Homelessness and harm reduction

Sir,

Stephen Hwang's article on harm reduction is interesting, unfortunately, although the studies he mentions are recent, there is nothing new in attempting to deal with the complex, and baffling disease of alcoholism by cutting down, on the contrary, ever since man first 'trod grapes'there have been many attempts to do the same.

Studies such as Dr. Hwang refers to offer hope to social learning theorists, that people who have become addicted to alcohol can 'learn' how to moderate their consumption, it also allows them to peddle their theory that alcoholism is a 'learned behaviour', such a hypothesis ignores the fact that no one sets out to become addicted, one can learn to socialise and to drink alcohol,whilst drinking too much may be frowned on, there are no rules of etiquette for addiction, nor does it discriminate; the homeless Dr. Hwang refers to did not start out there. Addiction in most cases,is, a gradual and progressive disease, it is insidous, it is also the disease of denial, who wants to admit that there are bodily, or physically mental different from their fellow man?

Dr. Hwang has already noted the extreme limitations of the studies he refers to, so,there is no need to dwell on the fact, that not only were the small number involved insufficient to draw any conclusions, self reporting evidence is noted for its unreliability, in this case more so. As an addictions counsellor of many years standing, I have yet to meet anyone who meets the DSM-1V criteria for alcoholism who accuratly indicates their consumption levels, they either lie deliberatly, or alas, in many cases, are too befuddled to recall. A further consideration is the generalisation, that alcoholics are 'people pleasers', leading them in many cases to tell the researcher, or counsellor what they think he wants to hear, thus making self reporting even more unreliable.

If anyone wants the truth about attempts to cut down, I suggest that they spend a year covering 3-4 'open' AA meetings a week, although the evidence again will be self reported, there are two advantages, (1) the people involved ae likely to be sober, therefore less fearful of telling the truth. (2) There will be considerably more numbers involved, thus increasing the reliability.

That old chestnut that 'AA is not for everyone', has two roots. (a) Because it is abstinence based,it goes against the social learning theory, and therefore attendence would be incompatible with it's therapeutic intervention. (b)Alcoholics offer the ostensible reason that it's because of the 'God bit', on the numerous occassions I have had the opportunity to probe the latter, using Prochaska & DiClemente's 'Cycle of Change', what eventually emerges, is the natural reluctance to akcowledge those 'mental and physical differences'.

One 'fact' that I have discovered in my 'research' is that until and unless, the alcoholic discovers what he would rather do than drink, he will have considerable difficulty in stopping, or staying stopped; there is also the frequently unspoken fear that he is too terrified to stop, it can take an awful lot of time and effort to bring any addict to that point,but at least by working within the framework of the transtheoritical model, the process has started.

In conclusion the idea of giving an alcoholic a drink on the hour, every hour because it will help him 'cut down', or reduce harm, appals me, if its such a good idea why don't we suggest it to smokers?. As H.L Mecken pointed out; 'For every complex problem, there is an easy solution that is neat, simple, and wrong'.

Peter O'Loughlin.

Conflict of Interest:

None declared