An essay by Paul Carr in last weekend's Wall Street Journal which describes how he stopped drinking and what he learned along the way, is a great example of a harm reduction approach to an alcoholic figuring out what he needed to do to get and stay sober and the changes he’s made in his life that have worked so far. He talks about his ‘relationship’ with alcohol and the positive and negative aspects of that relationship leading to the changes that he made in his life.

Many of the comments/responses on the website following the article are disheartening to me because they reflect the gigantic gap in the recovery and treatment community about what elements are helpful for people to get and stay sober. Sadly, there’s an air of arrogance and even contempt from both treatment professionals and those in recovery for this man who found a way that works for him.

As a harm reduction psychologist, it’s always a pleasure to work with parents who have the instincts and skills to maintain good communication with their teenager as well as the courage (and energy!) to set appropriate and consistent boundaries and limits.

Sometimes, however, these skills can be a double-edged sword and work against us, especially when the emotional and behavioral instability of our child keeps pushing us out of our parental ‘driver’s seat’ and into the passenger seat—or even worse, the back seat.

Being in the family back seat contributes to the fear that develops when we start losing control of a child’s behavior. This fear often motivates us to become even firmer in our resolve to ensure our child’s safety while keeping ourselves sane along with the rest of our family.

Enabling as a badge of failure

Parents learn about the ‘evils’ of enabling when support groups and counselors, in the interest in creating healthier boundaries, encourage us to directly confront our kids and not back down to the often self-destructive manipulating that at-risk teens will engage in.

Your child’s drinking or getting high is worrisome and often a challenge to figure out what steps to take.  Flexibility and being open to different approaches to prevention, counseling and treatment for substance use is crucial. Harm reduction approaches can offer you an approach allowing you to get back into the ‘driver’s seat’ of family control if you find yourself in the passenger seat—or even worse, the back seat.

The philosophy of harm reduction is based on our knowledge that human beings will always be engaged in behaviors that carry risks, like alcohol and other drug use and unsafe sex. Harm reduction embraces the value of each person’s dignity and the respect of a person’s right to make choices. This shifts the focus from attempting to restrict or prohibit risky behaviors to reducing the negative consequences associated with them.