This week: Harm reduction or abstinence?

Disclaimer: I’m not an expert. I’m not a therapist. What I am is a 33-year-old woman who has dealt with a lot of big life shit. In this new weekly advice column, I will try to help you sort out your tough issues by sharing my own experiences. Family disputes, career woes, sexual health, anxiety, addiction, crippling debt, a troubled marriage, loneliness—what’s keeping you up at night? What problem are you unsure of how to handle? Hit me with the tough shit (don’t worry: it’s totally anonymous) and I’ll give you the best advice I can in return. And if I feel that my expertise is limited, I’ll find a smart professional to weigh in on the subject. Because we can all use a little help sometimes.

Q: Do you think for anyone with substance issues, cold turkey is always the only answer, or can some people handle drinking moderately as long as they are dealing with their issues?

It sounds like the substance is the issue here. Or, at least, it’s what needs to be dealt with first before anything else can be sorted.

There is substance abuse and there is addiction. In my experience, many people can curb substance abuse by very carefully moderating their drinking, independently and/or with professional help—but some people can’t. And substance abuse can easily develop into addiction. I’ve met people who believe they were born addicts; others have shared that they experienced a kind of slide into addiction, that things worsened over the years. At 24-years-old they would have considered themselves heavy drinkers or recreational cocaine users, but by 31, alcohol and/or drugs controlled their lives. Put another way, they had zero control over the substance they abused; it controlled them. They became addicts.

There are those who believe that you can conquer addiction via harm reduction. I first tried to moderate my drinking when I was 19: Fail. I tried again at 25: Fail. Again, and again, and again: Fail, fail, massive fail. Then shit got worse. Read enough books, hear enough stories, or even watch enough movies about substance abuse (there are a ton out there!), and it will become clear that addictions usually get a lot worse before they get better. For that reason, alcoholism is often referred to as a progressive disease.

In my experience, from what I have personally gone through and what I have observed in hundreds of other addicts, abstinence works best.

I can’t really speak for others, but here’s why moderate drinking doesn’t work for me: I never want to just moderately drink. If I drank tomorrow, I don’t really know where that drink will take me. I might stop at three, but more likely I’d have six or seven. Maybe 12. Perhaps I’d be the life of the party, but it’s quite possible I’d flash someone (the things you do when you’re 21-years-old are, well, less cool when you’re 33). Likely I’d say something I would really regret later. Heck, maybe I’d trip in front of a streetcar and get killed. I don’t know! I never know what happens after that first sip—and that’s why I choose to abstain. For me, sobriety is a much more manageable and happy space to be in.

So, back to your question: Is cold turkey the only answer? No. But it’s my answer. In order for you to figure out if it’s yours, you need to take a really honest look at your situation and history. The idea of abstinence might seem impossible, and it might sound like a horrible way to live, but it isn’t and it’s not.

Talk to your family doctor. If you really want to stop and you can’t, call the AA hotline. Somebody on the other end of that phone can help you through this. And trust me: you will get through it.

Send questions to jenmcneely@shedoesthecity.com. All correspondence will be confidential. 

~ Jen McNeely