Harm Reduction Approach and Therapeutic Option of Moderate Drinking for Individuals with Drinking Problems
Torre, Robert, Zoricic, Zoran, Alcoholism
A smaller number of people, actually only dysfunctional alcoholics, are the privileged minority most therapeutic help programs are intended for. It is unjust that problem drinkers and individuals with mild alcohol dependence, i.e. individuals with a lower number of alcohol-induced problems, have fhe least opportunity to receive adequate help. Form the aspect of public health and as far as therapeutic as well as secondary preventive actions are concerned, they are a bigger and much more important population than a small percentage of dysfunctional alcoholics. Advocates of traditional concept of alcohol dependence as a »progressive disease« say that non-treated alcoholics do not want and refuse treatment till the moment when they reach bottom. The truth is, of course, totally different: the majority of non-treated alcoholics and problem drinkers will never reach the famous »bottom«, but on the other hand they experience significant problems caused by drinking and this is why they need help. But since they know that most of the traditional programs for drinking problems offer only abstinence as therapeutic goal, they are not motivated for such a radical change of drinking pattern and life style. Therefore, treatment systems ignore and discriminate them.1
Criticism of traditional approach to alcohol-induced disorders, based on the concept of alcoholism as a disease, says that individuals with drinking problem are a heterogeneous group that cannot be placed under the dichotomous regulation of presence-absence of disease, and since all of them do not have the same »disease« their treatment cannot be uniform either. As a matter of fact, not only are different forms of treatment more adequate to various alcohol induced problems, but they produce better results in comparison to systems of treatment with uniform approach to all individuals with drinking problems. Past help centers for individuals with drinking problems offered actually help only to the smallest proportion of the population that has the biggest number of alcohol induced problems, i.e. severely dysfunctional alcoholics. Others, the majority of individuals with drinking problems, who do not have significant social deficits or do not drink excessively and are not alcoholics but have drinking problems, are not covered by systems of therapeutic support. Moreover, classic systems of alcoholics' treatment are not adapted and usually non-alcoholics with drinking problems and functional alcoholics are discouraged by them.2
Narrowing the goal of addicts' treatment exclusively to complete abstinence, although it may seem done in good faith, actually leads to further marginalization and separation of alcoholics from the system of social protection, health, and social care. This is why abstinence should not be the only goal in treating dependence diseases, considering the fact that a number of people with drinking problems continue drinking for years without having the will or motivation to definitely say goodbye to alcohol.
Complete abstinence is not a necessary or exclusive goal of alcoholics' treatment since sometimes therapeutic insisting on abstinence can be counter-productive. At a glance, »harm reduction« programs reduce damage caused by drinking only for a short term, while long term they lead to non-drinking, i.e. abstinence, to the same or even bigger extent than programs orientated solely to abstinence. As a matter of fact, even the latter programs do not lead to abstinence in treated alcoholics but to harm reduction (reduction of drinking frequency, the quantity of drinking and decrease of alcohol induced problems).3
THE PUBLIC HEALTH FOUNDATION OF HARM REDUCTION APPROACH TO INDIVIDUALS WITH DRINKING PROBLEMS
Although in the last thirty years the knowledge of alcohol induced disorders has expanded and advanced so much, and the basic scientific paradigm of its understanding has changed, systems of prevention and help for persons with drinking problems have remained surprisingly identical in comparison to the past ones, and unfortunately they did not keep up with the pace of changes. …