HARM REDUCTION COMPLEMENTS TRADITIONAL CARE

Approach Can Minimize Ravages of Addiction While Helping
Patient

Charlie Sheen is addicted to alcohol and drugs. Although his antics
make international headlines, his story is remarkably ordinary.

According to reports, he started using substances at an early age and,
from the beginning, liked them way more than his other friends. Early
accomplishments simply couldn't substitute for the feeling that
alcohol and drugs gave him. The more he used, the more he couldn't
quit.

He has been in and out of rehabilitation programs since his youth. His
episodes of sobriety end not in a fall off the wagon, but a leap from
the Golden Gate into a sea of substances, with catastrophic
consequences for him, co-workers, family and friends.

According to reports, he assaulted his spouse, was arrested, quit work
and left those depending upon him without a paycheque. He ignores his
children and breaks his parents' hearts.

The only difference between Sheen and other people addicted to drugs
and alcohol is that he has a lot more money than most, a drawback when
it comes to facing up to the consequences of his behaviour.

He may get sober eventually and permanently, but it is equally
probable that he will kill himself first.

Most rehabilitation programs, probably the ones that Sheen attends,
emphasize abstinence, a laudable goal for all persons addicted to substances.

But there is a parallel approach, harm reduction. It is compatible
with the goal of abstinence but accepts the realistic fact that
sobriety may be a longterm proposition for some and that, along the
way, through starts and stops, the ravages of addiction can be
minimized, not just for those addicted but for those who live in their
communities.

What might a harm reduction program do for Sheen and for the community
surrounding him?

Harm reduction begins with the proposition that addiction is a health
problem, a recognizable disease that must be treated and may be cured.
Sheen's friends may have drank and taken drugs as much as he did, but
they didn't all become addicted like him.

Physiological, as well as other reasons, play an intricate part in who
becomes an addict.

Safe use of substances is one goal: No sharing needles or pipes, no
drinking and driving and learning how and where to consume safe
amounts. Looking after general health issues is another: Teeth, heart,
kidneys and lungs in particular.

Staying on treatment regimes is another. For instance, those who use
their HIV medications regularly and effectively prevent the
devastating diseases that could result for themselves and others.

These are all simple behaviours that can preserve the life of people
addicted to substances so that if they recover, they will do so
without many more complications, a crucial factor because many who are
addicted are young. If they never give up using substances, they may
at least be able to function in a manner acceptable to themselves and
others. All of this minimizes the worries and costs to family, friends
and community members.

Whether they live on the streets of Victoria, the suburbs of Gordon
Head or the mansions of Beverley Hills, those addicted to substances
are usually surrounded by people who give them two opposing messages.

Some, usually family, friends and counsellors, urge abstinence through
treatment and the promise of a rewarding sober life.

They look to the future.

Others, often fellow users and the last remaining confidantes, urge
participation in the next party, the next hit, happening right now.

Harm reduction workers give neither message. They emphasize the simple
importance of getting and staying healthy and the ways that this can
be accomplished. Their message is "you matter," "you need to look
after yourself" and "you can be a valued citizen in our community,
looking out for others," Because these messages are different, harm
reduction workers frequently connect with those addicted in a
different way, without judgment and with hope.

The path to recovery may be opened.

Harm reduction approaches, including needle exchanges and safe
injection sites, are sometimes criticized because they seemingly give
permission to people to keep on using.

But do they? Or are they instead a realistic and financially
appropriate response to a disease that has been hijacked by failed
drug and alcohol policies based upon moralistic assumptions about
substance use?

We all know how many users populate the prisons, mental hospitals and
health care facilities and the associated public costs. Most of us
have experienced the private agonies that individuals and their
families endure day after day with a person addicted to substances in
their midst. Charlie Sheen embodies that train wreck. Harm reduction
offers another approach that does not contradict traditional treatment
approaches, but complements them.