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Consequences, Addiction, and Harm Reduction

The conventional view of the 12 step treatment industry seems to be that consequences are a good thing, that the more bad things that happen to a person, the more likely that person will be to quit drinking alcohol or using drugs. People are told that they have to "hit bottom" to get better. My personal experience when I was in 12 step treatment was that any time that I questioned 12 step dogma, I was told that I needed to go back out and drink more until I was ready to come back crawling on my knees to beg for help. But is there any reality to the point of view that consequences help people beat addition? Or is the opposite true? According to Stanton Peele (1991) the people who have the most resources intact are the ones who are the most likely to beat a drug or alcohol problem. Resources include health, family and friends, education, and employment. When consequences are too great people simply fall into despair and lose all motivation to recover. If a person contracts AIDS from a dirty needle they may well say to themselves "I might as well shoot up since I am gonna die anyway." The biggest consequence of all is death. There is a saying at harm reduction programs like needle exchange that "Dead addicts don't recover."

So then we must ask why 12 step treatment programs are so insistent on people "hitting bottom". Is this because people with the fewest resources become the most fanatical or AA converts? Because people who have a life have better things to do? Is going to AA just a new addiction to substitute for the old addiction?

Conventional 12 step treatment programs merely assure people that they are "free of addiction" when they walk out the door and give clients no tools at all to deal with the reality that most of them will relapse and use drugs or alcohol again. Tons of heroin addicts leave 12 step treatment and try to shoot up their old dose and die of overdose because they were never warned how severely their tolerance had dropped while they were drying out. Warning people about tolerance drop would seem like a minimal harm reduction intervention to save lives. But the folks who love consequences would surely call it "enabling" and sooner see people dead than be "enabled."

Whatever may be the case--the truth seems to be that the best way to help people get a handle on drug or alcohol problems is to help them keep the consequences under control and not to encourage them to "hit bottom". Because "Dead addicts don't recover".


Peele S, Brodsky A. (1991). AA Abuse. Reason. 34-39.
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Kenneth Anderson, MA is the author of the book How to Change Your Drinking: a Harm Reduction Guide to Alcohol--a self-help manual for safer drinking, reduced drinking, or quitting alcohol altogether. Mr. Anderson is also the founder and CEO of The HAMS Harm Reduction Network. HAMS is the first world-wide, harm reduction-based support group specifically for people who drink alcohol. HAMS is lay-led and free-of-charge. Mr. Anderson has worked in the field of harm reduction since 2002. His wide range of experience includes serving as Director of Online Services at Moderation Management, and working "in the trenches" of harm reduction doing needle exchange in Minneapolis. Mr. Anderson is a member of The International Center for Clinical Excellence, the Global Alcohol Harm Reduction Network, and the International Harm Reduction Association.