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.

The holiday season is upon us in full force, and if we believe the media good-times advertising blitz, they'll be full of unlimited joy and good tidings. (I was never sure what tidings are. If anyone knows, let me know!)

Families with problematic substance users usually dread the holidays, the constant worry of their struggling family member spoiling the family's  good times with unpredictable behavior.

Here are some suggestions for not just  'getting through' the holiday season, but to help you and the rest of your family to enjoy it more.

Set firm and  respectful boundaries. This guideline for boundaries hold true 365 days a year, but re-establishing them during the holiday season will lower the likelihood of your holiday being disappointing.

Look at the larger picture. The fact that there are many other occasions down the road to celebrate, reflects an aspect of addiction and recovery that my clients often have a hard time grasping: addiction and recovery are a process that unfolds over time, with progress and relapse, ebbs and flows.

Manage your expectations is another important concept. Having a realistic and flexible sense of what to expect can make adjusting to the normal slips and slides of life in recovery easier.

Many people in addiction recovery also have chronic pain associated with illnesses or injuries. The stigma and public ignorance about addiction and recovery, combined with the epidemic of prescription opioid abuse, create frustrating barriers for many people to get quality, effective care for their pain management.

A recent article in The Philadelphia Inquirer by an anesthesiologist at the Hospital of the University of Pennsylvania identifies the problems built into our healthcare system and culture that contribute to the struggle that people with chronic pain have in getting relief. She describes chronic pain as "a staggering burden, reducing overall quality of life, social functioning, and psychological well-being". She cites a dated but significant research report estimating that pain costs the U. S. public $100 billion a year in associated health care, lost wages, and legal costs. And we know that with as we live longer, the problem is likely to get worse.