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Alcoholism

An Interview with Kenneth Anderson, M.A., on Alcohol Harm Reduction

David Van Nuys, Ph.D.
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Kenneth Anderson, M.A. Kenneth Anderson, M.A., talks about the harm reduction approach to problem drinking. He is the author of the 2010 book, How to Change Your Drinking: a Harm Reduction Guide to Alcohol. Mr. Anderson is also the founder and CEO of the HAMS - Harm Reduction Network. Mr. Anderson explains that HAMS is an acronym and that the H stands for harm reduction. The A is for abstinence from alcohol or drugs, and the M is for moderation. The S is for support. This lay-led, free-of-charge group offers support for people who wish to make any positive change in their drinking habits - from safer drinking, to reduced drinking, to quitting altogether. Harm reduction is a philosophy that supports any positive change. Mr. Anderson states that the difference between harm reduction approach and some of the more traditional approaches is some of the more traditional approaches were coercive and attempted to force abstinence on people against their will. He says that's not true of all of them, but some of them have used that approach, and that's not been very successful. He believes that usually you get a reaction and people say, "Well, I'm going to do just the opposite of what you're trying to force me to do," and it can often lead to more problems. So harm reduction found that an approach that meets people where they are at, and supports changes that they choose to make for themselves, is the most successful type of approach to use.

David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by Mentalhelp.net, covering topics in mental health, wellness, and psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist and your host.

On today's show, we'll be talking with Kenneth Anderson, M.A., about the harm reduction approach to problem drinking. Kenneth Anderson, M.A., is the author of the 2010 book, How to Change Your Drinking: a Harm Reduction Guide to Alcohol. Mr. Anderson is also the founder and CEO of the HAMS - that's H-A-M-S - Harm Reduction Network, a lay-led, free-of-charge support group for people who wish to make any positive change in their drinking habits - from safer drinking, to reduced drinking, to quitting altogether.

Mr. Anderson has worked in the field of harm reduction since 2002, and has studied psychology and substance abuse counseling at the New School University in New York City. He is a member of the International Center for Clinical Excellence, and the International Harm Reduction Association, and is a regular presenter at the National Harm Reduction Conference hosted by the Harm Reduction Coalition.

Now, here's the interview:

Ken Anderson, welcome to Wise Counsel.

Kenneth Anderson: Thanks for having me on your show, Dave.

David: Well, I've been reading your 2010 book, How to Change Your Drinking: a Harm Reduction Guide to Alcohol, and I noticed that Alan Marlett wrote the preface and Patricia Denning wrote the introduction. I'm not sure if you're aware that I previously interviewed both of them about harm reduction. But I think it's an important enough topic to deserve more coverage.

Kenneth Anderson: Well, those are certainly two of the most important people in the field. I was very grateful that they were willing to write a preface and an introduction for me. They've been very supportive of our organization since we founded it.

David: Yes. And your organization is HAMS. It's an acronym, and I'm an old ham radio operator, so I have the wrong association to it. What does the acronym HAMS stand for?

Kenneth Anderson: The H stands for harm reduction. The A is for abstinence from alcohol or drugs, and the M is for moderation. The S is for support. So we are a support group that supports any positive change in your drinking habits - from safer drinking, to reduced drinking, to quitting altogether.

We also have a subgroup email group that is specifically for drug users. It's not that we decided to segregate people, but the people themselves decided that they would like separate groups, so we accommodated them by giving the drug users one group, and then we have the drinkers on the other email group. And then we have a chat room where anyone can come in and interact, and we do a lot of online support, and that's one of the main things we do, is online support. We also have a live group in Brooklyn, New York.

David: Okay. And HAMS is a non-profit organization. Do I have that right?

Kenneth Anderson: That is correct. All the meetings and the online groups are free of charge. There's no cost to join. And all the information on the website, on the Internet, is free to use. Any professionals out there that visit the website, hamsnetwork.org, you are free to reproduce any information. All I ask is that you include the copyright on it. The only thing that we are actually selling is our book, which is actually rather reasonably priced at $17.00 for a very large, 286-page workbook. It's 8 x 10 inches. So that's the only thing that we do charge for, and I do say that the book is better organized than the website, so it is worth getting.

David: Yes, I agree, having gone through the book. It seems like it's a very valuable resource and, as you suggest, it is priced quite fairly. Well, let's back up a little bit and have us take you through your definition of harm reduction in case we have new listeners who haven't heard the earlier discussions about that. What is harm reduction?

Kenneth Anderson: Harm reduction is a philosophy that supports any positive change. As I said, we do harm reduction for alcohol. We support safer drinking or reduced drinking or quitting. Some people might want to stop drinking and driving. They've decided it's a bad idea. They might not be ready or willing to change the amount they drink, but even deciding to stop drinking and driving is something that we would support. I mean you can't walk into an AA meeting and say, "I want to still keep drinking, but I want to stop drinking and driving," because that's not what they're about. But our place is a place where you can do that.

So people have a misconception about harm reduction that harm reduction is opposed to abstinence, and that's not true at all. We view abstinence as one way of eliminating harm from a risky behavior, and we are totally in favor of anyone that chooses abstinence, and we're very supportive of people that successfully achieve abstinence.

The difference between harm reduction approach and some of the more traditional approaches is some of the more traditional approaches were coercive and attempted to force abstinence on people against their will. And that's not true of all of them, but some of them have used that approach, and that's not been very successful. Usually you get a reaction and people say, "Well, I'm going to do just the opposite of what you're trying to force me to do," and it can often lead to more problems. So we have found that an approach that meets people where they are at, and supports changes that they choose to make for themselves, is the most successful type of approach to use.

David: So, I gather that you see the reduction of drinking is kind of on a continuum where total abstinence is at one end, and then there are kinds of shades of gray, if you will, all along the way, of varying degrees of abstinence.

Kenneth Anderson: Absolutely. And of course we always want to emphasize reduction in risks and safer habits. Harm reduction can apply to anything in life, not just to drug or alcohol use. One example we could talk about would be driving an automobile. Now, one way to eliminate all the harm from driving an automobile is not to drive, to abstain from driving.

David: Right.

Kenneth Anderson: Well, it's not very practical, and most people don't choose that. A few do, but the majority won't. So we've introduced a harm reduction device called a seat belt for automobiles, and this is how - this is a way to reduce harm for people that drive automobiles.

David: Okay. The notion of harm reduction, short of total abstinence, really flies in the face of AA doctrine. And it seems like AA is just so much better known, and that's one reason I wanted to have this chat with you because, for whatever reason, it seems to me that everybody's heard of AA. I'm not sure that so many people have heard of the harm reduction approach.

Kenneth Anderson: This is true. We are not as well known as AA. However, many of my colleagues who work in harm reduction programs, like needle exchange, are actually themselves members of a 12-step group - Alcoholics Anonymous or Narcotics Anonymous - and they don't find that it's a contradiction for them. Many of them, when they were using drugs, when they were injecting drugs, used needle exchange programs, and then when they decided to stop, they found that the 12-step groups were a good way to help them to stop, and they find that the two are compatible.

One thing that you find in needle exchange is people will not try to convert you to join a 12-step program or talk you into abstaining. When you use a needle exchange, which is a harm reduction program, people say, "Thank you very much for bringing in the used needles and getting them off the street. Here's clean ones. We encourage you to always use clean ones." And it's not a place to proselytize.

So, I myself, because I wanted to learn about harm reduction, there wasn't really a lot out there for alcohol harm reduction at the time. So I volunteered for a couple of years on and off at the needle exchange in Minneapolis. And I gave out lots of clean needles; I took in lots of used needles. And it was a wonderful experience for me because it totally changed my attitude.

Harm reduction is so much of an attitude in addition to an intellectual thing that you have in your head. It is an attitude of always wanting to encourage every positive change, to meet everyone where they are at, and to always encourage people to carry out - carry through changes that they have chosen to make for themselves, and not to try to impose your own views upon other people.

David: Well, it sounds like it's a positive attitude, as opposed to one that's blaming the addict.

Kenneth Anderson: Absolutely. Blaming does not help at all.

David: And AA says "once an addict, always an addict" and that you can't take a single drink, but I gather that, even though there are people that belong to both organizations, that's not necessarily your belief.

Kenneth Anderson: Well, research by the NIAAA, the National Institute on Alcoholism and Alcohol Abuse, published in the NIAAA Spectrum in 2009, found that of people that resolved an alcohol dependence problem, about half resolved it by quitting completely, and about half resolved it by reducing their drinking to non-problematic levels.

And you can look this up online on Google. Just Google "NIAAA Spectrum," and you'll get an article called "Alcoholism Isn't What It Used To Be," and this is the result: people with alcohol dependence, a diagnosis of alcohol dependence - which is the current term that we use for alcoholism - about half will quit completely, and about half will resolve the problem by moderating.

David: Well, that's interesting. I wasn't aware of that research, and I'm sure some listeners will want to go to that site and look it up. What about the AA approach that says that you need a higher power?

Kenneth Anderson: Well, AA works for a fairly substantial number of people. The same article I was just referencing said about 20% of people with alcohol dependence will resolve the problem with AA or with a traditional treatment program. And that's a substantial number of people. The other 80% don't find that useful.

If you find a higher power to be useful, that's great; and if you find it through AA, that's great too. If you don't find that a higher power is useful, if you're an atheist, you don't need that. You can empower yourself with cognitive-behavioral strategies. We talk a lot about cognitive-behavioral strategies in the book and ways to empower yourself.

And self-empowerment is another way to overcome your problem. And research by Albert Bandura on self-efficacy says that the more that people believe that they are capable of changing for the better, the better success rates they have at making the change. So we help to encourage people and support people to believe in themselves and to believe that they are capable of changing for the better.

David: Well, that certainly makes sense to me. Now, that statistic that you cited of 20% success through AA, 80% by other means, that certainly is a surprising statistic; both to me and I suspect for many listeners would have thought that it would be just the reverse, that maybe AA would have been the 80%. Can you comment on the disease model? This has always seemed a little strange to me, to liken alcoholism to a disease. Is that a model that makes sense from your perspective?

Kenneth Anderson: I'll address that. Before I do, I want to go back to those numbers a little bit. Twenty percent succeed through AA; 55%, about, succeed on their own. There's another 25% that do not overcome alcohol dependence.

David: Okay. Thanks for that clarification.

Kenneth Anderson: But even among those, quite a number of those people do make some improvements and become safer as they get older. Now to go on to address the idea of a disease - if you are an alcoholism counselor, if you want to get paid by the insurance company to treat alcoholism, you need to have it classified as a disease, and that's why in the DSM-IV we have alcohol dependence and alcohol abuse as diagnoses. So it is good for people that want to get paid by the insurance company for work that they do with people with alcohol problems.

In a larger sense, is it useful to tell people that they are diseased, that they are powerless? Our approach is just the opposite. We say people are - you don't have a disease; you have a maladaptive coping mechanism. You've used alcohol in the past because it worked to solve some problems. Maybe it helped you with anxiety, with depression, social phobia. Alcohol can be helpful in many ways, especially at first.

But then as people continue to drink more, it begins to have problems associated with it; so what was originally a good coping mechanism becomes a problem in and of itself. So we call it a maladaptive coping mechanism, and what we do is try to teach people to find new coping mechanisms that will not be accompanied by problems, to deal with whatever they were using alcohol for - whether it was anxiety, depression, social phobia, or whatever.

David: Yeah, but there is some kind of a biological and genetic substrate as well, isn't there? Isn't there evidence that there is a genetic component to this, and certainly there are sort of biochemical, brain-related reasons that tap into addictive phenomena as well? Not just habit, right?

Kenneth Anderson: Well, there are some genetic susceptibilities. We know that. There's been a lot of interesting research on this, and what we found is genetic susceptibilities play a certain part. Environment is also a very important factor. And our approach - we really believe that people have a choice, and we believe that this is not a factor that really plays into things. So some people don't believe in free will, don't like the word "choice," so that's why Albert Bandura talked about self-efficacy - belief in the ability to change. But we believe that these are all important factors.

Dr. Gabor Maté wrote a book called In the Realm of Hungry Ghosts, and he talked about how trauma can turn genes on or off. Human beings in particular, when they are born they are still very undeveloped. A horse when it's born can run the same day that it's born. Human beings take a year to learn how to walk. Our genes are turned on or off by the environment, and Dr. Maté talks about the effects of trauma turning genes on, genes for addiction on. And people that have been very traumatized are more likely to be addicted. So we believe - the evidence overwhelmingly shows that environment is extremely important, as well as genetic susceptibility. They're both very important.

David: Okay. Shifting just a little bit - how old is the harm reduction movement?

Kenneth Anderson: The harm reduction movement in the United States got its momentum going with the AIDS crisis, and some of the early manifestations were ACT UP. And people were trying to find some way to deal with AIDS, and one thing that we realized that we could do was give people clean needles, condom distribution, education about safe sex. These were all very important things; they were closely tied up in the 1980s with each other.

And there were a lot of laws against paraphernalia then, so a lot of the needle exchange was illegal, underground, conducted out of trunks of cars and things. And it became more legitimate in the '90s. Every state in the United States except one now has legalized the possession of clean needles. Texas is the only state left that will still - has criminal penalties for the possession of a clean needle without a prescription. But that's a bit of the history of the harm reduction movement in general.

Our organization was founded in January of 2007. It was based on harm reduction principles that had already been put into use with drug users. So I built upon that and tried to adopt it to people who drink alcohol. I did this because I had a problem with drinking too much alcohol myself in the past. And when I heard about harm reduction, I realized that this was something that I could utilize for myself.

And I started studying it more deeply, and I realized that more people than myself only could use this, so I wanted to form a group that would help others that did not find the more traditional approaches had an appeal to them. For me, I tried AA and actually wound up drinking more, and I drank till I had severe withdrawal. I wound up in detox so I didn't have a heart attack, and that was my personal reaction to the 12 Steps, just the opposite of what you would like it to be.

David: Thanks for sharing that, your personal story with us. Are you able to drink socially now?

Kenneth Anderson: Yes. I've spent a long time changing my drinking habits, and currently I generally drink one night a week to intoxication. I drink safely at home. I don't drink on a work night. I drink a large amount of alcohol, but I don't leave the house, and it's very safe and doesn't cause me any problems. And on occasion I will have one glass of wine with dinner when I'm out with people, but I'm not seeking any intoxication or any effect from the alcohol then. I'm just drinking to be sociable and do the same thing that everybody else does. So it's no temptation for me to continue drinking after the one glass of wine in that sort of a situation.

David: Well, that's really fascinating. It sounds like a very - kind of a unique pattern, and I suppose that really honors the fact that each one of us is unique and maybe requires our own sort of unique approach or balance.

Kenneth Anderson: Absolutely. We encourage everyone who comes to our HAMS program to make their own plan. We encourage people to write these things out. It's very helpful to write them out. As I said, we have an email group, and many people post their plans on the email group. But we have as many different plans as we have different people.

Some will want to have only two drinks a night, and want to drink seven nights a week, but limited to two standard drinks. And this is actually the healthy limit that the USDA says is better for your heart health. Other people will want to be intoxicated on occasion, but they will plan it so that they're safe, they don't have to drive, and they don't engage in other high risk behaviors, such as unsafe sex with strangers or drinking and dialing or various other unsafe behaviors that tend to accompany alcohol, the intoxication. We encourage people to make a plan ahead of time, so that they won't put themselves at risk of getting into these behaviors.

David: Yeah. One of the questions that you address in the book is how much alcohol is too much. And you did say that there's a government organization that says two drinks a night, seven nights a week, would be about right. Is that the answer to the question, how much alcohol is too much?

Kenneth Anderson: Well, it's really up to the individual. Different people will find different amounts to be right for them. I mean some people will enjoy becoming intoxicated on occasion. It is behavior that has some risks that accompany it, but there are ways to plan ahead to reduce the risks. Some people enjoy sky diving. They like jumping out of planes. This is also a risky behavior. It gives them a big adrenalin rush. You know, we don't have a moral disapproval of skydiving, but we do expect people to have a parachute and to know how to use the parachute when they're going to engage in this.

David: Why is it that some people do drink too much?

Kenneth Anderson: I think generally it starts out - as I said, alcohol is a positive thing for most people who later develop drinking problems. Initially it's a positive thing and then, as the years go by, it gets to be a bad habit and the amounts go up. I mean your tolerance to alcohol does change. It goes down as you drink more, and you tend to drink more alcohol as the tolerance drops. And people can tend to use alcohol to deal with more new situations than they did before, and it kind of creeps up on you and suddenly you find yourself with a drinking problem, and you didn't really notice it was sneaking up on you. And you say, "Oh, I don't like this. I don't like the way things are right now," and you decide to change.

David: I think I was lucky to have maybe some kind of a built-in safety mechanism. In my youth I drank. College years, we would drink quite a bit to get very intoxicated, but I found that I just had horrible hangovers - retching, vomiting, and so on - and my body just was telling me so loudly that, whoa, this just isn't worth it. That was the cure for me.

Kenneth Anderson: Well, the research actually tells us that most college binge drinkers will stop when they graduate from college, when they go to graduate school or when they get a job, when they get married, when they get more responsibilities. People grow up. Stanton Peele calls this "maturing out of your bad habits," and this is very common. And actually most college binge drinkers will actually - when they get responsibilities, when they start growing up a little more and graduate from college and get into life, they will stop this kind of binge drinking.

David: Well, that's probably reassuring to some parents who might be listening. Now, in your book, you mentioned 17 elements that are involved in your harm reduction approach, and that's probably too many for us to go through here individually. Maybe take us through some of the ones that are most salient for you.

Kenneth Anderson: Certainly. We have 17 elements, and we call them "elements" and not "steps" because all of them are optional, and they can be done in any order. We don't have to start at number 1 and work through to number 17. If you find just one that appeals to you, that might be the only one that you need to do to resolve your problem.

If you don't know where to start, we do suggest starting at 1, because this is kind of a default order for people that haven't decided where they want to start. And number 1 is to do a cost-benefit analysis of your drinking. Some scholars call this a "decisional balance sheet." It's the same thing. You get out four sheets of paper, and on the first you write down the pros of continuing to drink as you currently do. On the second, you write down the cons, the negatives, of continuing your current drinking habits. On the third, you write down the pros of your change goal. For example, maybe you want to quit drinking, so you can write down the pros, the positives, of quitting drinking. On the fourth, you can write down the negatives, the cons, of your change goal. So you might write down the negatives of quitting drinking.

And some people might ask, well, why would I want to write down the positive things about drinking if I want to quit? Well, it's actually very important to do this, because if you don't write those down, they stay in your subconscious, they sneak up on you when you're not thinking about it, and pretty soon you have a relapse and you're drinking again, and you don't even know why. Really, it's because you tried to repress the positive things instead of realizing that they are there.

What happens when you realize that there are positive things about drinking, you can say, "Oh, wait. Drinking helps me to relax. What other strategy can I use to help me relax? Can I exercise? Can I do yoga? Can I meditate?" There are all kinds of things. So be aware and then think about other ways to overcome these problems that you used alcohol for before. Maybe you had social phobia, didn't know how to talk to people, and maybe now you want to try to join Toastmasters, so get experience talking in front of people so that you won't be so shy next time that you're addressing a crowd.

David: Well, I see you've got a lot of good alternative ideas. What's another one or two of the key elements of the 17-element program?

Kenneth Anderson: Well, one that's very useful and we suggest very strongly to almost everyone is charting. And you can do this with a calendar. We want you to write down the number of drinks you have each day. And it's important to learn what a standard drink is in order to be able to chart.

So a standard drink is one 12-ounce beer at 5% alcohol, or a 5-ounce glass of wine at 12% alcohol, or a shot, 1-1/2 ounces, of hard liquor at 40%, 80 proof of alcohol. These are the standard drinks. And you want to record the amount you drink each day in standard drinks. And some people find that the very act of recording the number of drinks they have each day helps them to cut down even when they're not trying to cut down, because it makes them so consciously aware of what they're doing.

You can also use the chart to make a drinking plan. Say you're using a calendar. You can write down if you want to abstain from drinking on, say, Monday. For Monday write down zero drinks. That's your goal. If you plan to drink moderately on Tuesday, you might want to write down a goal of two drinks. If you want to have a safe day where you're going to be intoxicated on Saturday night because you know it's your weekend, you might want to write down a goal of 10 drinks. And that's a way to plan your drinking using the chart, as well as tracking the drinking.

And then you can compare the plan with the actual outcome and see did you stick to the plan, did you not stick to the plan. What new strategies can you create to stick with the plan better next time if you did not manage to stick with the plan? Besides using a calendar - that's one way to do it - we also in the book have tracking worksheets, which are a little more detailed, where you can fill out a bit more detailed information, and it's kind of already set up for you in the worksheet.

David: Yeah, I can see where that would make sense, and I can also see some relationship maybe to cognitive-behavioral therapy or CBT, which I think you mentioned earlier. And are there other ways in which the cognitive-behavioral therapy fits in with your approach?

Kenneth Anderson: There are many ways. Many people who drink too much have a co-occurring problem such as depression or anxiety or social phobia, as I mentioned. And there are cognitive-behavioral techniques that you can use to deal with these. One of the best books written on this is by David Burns. It's called Feeling Good, and there's also a Feeling Good Workbook that goes with that. And this is a very detailed way. We do have a chapter that gives you some basic techniques, too, for dealing with this. If you want more detail, I highly recommend Dr. Burns' book.

There are also AVRT strategies. This was developed by Jack Trimpey in Rational Recovery, and this is very closely related to the cognitive-behavioral approach. This is a way, when you want to have a day when you abstain from alcohol or if you want to abstain permanently from alcohol, you can disassociate your rational mind from that voice that's telling you to drink, which Trimpey calls the "lizard brain" or the "beast brain." And you can talk back to that voice, and tell that voice "you can go to heck; I'm not going to have a drink."

David: Interesting that you mentioned David Burns. I hate to be such a name dropper, but I'm also pleased to say that I was able to interview him and had a delightful interview. Now I notice, beyond CBT, you also draw on some other psychological theories - for example, rational emotive therapy and DPT. Maybe you can say a little bit about those two and where they fit in.

Kenneth Anderson: Yes, dialectical behavioral therapy, DBT, is a more recent development, a modification of CBT by Marsha Linehan, that was originally used to deal with borderline personality disorder. But I found that - you know I thought many of these things from DBT fit very well with people with substance abuse problems too. And DBT teaches you about mindfulness. It teaches you about accepting things. Maybe you don't feel good right now, maybe you feel really crappy right now, but DBT says you can accept that and just accept that's the way it is, and that it won't last forever.

Another thing that DBT talks about is distraction and soothing, self-soothing. And one way to distract yourself if you are having a craving for alcohol, you could decide to go sweep the floor instead, and entirely concentrate 100% of your attention on sweeping your floor, and that will distract you from thinking about alcohol and having a craving. You can self-soothe, get ice cream, take a nice, hot bath with nice smelling bath salts, aromatic bath salts - other things, anything that will make you feel good. These are some of the techniques that we've adopted from DBT, and they seem to be very successful for people with substance abuse problems, as they have been for people with borderline personality disorder.

David: Yes. Actually, I also interviewed Marsha Linehan, and I think you've given a great recap of that approach and how it can be applied in your work. I notice that you also talked about naltrexone and the Sinclair Method. And some time back I actually interviewed David Sinclair, and he was very persuasive about that approach. What do you see as the pros and cons of that approach? I know he's working with it in Scandinavia. I'm not sure it's so big here. What do you see as the pros and cons?

Kenneth Anderson: Well, right now the biggest difficulty people seem to have with the Sinclair Method is finding an MD that will prescribe naltrexone according to the Sinclair Method. Because they go in and they ask for the naltrexone, and they say, "Have you heard of the Sinclair Method?" and the doctor says, "No, I haven't heard of that," and they start to explain it, and they're "I'm the doctor. You're not the doctor. Don't tell me what to do." So people actually seem to have quite a difficult time to actually get the naltrexone prescription for this. And doctors often say, "Well, let me give you the implant." But the implant won't work for the Sinclair Method.

We've had several people on our online support group try the Sinclair Method, and several of them reported good success. Others reported that it wasn't helpful to them. But I say try anything as a possibility. As I said, several people from our online support group reported good success with the naltrexone according to the Sinclair Method.

And I'll just recap very briefly that, in the Sinclair Method, you take the naltrexone only before you drink. You take it an hour before drinking, and it eliminates the reinforcement of the alcohol, so it extinguishes the conditioned response to drink. And the reason Sinclair says you don't want to take it other times, you don't want to extinguish your good behaviors. You don't want to lose your desire for sex or exercise or other positive things. You're only trying to work on eliminating the drinking, so he says take it only before drinking so that it only extinguishes the drinking behavior.

David: Yeah, so that's unlike Antabuse, which is more widely used, or at least was in the past. Am I correct that Antabuse makes a person nauseous if they drink?

Kenneth Anderson: It not only makes you nauseous, it raises your blood pressure, gives you headaches. It can kill you if you drink heavily on a large dose of Antabuse. So it's actually quite dangerous medication.

David: Let's talk a bit about withdrawal. That's a real process with physical symptoms, right? What do you recommend for getting through that?

Kenneth Anderson: Well, some people find that they can taper off of alcohol using alcohol itself by reducing their drinks gradually a bit at a time. And a lot of people say, "I don't want to have alcohol dependence on my medical records because I can't get insurance later." It causes all kinds of problems if you get a diagnosis of alcohol dependence on your medical records. And so people have been coming to me, sending me emails "are there ways to taper off?" So I finally wrote a page on the website and put it in the book about ways to taper off of alcohol using alcohol itself, because I had known several people that would do this periodically when they drank too much and started to have withdrawal.

We recommend that you use beer, and that you start at one beer an hour and then cut it down to one beer every two hours. And it is a safe way, and it's actually been researched in medical journals that it is as effective as using other medications. Some people find it very difficult to control their consumption when they're trying to taper off using alcohol. That's why we say beer, because it's harder to drink a lot of beer at once than it is vodka or some other hard alcohol. So the people that do taper usually find that the beer is more helpful.

Some people find that it just is not possible for them to taper. They can't get enough control over their use. So it's also possible to use Librium or Valium, to get a prescription from your doctor for that to take home. But then you will have this on your medical records that you have alcohol dependence, and some people don't like that. But I mean the Librium and the Valium and the alcohol all have the same effect: you take them to keep the GABA receptors from getting overactive, and then you taper down slowly on the Valium or the Librium, or taper down slowly on the alcohol, and you can get off safely.

Some states actually do not allow you to do a take-home prescription any more. I know that Minnesota is one because I had the personal experience there that you will be put in a 72-hour lockdown in detox if you go into any emergency room or any hospital for alcohol withdrawal.

David: Well, Ken, you are a treasure trove of information on this topic, as is your book. As we wind down, is there anything else you'd like to say?

Kenneth Anderson: I would like to say that we support every positive change, and that you out there, the listening audience, can adopt this idea whether you are a drinker or not. It is always important to be good to yourself. Whenever you want to change any habit, always praise yourself for making any positive change. Don't beat yourself up for being imperfect, because imperfection is a normal.

I mean it is normal to have some slip-ups. And you can say, "Okay, that was a mistake. Let me make a new plan so I don't make the same mistake next time." Don't go, "Oh, this is terrible, that I didn't abstain completely and perfectly." Because what we've found - particularly Dr. Alan Marlett talked about this a lot - people that beat themselves up for failing to abstain perfectly from alcohol would feel so miserable that they had to drink more and would go on benders for weeks or months on end because they were so unhappy at their failure to quit completely all at once.

David: Ken, that sounds like very solid advice. Ken Anderson, thanks so much for being my guest on Wise Counsel.

Kenneth Anderson: Thank you so much for having me.

David: I hope you enjoyed this conversation with Kenneth Anderson, M.A. His book, How to Change Your Drinking, is an excellent resource for friends, family, or individuals wishing to moderate or stop their drinking. This book is both encyclopedic and authoritative. It's filled with references and worksheets and specific advice and resources. In addition, you'll find lots of information on the HAMS website, which again is www.hamsnetwork.org.

Also, for more background information, I'd encourage you to listen to the other interviews I mentioned in our conversation, which you can find by searching the archives both at wisecounselpodcast.com and shrinkrapradio.com. I'm referring to my interviews with Alan Marlett and Pat Denning on harm reduction, and David Sinclair on the Sinclair Method, and Marsha Linehan on dialectic behavior therapy, or DBT, as well as my conversation with Dr. David Burns.

You've been listening to Wise Counsel, a podcast interview series sponsored by Mentalhelp.net. If you found today's show interesting, we encourage you to visit Mentalhelp.net, where you can add a comment or question to this show's web page, view other shows in the series, or simply page through the site, which is full of interesting mental health and wellness content. Access the show's page and show archive information via the podcast box on the Mentalhelp.net home page.

If you like Wise Counsel, you might also like ShrinkRapRadio, my other interview podcast series, which is available online at www.shrinkrapradio.com. Until next time, this is Dr. David Van Nuys, and you've been listening to Wise Counsel.

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About Kenneth Anderson, M.A.

Kenneth Anderson, M.A. Kenneth Anderson, MA is the author of the 2010 book "How to Change Your Drinking: a Harm Reduction Guide to Alcohol". Mr. Anderson is also is the founder and CEO of The HAMS Harm Reduction Network, a lay-led, free-of-charge support group for people who wish to make any positive change in their drinking habits from safer drinking to reduced drinking to quitting altogether. Mr. Anderson has worked in the field of harm reduction since 2002 and has studied psychology and substance abuse counseling at The New School University in New York City. He is a member of The International Center for Clinical Excellence and the International Harm Reduction Association, and is a regular presenter at the National Harm Reduction conference hosted by the Harm Reduction Coalition.

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