What is “harm reduction” and can it help my brother-in-law?

Stanton:

My brother-in-law is 45 years old and in advanced stages of alcoholism. He’s been out of work for years, his girlfriend is about to move out, and we fear his next step is homelessness. My first question is – can he recover this late in the game? He’s been to one treatment facility, and has turned away from any number of attempts at intervention by the family. He has never bought into the idea of quitting, and I don’t expect he ever will. (He’s been hospitalized three times with seizures after a few days of sobriety.) But, if he wanted to stop drinking, is it even possible? Does the body get so far gone that an alcoholic can’t stop?

I’m suggesting to my husband that he help protect his brother’s assets, find a living situation to keep his brother off the streets, and basically keep him safe until his eventual death. It almost feels like we would the ultimate enablers and would be helping him die. Are we giving up too soon? Is it ever OK to do what I’m suggesting?

Beverly

Stanton

Could you explain from a lay perspective (as opposed to a clinical one if they are not one in the same…) what “Harm Reduction” is and how that could be implemented into law in the U.S.?

John Rubin

PS – your website is where a lot of folks go to get the truth; peer reviewed, science. Not 1930’s faith healing! – May your courage continue to be as great as your intellect.

Dear Beverly:

Your question is a good one, and a humane one. It also mirrors thinking and debate throughout the alcoholism and treatment fields.

In the first place, yes, some people do recover from the most gargantuan alcohol and drug problems, even late in life.

However, as your questions indicate, the longer a person drinks alcoholically, the less likely recovery, and certainly full abstinence, becomes.

What, then, are we to do if we care about such people?

One approach, called harm reduction, outlines exactly what you describe — “protect his assets, find a living situation to keep him off the streets, and basically keep him safe until his eventual death.”

That is, do all within one’s power to humanize a person’s existence, given that they are not able to lick the addiction itself.

You worry that this then becomes merely a colossal case of “enabling.” But consider two things. Your brother-in-law has been exposed to treatment already, and it failed. If you really accept the medical model, what do you for a person who has a terminal disease who does not respond to treatment? You protect them and their assets and you make their lives as comfortable as possible.

But it is more complicated than this. Your brother can be capable of moments — and more — of sobriety.

And it is possible that providing for his comfort will relax him so that he actually drinks less harmfully. Thinking about how to provide for his comfort while encouraging him — and offering him — treatment or other opportunities to reduce his drinking is the work you can do to fight the charge of being enablers. This include making sure that he is getting medical care for the the health problems he no doubt has.

I would discuss this with his girlfriend — if she is “about to move out,” perhaps a new arrangement will allow her to protect herself better while maintaining a relationship with your brother-in-law that seems to have meaning to her. Maintaining contact with other people who are not alcoholics is certainly an important ingredient in improving and supporting your brother-in-law’s life.

Where I am going is to avoid an all-or-nothing perspective on your relative. That is, the fact that he cannot quit drinking, or alcoholism, does not mean that there cannot be progress and even stability and fulfillment in his life. Thus, you are not “giving up” on him. To some extent, it just requires getting away from an all-or-nothing way of thinking about the problem.

This is not a popular way of thinking in the U.S., where we say, “Addiction is a medical disease — now get over your disease, or we wash our hands of you.” Thus it will be difficult to get supportive medical, and certainly alcohol, treatment for your brother within this framework. You will have to patch this together yourselves by searching out humane, nondogmatic providers.

And your brother-in-law is lucky to have a thoughtful and concerned person like you in his life.

Stanton

Dr. Stanton Peele, recognized as one of the world's leading addiction experts, developed the Life Process Program after decades of research, writing, and treatment about and for people with addictions. Dr. Peele is the author of 14 books. His work has been published in leading professional journals and popular publications around the globe.