Part of the problem I have with the abstinence talk is that it often seems to presuppose that abstinence itself is a good in its own right rather than being a tool that can help people lead a good life -- no different in kind than medication assisted treatment or spirituality -- something that can benefit some people but isn't a goal in itself or necessarily the best means for everyone.
And yes, if all you mean is the idea that some people would be better off doing no drugs of a given kind than sure it's not incompatible with anything but that's just not what people are reacting to when they push back on the abstinence approach. Yes, we need to avoid just falling into affiliative groups and should try to speak preciscely but at the same time that doesn't mean we should ignore the fact that often when people speak about abstinence or harm reduction they are importing a broader background value system.
I mean, think of it by analogy to politics. Yes, I don't like the way politics has become all affiliative and vibe rather than policy based. But at the same time, you shouldn't ignore the fact that you do understand that a certain kind of rhetoric does predict that a politician is likely to behave in ways you don't like.
Thanks! I think that's a fair point that certain types of rhetoric/affiliations may predict someone's behavior in certain spheres. But I don't think we should assume that people working in an abstinence frame (personally, as treatment professionals, or otherwise) will necessarily support or oppose certain policies. For example I have come to know a lot of people in abstinence-based, even very traditional 12-step recovery, who also support harm reduction policies that the mainstream would label radical.
In the end though of course I agree that there are a lot of people in the abstinence camp who assume that it's the right way for everyone, one size fits all. Sadly this is probably the majority although a shrinking majority, I hope. In my book I try to make this distinction by talking about "abstinence-only" (rather than say "abstinence-based") policies and treatment programs. Abstinence-only is usually a big problem and flies in the face of the realities of life.
Yes, I think that is true and reasonable. Reading what you said again, I realized you probably had in mind certain policy, medical professional etc discussions where I agree it makes sense to put ultimate disagreements on moral foundations and values to the side and focus on practical issues.
My pushback was more because I didn't really understand the context you had in mind and -- while I totally agree it's awful when we spend time fighting about what's the right kind of person to be instead of doing what we all agree on -- I do think those values differences can matter in other contexts (choosing a psychologist to help treat someone who has strong feelings on the issue for instance and sometimes you want to build movements based on similar values and reach the compromises outside of it).
When confronted with a less than wonderful hotel, one can take an abstinence approach of checking out, but, as your post implies, there are softer, gentler ways of reducing harm: cognitively reframing the experience to focus on the good, lowering expectations, deciding to take a bath rather than braving the jacuzzi, etc. In all areas of life, we´re constantly navigating the abstinence/harm reduction continuum and there´s no one right answer for every question. I´m grateful for the range of harm reduction options, cause otherwise my partner would of long ago divorced me.
Harm reduction if practiced in collaboration with all treatment providers, and local communities might have a chance to reduction the harm that is caused drug addiction. To be clear, all that comes with addiction. What we have now is a giant petri dish of an experiment, lacking collaboration with all involved agencies. Local residents are subjected to the unfortunate outcomes, sleeping on sidewalks, defecation on sidewalks, theft, and other law violations that are ignored by local authorities due to the overwhelming numbers. The poor, or underinsured, with significant trauma, are the least likely to obtain treatment. Bringing society as a whole onboard, with a clear harm reduction plan, that not only reduces the harm to the patient, but the harm to locals. This is a small paragraph; the problem is so much greater. Helen
Thank you for this! I've experienced this friction as I've been learning more about contingency management. I get "in trouble" with some folks in that world when I talk about CM as a part of an ecosystem of care that includes non-abstinence based goals for stimulant use, and then also with some folks in harm reduction (though rarely those on the front line delivering services) when I discuss the evidence base for CM which is strongest on abstinence-related outcomes. But we all ultimately have the same goal!
Thanks Frances. That's an interesting example. In these cases, it sounds like people reactively assume a bigger philosophy or end goal when they hear you talking about CM. This is the kind of backward reasoning that is a big problem. Ie someone hears CM and assumes you are "for" this or that bigger philosophy or stance, rather than just evaluating the proposed intervention on its merits, pragmatically.
Part of the problem I have with the abstinence talk is that it often seems to presuppose that abstinence itself is a good in its own right rather than being a tool that can help people lead a good life -- no different in kind than medication assisted treatment or spirituality -- something that can benefit some people but isn't a goal in itself or necessarily the best means for everyone.
And yes, if all you mean is the idea that some people would be better off doing no drugs of a given kind than sure it's not incompatible with anything but that's just not what people are reacting to when they push back on the abstinence approach. Yes, we need to avoid just falling into affiliative groups and should try to speak preciscely but at the same time that doesn't mean we should ignore the fact that often when people speak about abstinence or harm reduction they are importing a broader background value system.
I mean, think of it by analogy to politics. Yes, I don't like the way politics has become all affiliative and vibe rather than policy based. But at the same time, you shouldn't ignore the fact that you do understand that a certain kind of rhetoric does predict that a politician is likely to behave in ways you don't like.
Thanks! I think that's a fair point that certain types of rhetoric/affiliations may predict someone's behavior in certain spheres. But I don't think we should assume that people working in an abstinence frame (personally, as treatment professionals, or otherwise) will necessarily support or oppose certain policies. For example I have come to know a lot of people in abstinence-based, even very traditional 12-step recovery, who also support harm reduction policies that the mainstream would label radical.
In the end though of course I agree that there are a lot of people in the abstinence camp who assume that it's the right way for everyone, one size fits all. Sadly this is probably the majority although a shrinking majority, I hope. In my book I try to make this distinction by talking about "abstinence-only" (rather than say "abstinence-based") policies and treatment programs. Abstinence-only is usually a big problem and flies in the face of the realities of life.
Yes, I think that is true and reasonable. Reading what you said again, I realized you probably had in mind certain policy, medical professional etc discussions where I agree it makes sense to put ultimate disagreements on moral foundations and values to the side and focus on practical issues.
My pushback was more because I didn't really understand the context you had in mind and -- while I totally agree it's awful when we spend time fighting about what's the right kind of person to be instead of doing what we all agree on -- I do think those values differences can matter in other contexts (choosing a psychologist to help treat someone who has strong feelings on the issue for instance and sometimes you want to build movements based on similar values and reach the compromises outside of it).
When confronted with a less than wonderful hotel, one can take an abstinence approach of checking out, but, as your post implies, there are softer, gentler ways of reducing harm: cognitively reframing the experience to focus on the good, lowering expectations, deciding to take a bath rather than braving the jacuzzi, etc. In all areas of life, we´re constantly navigating the abstinence/harm reduction continuum and there´s no one right answer for every question. I´m grateful for the range of harm reduction options, cause otherwise my partner would of long ago divorced me.
Harm reduction if practiced in collaboration with all treatment providers, and local communities might have a chance to reduction the harm that is caused drug addiction. To be clear, all that comes with addiction. What we have now is a giant petri dish of an experiment, lacking collaboration with all involved agencies. Local residents are subjected to the unfortunate outcomes, sleeping on sidewalks, defecation on sidewalks, theft, and other law violations that are ignored by local authorities due to the overwhelming numbers. The poor, or underinsured, with significant trauma, are the least likely to obtain treatment. Bringing society as a whole onboard, with a clear harm reduction plan, that not only reduces the harm to the patient, but the harm to locals. This is a small paragraph; the problem is so much greater. Helen
Thank you Helen. I agree what's needed is a clear and coordinated plan when major reforms are involved.
Thank you for this! I've experienced this friction as I've been learning more about contingency management. I get "in trouble" with some folks in that world when I talk about CM as a part of an ecosystem of care that includes non-abstinence based goals for stimulant use, and then also with some folks in harm reduction (though rarely those on the front line delivering services) when I discuss the evidence base for CM which is strongest on abstinence-related outcomes. But we all ultimately have the same goal!
Thanks Frances. That's an interesting example. In these cases, it sounds like people reactively assume a bigger philosophy or end goal when they hear you talking about CM. This is the kind of backward reasoning that is a big problem. Ie someone hears CM and assumes you are "for" this or that bigger philosophy or stance, rather than just evaluating the proposed intervention on its merits, pragmatically.