine. Next question, number two, why do you drink? I always get this long pontificating answer that says something along the lines of because I had this happen or I feel anxious or depressed or whatever. And then I stumble around for a while.

It usually takes them anywhere from two to ten minutes to explain the reasons they drank. And they give me all the reasons. My dog died. My wife left me. I lost my job. It's all... After they get done, I say, look, I'm going to make it easy for you. It's one word. You drink, and the reason is one word, uncomfortable. And so when I say that word, they go, huh, yeah, depressed, anxious, sad, whatever. It's always uncomfortable. It's an uncomfortable feeling. You're trying to get rid of it.

So harm reduction doesn't really address that. in most people's minds, the reason that they drink. It's the drinking or the drugs. That to them is harm reduction. So instead of drinking 10, I'm going to drink one and I can do that. So it's controlled drinking. That is a form of abstinence. That is. I'm going to abstain from binging. I'm going to abstain from getting unconscious. I'm going to abstain from 10 drinks and I'm going to have one. So I'm abstaining from the number.

And so harm reduction is about reducing the harm. Now all you've done is just reduce the coping mechanism. This is why it doesn't work. This is exactly why it doesn't work. All you've done is reduce the thing that you were using to cope with the actual problem. So if you're, by definition, going to engage in harm reduction, you need to reduce the thing that's causing you harm. And it's the, I don't feel comfortable. I'm uncomfortable. Why?

Because I was molested as a child, or I was abandoned as a child, or I was physically abused as a child, or I was verbally assaulted as a child. I witnessed horrific events as a child, dead bodies floating down rivers in countries my parents took me to or whatever. That's the harm reduction, the memory, the experience that you had as a kid that caused you tremendous trauma.

So if you're going to engage in harm reduction and you're actually applying it correctly to the addiction model, it's not reducing the amount of the coping mechanism, the heroin, the fentanyl, the alcohol, the crack cocaine, what you're doing or what you need to do is reduce the thing that causes the harm. So now we need to reduce the impact of trauma on you. And that's why I think that the correct usage of the term harm reduction needs to be applied to the thing that's actually causing harm.

Your coping mechanism is, you know, yes, the chemical ingestion causes you harm. Okay, I'll give you that. But the thing that's actually making you use the drug of choice is the thing that's harming you. And that's the thing that never gets addressed when somebody says, I want to engage in harm reduction. Okay, well, let's work on the trauma that you had as a kid. Let's work on that thing that makes you feel uncomfortable.

And I wish more clinicians out there would understand, take the time to really study addiction, to really understand what's going on with that person. And I'm not trying to disparage my colleagues, but for God's sake, would you please stop telling clients that harm reduction is possible and let's try that experiment?

Because all you're doing is you're pandering to somebody's need to use their drug of choice and be approved for the usage by a And I can promise you, that's what the person is doing when they come in to see you and they say, I want to engage in harm reduction.

They are trying to get you as a clinician to give them permission that they can prove that they were given to their loved ones who have tremendous concern about the fact that the person is dying in front of them because of their use of their drug of choice.

They can tell their relatives, their loved ones, no, but my therapist, my doctor, the clinician that I see that's the quote-unquote expert in healthcare and my particular specialty of healthcare, of addiction, they told me that I should be able to drink one drink or smoke a little pot to kind of settle my nerves.

And, by the way, if you see somebody who says that, I'm going to hazard a guess that they are probably not going to actually want to get into your childhood trauma with you as a means to improve your situation because they don't understand addiction.

And if you, as a person who has addiction, are trying to foolishly get yourself into a place where you can engage in harm reduction and you get approval for that from a clinician, all you've done is circumvent the whole process of getting better and saving your life and improving by getting somebody who is a clinician to also approve the harm reduction. And I may get some blowback on that, but that's my stance.

And I have been in this field for a long time and have studied this for a long time and have practiced this a long time. Harm reduction... For the most part, I'm not going to say 100% of the time because I can't verify that. I'm just going to say with my experience, fails. Every time, at least in my office, it always fails.

And I actually am trying to do what I'm telling people that they need to do if they're trying to do harm reduction, which is to work on the actual problem, which is the trauma that the person experienced. I'm trying to do that, but gee, you know what? I can't get through. I can't get through. I can't break through with that client because they keep using this faulty coping mechanism and turning back to it while they're engaged in that harm reduction. by using their drug of choice.

Because every time I get them to a point where I can start working on the uncomfortable, unfortunately in that process you have to pull the person into the discomfort and help them, guide them through it and learn how to think about things and feel about things in a different way in that attempt. I can't. Because every time I do, they feel uncomfortable. They go right back to their drug of choice. So they go have a drink. And they always lie. It's one. It's not one.

They always end up having like five or six. Or just one big barrel of something. Their measurement of a drink is sketchy and questionable at best. So every time I try to get them to a point where I can help them walk through that process of exposure to the feeling bad so we can work on how to process it differently, they leave my office and a day later they feel crappy.

They don't go to a meeting, they don't talk to a sponsor, they don't do the hard work because they can just go get their drug of choice and it's a much shorter, simpler answer. So it doesn't work unless you can get them to start to transition away from it. And that is also part of the magic of getting somebody to go into a rehab. It's not the cure, but it is the physical barrier between you and your drug of choice so that your brain can function better.

I've had four clients in the last two weeks report to me that their thinking is better because they have been abstaining from their drug of choice for a year, year and a half. One of them was about ten and a half months. they feel better and it's weird. It's like all of a sudden they start firing in all cylinders.

And again, medically, we know that the brain starts to heal after about a year to a year and a half of abstaining from the drug of choice, where you start to rebound from the neurological damage that's occurred because of your drug of choice. So it takes that length of time. So they start to feel different and they feel better. And so they don't need to have as much support as they did because they feel okay, they're comfortable.

When they are uncomfortable because they've employed all the new coping mechanisms and techniques to move that direction, it's because their discomfort, when it occurs, they actually can process through it rather than try to drink it, snort it, smoke it, or shoot it away. And so... Teaching people how to engage in harm reduction is about teaching them how to cope with their feeling uncomfortable.

And they may have a slip here or there when they're doing that, but if they're constantly using their drug of choice, it's kind of like getting married but still wanting to talk to individuals that you feel attracted to all the time. and acting as if you're single, saying, oh, well, there's no harm because I'm married, I'm committed. Yeah, you are, but you're not, right?

And so you don't really engage in a meaningful, bonded relationship with your spouse because you keep flirting with other men or women And so what you end up doing is living like a married person in every way, with the exception of you're still engaging in the behaviors of somebody who is single. Behaviors being thoughts and talking without engaging in physical contact or going out on dates with somebody.

But aside from that, all the flirting and the talking and everything else, well, that's dangerous. It's very negative impact on a marriage. And it's the same thing with drugs of choice. And when you're engaging in everything with a drug of choice, except for the drunkenness or the high, so having one, you really haven't achieved what you're trying to achieve, which is getting sane, stable, and sober. So harm reduction, mystery or myth? I think it's both, but mainly it's a myth.

It doesn't exist, and you can't get anywhere with that. So I can't really recommend it. I can't say that I support it. If you want to try it, great. Give it a try because, you know, experiments have outcomes, and you just go with what the outcome is. It's called science. That's how we find things out. We experiment. And we'll do one thing once, and if it works, we try to repeat it so we can say, oh, it's a fact because, look, I repeated it 10 times, same outcome.

Here in this office, harm reduction, experiment, experiment, experiment. Outcome is always the same. Fails. It doesn't work. And with that, I mean long term, meaning more than two years. So you may be able to drink one drink and you can do that. But depending on who and what you are and how you've been living, it may end up, you know, two months later, two weeks later or a year later. Being more than one. And now you're back to where you started. And that's the sad tale of what happens.

When people come back into my office. And they're right back where they started. And they're in a full blown relapse. So mystery or myth. I think it is a mystery. Because it's a myth. And I'm going to stand by that. Well, I hope you've enjoyed this episode of Doc Jacques, Your Addiction Lifeguard. If you have a need for recovery, please go out and get that help. Go to rehab. Go to a meeting. Get a sponsor. Start reading books, watching YouTube videos, and listening to podcasts like this one.

And get the help that you need to get sane, stable, and sober so you can live a full and productive and happy life. It's not worth ending your life just to save your addiction. How about saving your life instead? So if you need help and it's immediate, go to the emergency room. But otherwise, reach out to somebody like me, Dr. Jacques DeBruker. You can reach me through my website, wellspringmindbody.com. Send me an email and ask for help. I'm there for you.

So if you like this podcast, please listen to the future ones. And thanks for listening. See you next time.