Holiday tips from a harm reductionist
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You probably know what it feels like to be in the throes of holiday stress. This stress may include dealing with difficult people, feeling obligated to take care of everyone around you, or trying to push down feelings of grief and loss that seem to come up every year around this time.
The holidays may exacerbate depression or feelings of loneliness and isolation.
It may seem like you are alone in your suffering, and drinking at the local bar or using other drugs may seem like the best way to escape these feelings and feel a sense of belonging. The drinking or drug use may work very well in those respects, but you may find that your bar tab is not the only cost you are facing as a result of drinking more than you had intended.
The Stonewall Project, a program of the San Francisco AIDS Foundation, provides harm reduction services for gay, bi, and trans men who have sex with men. At this time of year in particular, we see many guys who are dealing with holiday stress, trauma, and shame, and find themselves self-medicating with substance use and misuse.
Many of the men who participate in our program have experienced treatment in the past that required total abstinence, and offered a one-size-fits-all formula for recovery. Often, we notice expressions of surprise when we tell participants that they can pursue managed use, abstinence, or abstinence from one substance but not from others. Decades of research confirm that most people with substance use problems make positive changes without seeking or achieving lifelong abstinence.
Harm reduction is a philosophy that meets people where they are, and accepts the reality that people use substances and will continue to do so. In harm reduction, success is defined as any positive change, and providers offer support and feedback, but not instructions or demands.
If you feel your use of substances is becoming a problem, you may not want to quit entirely, and it may not be necessary to become abstinent. Harm reduction offers a wide range of approaches to any behavior that is troubling you.
Here are some highlights of how you may use harm reduction with respect to drinking:
Many people find that other substances are less harmful than alcohol, and can serve many of the purposes alcohol serves. For example, you may drink one night, but another night you may smoke cannabis rather than drink. The substitution can also be something other than a substance such as exercise, sex, or good food, or maybe watching "RuPaul's Drag Race."
Fundamentals of moderate drinking
Many people find that eating before drinking, alternating between water and alcohol, drinking beer or wine rather than hard alcohol, or leaving the ATM card at home can help prevent excessive drinking and its related harms. Some people set a firm limit on the number of drinks they will consume, bearing in mind that Castro bars offer overly generous portions of alcohol in their drinks. Some people designate days as either abstinence days or drinking days.
Safer drinking habits
You may not be as concerned about your quantities, but may be very concerned about safety in drinking situations. For example, driving may not be a good idea if you plan to drink. You may want to become more aware of behaviors that tend to come out when you drink heavily such as risky sexual encounters, violence, blackouts, accidental injuries, or reduced inhibitions. Having a friend accompany you for drinking adventures may be a helpful strategy as well if safety is a concern.
Harm reduction philosophy is certainly not against abstinence. Some people will decide that it is very difficult to manage drinking and the consequences of alcohol consumption are too severe. Abstinence certainly reduces a lot of harm if a person is ready, willing, and able to do it.
These are just a few of the countless strategies people use to help reduce harms. This is certainly not a new idea. People have been practicing harm reduction throughout human history, but we did not have a name for it. If you fasten your seatbelt when driving, for example, you are practicing harm reduction.
You are the only one who truly knows what you want from life, and how much risk you are willing to accept. Harm reductions asks you to take an honest look at yourself, and develop creative and realistic plans to reduce harm to a level consistent with your goals.
Jeremy Prillwitz has been a harm reduction counselor at the Stonewall Project since 2012. He regularly presents at conferences and provides trainings on harm reduction and related matters, and is currently writing a book on harm reduction as a treatment philosophy.