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Harm reduction and abstinence

Where do we stand on harm reduction and abstinence as treatment goals for alcohol/drug dependent people?

Harm Reduction, when regarded as an end in itself, is what causes the philosophical and practical incompatibility. When regarded as part of the process of achieving the (ultimate) goal of Abstinence, both are wholly compatible. (Waller and Rumball, 2004.)

At the Council we believe you might have bought it (alcohol or/and drug dependence), you might have caught it, you might even have been born with it – what’s important is: what are you going to do about it?

Some who propagate the ‘false dichotomy’ between Harm Reduction and Abstinence treatment goals are still, many would argue, fighting the notorious battles of the 1970s ‘between scientific and belief-based views of alcohol problems’. (Sobell & Sobell, 1995.) We at the Council believe that the kernel of this argument lies not between the merits or otherwise of Harm Reduction and Abstinence, but between each treatment programme’s right to co-exist in an increasingly competitive and evolving field; and that this argument is being camouflaged by misguided protagonists from both sides waging battles on false fronts. (Szasz, 1973.)

Perhaps, as AA suggests, ‘acceptance is the answer to all our problems’ (AA World Service Inc., 1976.) – acceptance of each treatment programme’s right to co-exist. The issue at the heart of Northern Ireland politics over the last 100 years springs to mind – and we’re not being frivolous in our comparison here, because both issues have consequences of life and death unless satisfactorily resolved. This piece is taken from the Guardian newspaper of 14th March 2007. Nicholas Watt et al., (2007) describes the main protagonists in the solution to the Northern Ireland troubles thus: ‘A fierce Protestant, Mr Paisley is the founder and moderator of the Free Presbyterian Church, who has outraged Catholics by denouncing the Pope as the Anti-Christ. Mr Blair, is an Anglican who attends mass with his Catholic wife; Gerry Adams and Martin Maguinnes, political leaders of Sinn-Féin, ex para-military leaders of the IRA, and both ardent Catholics.’ However, peace in Northern Ireland was their (ultimate) common goal. And in order to achieve that ‘common goal’, they had to put aside their differences and accept ‘power-sharing’ as the only possible way of achieving that longed-for peace.

What the common goal?
The ‘common goal’ in addiction to alcohol and drugs is recovery. And for that to be achieved, both Harm Reduction and Abstinence (and all other approaches) have to be compatible and, more importantly, be accepted as such. This ‘can be achieved only if many men, not just a few, are willing and able to confront frankly, and tackle courageously, their ethical, personal, and social conflicts – which means ‘having the courage and integrity to forego waging battles on false fronts.’ (Szasz, 1973.) We at the Welsh Council have that courage and integrity…..


Alcoholics Anonymous. 1976. 3RD ed. New York: Alcoholics Anonymous World Services, Inc.

NICHOLAS, W., BOWCOTT, O., WINTOUR, P., 2007. Blair’s Secret Weapon in Paisley talks: religion. The Guardian. 14 March 2007. p1.

SOBEL, L. C., SOBEL, M. B., 1995. Alcohol consumption measures. In: Allen, J. P., Columbus, M., eds. Assessing Alcohol Problems: A Guide for Clinicians and Researchers. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

SZASZ, T. S.,1973. Ideology and Insanity: essays on the psychiatric dehumanisation of man. London: Marion Boyars.

WALLER, T., RUMBALL, D., 2004. Treating Drinkers and Drug Users in the Community. Kundli: Blackwell Publishing.

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