Alexander DeLuca, M.D.
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Jim Cannon's Report on MM at the 4th National Harm Reduction Conference: "Taking Drug Users Seriously"- Seattle, December 2002
[see also: Ana's report on this conference]

By: Jim Cannon, Executive Director of Moderation Management[Original date circa 12/2002. Originally posted to on 11/17/2003.


"National Policy is important and I want to learn more about it."
   Ana the Drummer Woman

"Make a habit of two things: to help, or at least to do no harm."
   Hippocrates Epidemics, Bk. I, Sect. XI

"First, do no harm."
   The Roman physician, Galen

After attending the HRC conference in Seattle, I came away with the understanding that National policy and the collective American consciousness would be greatly elevated if they included harm reduction solutions for people addressing substance abuse issues. These solutions are cost effective and humane. They are effective. Inexplicably, implementing them is resisted with zealousness.

For better or for worse, national policy and the American consciousness are difficult things to alter. It requires an audible and persistent voice. The Harm Reduction Coalition is an alliance of small groups, each with a small voice. Each voice works very hard and shouts very loudly in order to be heard in Washington. The Coalition, of which the MM Network is a member, brings these voices together and creates some serious volume.

So, I want to send a special thank you to everyone who helped send Ana and I to Seattle where we were able to add our voices to that gathering, and support the Coalition. We made many friends and shared many ideas.

My favorite new friend comes from Minnesota. He manages a residence for 40 chronic public inebriates called Anishinabe Wakiagun. The alcoholic beverages of choice among his residents are mouthwash, and vodka when they can afford it. The home has one rule and one very strong suggestion.

The rule: The residents must eat at least one meal per day.

The strong suggestion: The residents should sleep inside at night.

They are welcome to bring their alcoholic beverages in with them. That is it.

By modern American standards, this situation would seem highly suspect, immoral and perhaps illegal. The simplicity and brilliance of the institution almost dropped me to the floor. The community where Anishinabe Wakiagun exists also embraces this marvelous idea. They insist on supporting and funding it. Why would a community support a home that enables such behavior? The answer is very simple, too simple. This residence saves the community hundreds of thousands of dollars each year.

Chronic inebriates usually enter the health care or criminal justice system several times each year. They enter the system more often in winter. They enter through an emergency room or handcuffed in a police car. Once a human being enters the system, the costs begin to accumulate. The only pocket deep enough to pay the bill is the community. Be the community local, county, state or national, the community pays the bill. My new friend can house 40 people for a year on the same budget that it would cost to hospitalize eight of them for a month. The savings are staggering.

Reducing the harm associated with self-destructive behavior is just less expensive and more effective than forbidding the behavior, which does not seem to work at all. Every solution and program discussed at the conference was less expensive than those currently in place. Coincidently, they also treated the clients with much more kindness and respect.

Many different people were at the Harm Reduction Coalition's conference in Seattle. Very few were focusing on Alcohol abuse and dependence. The majority of the attendees were addressing issues surrounding illegal substances, and preventing the harm caused by their careless use. For years, I smugly distanced myself from people with those problems. Those problems were not like mine. I had a drinking problem. They had a drug problem. Now I see our problems as very much the same. Each of us, for whatever reason, repeatedly opted to behave in a self-destructive manner. However illogical these choices were, no matter how destructive, we made the same choice so often and so consistently, it is difficult to argue that we lacked compelling motivation to do so. We may have had very poor reasons, but the motivation, whatever it was, was clearly overpowering.

For me, something about getting drunk, no matter what the cost, was consistently more appealing than my real life. For a junkie, something about shooting up, no matter what the cost, was consistently more appealing than unfiltered reality. What is the difference? The only difference evident to me is that alcohol is legal.

When substance abuse or dependence is involved, the United States may be the only industrialized nation on the planet that specifically omits harm reduction from its national health policy. Many people who have come to Moderation Management for help have suffered because of this policy. At least I have.

When I first realized that I was becoming dependent on alcohol, I sought help. Like a lamb led to slaughter I was ushered into the welcoming arms of the recovery industry. Within six months, a mild dependency problem exploded into destructive episodes of severe dependency, causing family, legal and money problems that never existed before I sought help.

When I presented for care with a mild problem, the health care system immediately prescribed the most radical solution, which was a lifetime of abstinence and 12 step meetings. The people who treated me had good intentions. They were actually trying to help. My immediate relatives, who encouraged me to trust the recovery industry, were genuine in their love and affection for me. They did not know that they were placing me in the hands of a system that would actually do more harm than good. How could this happen?

It happened because of national policy. The National Institute of Health, which is the home of the National Institute of Alcohol Abuse and Alcoholism, refers to alcoholism as a disease and defends its position with long argument and apology. However, there is no empirical evidence that alcoholism exists as a clinical phenomenon, much less can it be called a disease. Alcohol abuse, dependence, intoxication, and withdrawal are all clinical diagnosis of alcohol related problems. Alcoholism can not be treated by a licensed physician. The physician cannot bill for it because there is no DRG (diagnostic related group) for it. Insurance forms need DRGs.

However, almost every American, most clinicians, and even the the National Institute of Health uses the words alcoholic and alcoholism as if they were scientific clinical terms. They are not. They are words from American pop culture that were meaningless a few decades ago. When the average American pictures an 'alcoholic', their mind's eye sees someone who would be diagnosed as severely dependent on alcohol, for which there is a DRG. These people represent a small fraction of all the people with alcohol problems. What about all the others, including us, who know we have a drinking problem and want to do something about it? There is little or no room in either our health care system or our collective American consciousness for us to find or develop solutions for our problem.

When 500 mg of a drug is prescribed to treat a problem that could be treated with 50 mg, the patient often gets sicker. When surgery is performed on a patient when medicine would be equally effective, the patient does gets sicker. When a limb is amputated, or an organ removed when other less radical measures would have sustained the patient's health, the patient is damaged for life. This very type of harmful treatment is occurring when people seek help with a substance abuse problem. And this is happening because it is national policy.

This is why Ana stated in her report on the Seattle conference that, "National Policy is important and I want to learn more about it." This is why I am so deeply committed to supporting both the Harm Reduction Coalition, and the Moderation Management Network. Our MM self help and support groups are one of the best options yet to help people explore the options and find the best solution to their drinking problem.

I hope the Harm Reduction Coalition and the MM Network can continue to work together hard and often in the months and years to come. The strong symbiosis between our two organizations was not evident to me two years ago. It was still vague in this November. After this conference, it is quite clear.


"Moderation in all things"
   Aristotle circa 350 BC

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Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D., FASAM.

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Originally posted:  11/17/2003

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