Pubdate: Wed, 01 Jun 2011 Source: Victoria Times-Colonist (CN BC) Copyright: 2011 Times Colonist Contact: http://www2.canada.com/victoriatimescolonist/letters.html Website: http://www.timescolonist.com/ Details: http://www.mapinc.org/media/481 Author: Marilyn Callahan, Times Colonist, Professor Emeritus University of Victoria school of social work. 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. - --- MAP posted-by: Richard R Smith Jr.