Harm Reduction series – Page 11 – Matters of Substance

While it works for some people, abstinence is not an effective approach for everyone. So why do the majority of drug and alcohol recovery programs promote abstinence as the only acceptable outcome? What about approaches that support anyone who is looking to make a positive change in their habits, no matter how small?

While working in needle exchange programs, I was struck by how these initiatives met people where they were at and respected the autonomy of the individual. These notions formed the basis of the HAMS Harm Reduction Network.

HAMS (Harm reduction, alcohol Abstinence and Moderation Support) is a free-of-charge, lay-led support and informational group for people who wish to make any positive change in their drinking habits, ranging from safer drinking to reduced drinking to quitting alcohol altogether. This means it does not matter how much you drink or how little you drink; all that is required is that you are contemplating making a change for the better. If you decide that you want to stop drinking and driving but still want to get drunk every day, you are welcome at HAMS. If you have only one drink per day, but want to go to none, you are welcome at HAMS. We even offer a supportive environment for ex-AAs who have chosen to experiment with moderation, because we believe it is safer for a person to try drinking again with information and support than to try and do it on one’s own.

Individuals are always encouraged to choose their own goals and are supported in these goals. Goals are never assigned to individuals by the organization or other members. In fact, HAMS members avoid giving advice unless it is directly solicited; we find it for more useful to share our experiences and what has worked for us rather than to tell others what they ought to do. There is no sponsorship in HAMS and there are no “old timers;” however, members will often partner up to be “abs buddies” who will choose to do a period of abstinence from alcohol, such as a week or a month. Members also partner up to be “mods buddies” and set moderate drinking goals to share together. Often half a dozen people may be buddying up at a time, each choosing a different abstinence or moderation goal.

Another feature of HAMS is that it offers both in-person meetings and online support via an email support group and a real time chat. While some attend the live meetings, many members express a preference for online support over live meetings both for reasons of convenience and of confidentiality. Our online group has around 1,200 members, although group membership is not required to participate. Around 8,000 people have purchased the HAMS book, How to Change Your Drinking: a Harm Reduction Guide to Alcohol. This means it is likely that many people are using the book on their own without participating in a group.

HAMS owes a great debt of gratitude to all the harm reductionists who have gone before us. By offering a welcoming environment that respects a person’s chosen goals, HAMS aims to reduce alcohol-related harm and potentially save lives.

Author: Kenneth Anderson, Executive Director, HAMS: Harm Reduction for Alcohol

http://hamsnetwork.org

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

“Our government has a zero-tolerance policy for drugs in our institutions.” This comment comes from Canada’s Public Security Minister Vic Toews, responding the 2012 Federal lawsuit filed by four HIV groups and a former Canadian Correction inmate seeking a supervisory injunction – a court order that would force Ottawa to establish Canadian prison-based syringe access programs (PSAPs).

You may be asking yourself: “Drugs are illegal and prisons are drug-free, so why would we give inmates needles to commit a crime?”

The reality is prisons are not drug-free and needle-free; never have been, never will be.

Contrary to the assumption that prisons are a highly restricted, secure environment, virtually no prison in the world has been able to keep drugs completely out. Needles are easily smuggled in or can be made from various items already in prisons (see example here). These needles are shared, often for a fee, between anywhere from 10 to 20 inmates.

Roughly 80 percent of inmates arrive with substance use problems and incarceration has absolutely no effect on reducing injection drug use. The Correctional Service of Canada itself admitted that 17 percent of male and 14 percent of female inmates reported injecting drugs while in prison – 60 percent of the time with a used syringe.

The danger here is that our prisons have become hot spots for HIV and hepatitis C virus (HCV) transmission. To begin with, HIV and HCV prevalence rates in prisons are at least 10 and 30 times higher than the population as a whole. A Vancouver study estimated 21 percent of all HIV infections among people in Vancouver who inject drugs were acquired in prison.

In the face of our government’s “zero tolerance” policies, Canada has acknowledged that drug use does exist in its institutions. Currently, bleach kits, which inmates can use to sterilize syringes, are available upon request. Advocates for PSAPs see bleach kit programs as a step in the right direction. But these programs have also come under scrutiny. Research shows inmates report limited access to such programs, particularly because they come with increased surveillance and stigmatization from correctional officers.

In addition to principles based on prohibition, the reason the Correctional Service of Canada has not moved forward with PSAPs is because of the concern that inmates may turn syringes on officers and use them as weapons. What is the evidence behind this?

In the 60 PSAPs across 12 countries introduced since 1992, there have been no reports of needles from PSAPs being used as weapons. Rather, evidence shows:

Reduced needle sharing
Reduced needle pricks
Decreased HIV and HCV transmission (also safer for officers if they do get pricked)
No increase in drug use or injecting
Reduced drug overdoses
Increased referrals to drug treatment programs
Effectiveness in a wide range of institutions

Despite this compelling evidence, PSAPs remain a tough sell in Canada. One possible reason why prison health has not been prioritized by the public may be due to a misconception that people stay in prison forever. But prisoners (including those who have contracted HIV and HCV) do not stay behind bars forever. Over 95 percent of people are eventually released back into the community. They are our brothers and sisters, mothers and fathers, sons and daughters. They are part of our communities – making prison health a vital component of public health.

Ignoring this fact not only harms public health more broadly, but, by definition, also violates human rights. HIV advocacy groups argue many rights are violated by refusing PSAPs, including the right to the highest attainable standard of health.

If not evidence, what will it take to introduce true public health and human right standards for Canadians behind bars?

Author: Alissa Greer, Research Project Coordinator at Rocky Mountain Poison and Drug Center

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Category: Harm Reduction series

Abstinence and Alternatives: Alcohol Harm Reduction