Abstinence and Alternatives: Alcohol Harm Reduction

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.

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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.

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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

21st century drinking in BC: more convenience, more government revenue and reduced harms?

On Friday January 31, 2014 the BC government endorsed all 73 recommendations contained in John Yap’s landmark review of liquor laws with the stated goal of modernizing BC’s approach to managing alcohol. Modern drinking in British Columbia will mean consumers are able to purchase and consume more types of alcohol and in more places. Bars, nightclubs and restaurants will be able to compete aggressively on price by offering happy hours; Canucks fans will be able to consume hard liquor while watching a game; festivalgoers will be able to purchase alcohol and wander freely as they drink it; shoppers will be able to buy alcohol with their groceries and parents will be allowed to bring their children into pubs.

The government heralds these and other measures as a way to free businesses and charities from cumbersome, out of date regulations. Interestingly, the media release is relatively silent on an encouraging swathe of other recommendations in the report that, while less politically appealing, make BC’s approach to alcohol also more responsive to health concerns. Mr Yap clearly heard the messages delivered during the review by individuals and groups concerned with health and safety, including those summarised in the CARBC submission.

We congratulate Mr Yap on his acknowledgement that alcohol is a major health issue and not just a matter for the economy, for tourism and government revenue. His very first recommendations concern the need to communicate the serious health effects of alcohol more effectively to British Columbians along with active promotion of the national drinking guidelines. The report even mentions the word “cancer”. This is critically important: at the present time the BC Liquor Distribution Branch has absolutely no mandate to acknowledge, address or monitor the health and safety consequences of the product it so efficiently distributes across our province. It will now be required to collaborate with health experts to design educational materials and, more importantly, consider how to price the many thousands of its alcoholic products so that: a) they are not too cheap and b) their price reflects their degree of potential harmfulness i.e. alcoholic strength.

Perhaps wisely, the government press release has not trumpeted the recommendations on alcohol pricing. It has used only cautious language stating rather timidly that the BC Liquor Distribution Branch should “consider” setting minimum prices according to the ethanol content of drinks and whether they are at “an appropriate level”. Such policies, while possibly the most effective available to government to reduce alcohol-related harm, are undoubtedly not quite as popular as the introduction of happy hours and less red tape for small business.

For the past eight years CARBC has been collecting and reporting indicators of alcohol consumption and related harms across 89 local areas of the province as part of the Alcohol and Other Drug (AOD) Monitoring Project. When Mr Yap’s report asserts that in 2011 there were 20,542 alcohol-related hospital admissions and 1191 alcohol-related deaths, those estimates were calculated by the AOD project team. They were also the basis of research published in the American Journal of Public Health identifying the significant positive impacts of minimum alcohol prices on BC hospital admissions. This same paper also identified negative but smaller impacts on hospital admissions from the increased availability of alcohol associated with the large increase in private liquor outlets that occurred between 2002 and 2006.

On the basis both of local and international research, if the government proceeds with only the more popular recommendations in the report, the net effect will be upward pressure on levels of alcohol consumption and increased harms. If the key recommendations for higher minimum prices based on ethanol content are fully implemented, the net effect will be reduced alcohol-related harms and increased government revenues. Maybe this is what 21st century drinking should be: more choices, more responsibility, more convenience and more financial incentives to produce, promote and consume less harmful products. Perhaps also more funds for treatment and prevention. We at CARBC will continue to watch and hope that the easier and popular policy changes will not be implemented in advance of those which are less popular but more effective in terms of protecting health and safety. Either way, we will observe and report the outcomes as they unfold.

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Authors (left to right): Tim Stockwell, Dan Reist, Kara Thompson, Gerald Thomas, & Kate Vallance