Introducing the HAMS Harm Reduction Program - An AA Alternative

Is abstinence a necessary goal?

Depends on who you ask – but whether you want to quit or just cut down, there’s room for you at harm reduction focused HAMS meetings, where baby steps of progress lead to longer journeys in the right direction and the motto of note is simply ‘better is better’.

Though AA gets most of the attention, you have other community self-help groups, such as SMART Recovery and also the alcohol harm reduction focused HAMS, a peer-led and free-of-charge support group. The acronym HAMS stands for Harm reduction, Abstinence, and Moderation Support.

There’s something unorthodox about a self-help group like HAMS that supports as much drinking as you seek (goals are all individual and never judged) but for advocates of HAMS and other harm reduction approaches, abstinence-only programs don’t meet all needs and too many people never find success or comfort within-abstinence only confines.

As an alternative, HAMS strives to meet drinkers where they are and to offer support and education toward any reduction in drinking, no matter how slight – because as they say in HAMS, better is better.

HAMS is a non-profit evidence-based program and centers around the working of 17 elements (CBT or behavior modification tools) and participation in support group meetings. The HAMS program is outlined comprehensively in Kenneth Anderson's manual ‘How to Change Your Drinking’.

Is HAMS right for you?

For more on the program, we asked HAMS' founder and executive director Kenneth Anderson, MA a number of questions on the workings and potential benefits of this newer option.

An Interview with Kenneth Anderson

Choose Help - Hi Kenneth, to get started with this, where can I find a HAMS meeting and approximately how many people are active HAMS users right now?

Kenneth Anderson - HAMS support groups function primarily online; HAMS has both an email support group and a real time chat. The email support group currently has 1,237 members and an average of about 20 messages are posted to the group each day. HAMS chat is scheduled at 9 PM Eastern time 7 days a week; scheduled chats are active and lively with up to a dozen people interacting at once. Many users also make use of the chat room outside of scheduled hours. People from all around the world make use of both the chats and the email group. There is also a live HAMS group in Brooklyn, NY and a professionally led group is facilitated by Cynthia Hoffman in San Francisco.

Choose Help - Don’t people seeking an alternative to AA and the 12 steps already have a viable alternative group with SMART Recovery? How is HAMS different from SMART?

Kenneth Anderson - SMART Recovery is an abstinence based group aimed at people whose goal is total abstinence from a problematic behavior or substance. HAMS is based on the principles of harm reduction; HAMS encourages any positive change from safer drinking to reduced drinking to quitting alcohol altogether. Aside from this difference, there are many similarities between HAMS and SMART: for example, both make use of a tool called a Cost Benefit Analysis (also known as a CBA or Decisional Balance Sheet). Both also make use of many tools borrowed from Cognitive Behavioral Therapy such as the ABC method developed by Dr. Albert Ellis.

Choose Help - OK, could I do HAMS and AA or SMART at the same time?

Kenneth Anderson - Yes. HAMS members are welcome to use whatever works to attain their goals vis a vis alcohol. A fair number of HAMS members eventually opt to quit drinking entirely and many of these people decide to be involved with both HAMS and SMART. SMART tends to be the most comfortable abstinence program for HAMS members because of its grounding in science, but it is not unheard of for HAMS members to attend AA as well. HAMS realizes that people know deep down what is best for themselves and hence HAMS encourages its members to think for themselves and make their own decisions.

Choose Help - How long do people usually spend working the HAMS system?

Kenneth Anderson - This varies widely depending on the individual; HAMS members are welcome to stay a lifetime if they find it beneficial or if they choose to stay to help others. Members are also free to come and go as they please; some will dip their toe in the water, leave for a few months or a year and then come back later and make a stronger commitment. There is no pressure and no one will say "I haven't seen you at meetings lately." However, it seems that many people manage to get their drinking under control in something like a year's time, although some people may move faster and get it together in a couple of months while others may take a couple of years. A saying we like is "This ain't no hoss race."

Choose Help - Does HAMS work? Do you keep any kind of outcome records?

Kenneth Anderson - It is fairly difficult to track outcomes on a loosely knit group like our own where people are very much free to come and go as they like, however, in the future we are looking at the possibilities of doing some more formal research on the group, possibly in conjunction with some of our academic colleagues.

Choose Help - You don’t try to persuade people to quit alcohol completely, but in your experience, do people tend to have better outcomes from quitting completely with the HAMS system or with moderating?

Kenneth Anderson - My guess is that about one fourth of HAMS members will eventually opt for quitting alcohol entirely or almost entirely. HAMS is the newest kid on the block and we don't have anywhere near the visibility of AA or even SMART. Since our members have to work pretty hard to find us they tend to be aware of all the other options out there because they have spent some time Googling. So it is fair to say that our self selected group is definitely skewed and very far removed from a random sample; I believe that people already have a good idea of what they want by the time that they find us. I think that the numbers might be very different if HAMS were as well-known as AA and I am waiting for that day to come.

Choose Help - Isn’t rock bottom necessary?

Kenneth Anderson - The notion that people have to "hit bottom" to overcome an addiction is one of the most damaging myths ever created and undoubtedly kills tens of thousands of people each year. The research tells us that the more resources a person has intact in terms of family, employment, housing, social life, etc., the better chance that person will have of beating an addiction. Stanton Peele discusses this research in depth. Moreover, the more trauma that a person suffers, the lower their chance of beating an addiction. Gabor Mate is a good source on trauma and addiction. Telling people who question AA dogmas that they need to go out and drink more and suffer more and that once they suffer enough they will come crawling back to AA on their knees has undoubtedly killed a lot of people. NESARC tells us that the majority of people who overcome an addiction to alcohol do it on their own without AA and without treatment. Our goal at HAMS is to help them get there faster with less damage on the way.

Choose Help - Some people might argue that a harm reduction approach might work for a person with a mild to moderate substance use disorder, but for someone with a very serious problem, an abstinence focused program is a better choice. How do you feel about this?

Kenneth Anderson - It would be great if there was some magic wand we could wave and make everyone with an alcohol problem abstain completely, but that doesn't exist. Trying to force AA on people against their will usually backfires and makes them drink more than ever. And we know what a dismal failure prohibition was and is. When we do needle exchange, we don't make moderate heroin use a prerequisite to getting clean needles. We don't tell those who are addicted to heroin that they need to quit if they can't moderate their heroin use. Quite the contrary, we recognize that the more dope a person shoots the more clean needles that person needs. Keeping drug users healthy and AIDS-free increases the chance of recovery down the road. Likewise, the more alcohol a person drinks and the more alcohol related harms a person has in their life, the greater the need of that person to practice harm reduction. It might mean selling your car and getting a bus pass if that is the only way you can stop drinking and driving. The important point is to stay safe and alive until you are able to either quit drinking or cut back to a point of no harm. Because dead addicts don't recover.

Choose Help - Why is it important to write down and talk about your CBA (Cost Benefit Analysis)? Why can’t you just keep it to yourself?

Kenneth Anderson - Did you ever have really good idea, fail to write it down, and the next day you can't remember what it was? Writing things down fixes them in one's mind, makes them real,, and keeps them accessible to memory. This is why students need to take notes in class--what they write down is what they will remember. There is also research by Richard Wiseman which shows that for many people, sharing a behavioral change goal in a safe environment can increase one's odds of success with this goal.

Choose Help - Let's talk about the health implications of continued drinking. Using your risk ranking, you define low-risk drinking as between 15 and 29 drinks per week for men and 8 to 24 drinks per week for women. This seems higher than what’s recommended by a lot of health agencies – for example, by SAMHSA definitions, having 7 drinks in a sitting 4 nights a week would be defined as 4 binge drinking sessions per week. Wouldn’t that level of drinking put a person at high risk for health problems?

Kenneth Anderson - What is actually bizarre is SAMHSA's definitions of heavy drinking and of binge drinking. SAMHSA defines anyone who drinks more than four standard drinks in a day in the past thirty days as a binge drinker. Anyone who on five days of the last thirty days exceeds the four drink limit is classed as a heavy drinker. In other words the man who has twenty five drinks a month is in the same category as the man who downs a liter of vodka per day, seven days per week. SAMHSA makes no distinction between the man who has twenty five drinks a month and the man who has over seven hundred drinks a month--according to SAMHSA they both fall into the category of heavy drinker and there is no distinction between them. Epidemiologists who have used these definitions to categorize drinkers have found that they lead to the bizarre conclusion that heavy drinkers live longer than non-drinkers.¹ Other epidemiologists who use more realistic criteria such as the DSM IV criteria for Alcohol Dependence, on the other hand, come to the far different conclusion that heavy drinkers die about 20 years sooner than the general populace.² This is why we at HAMS categorize those who exceed the SAMHSA/NIAAA limits for moderate drinking (4 daily and 14 weekly for men; 3 daily and 7 weekly for women) on a continuum which ranges from the very high risk drinkers who put away a quart or more of vodka daily seven days a week to those at much lower risk who may down a six pack on Saturday night and not drink at all for the rest of the week.³

Choose Help - Some of the instructions in your book differ from conventional best practices, such as using beer to taper with to avoid excessive alcohol withdrawal symptoms. Have you received any feedback on the beer taper concept from doctors or other medical professionals?

Kenneth Anderson - Some people are absolutely unwilling to check into a medical detoxification program, either because they do not want a diagnosis of alcohol dependence on their medical records, because they have no medical insurance, or because they have experienced horrific treatment at the hands of addiction treatment provides in the past. Since these people are at risk of death if they stop alcohol cold turkey, we have provided instructions on how to detox using alcohol. Doctors have used and continue to use intravenous ethanol as an alternative to benzodiazepines in some cases, so using alcohol to detox from alcohol is a medically accepted practice⁴.⁵ It is always safest to detox under medical supervision with a reputable provider, unfortunately many states lack regulations on addiction treatment and there are untold numbers of unscrupulous treatment providers who kill people with cold turkey lock down detox every year. There is unfortunately, no FDA for addiction treatment and no federal regulation to prevent this and require the use of evidence-based best practices. It is truly the wild west out there.

Choose Help - How suitable is HAMS for a person with a co-occurring mental illness? In some cases, isn’t it really necessary for a person to abstain from all drugs and alcohol for a while in order to make an accurate diagnosis of mental illness?

Kenneth Anderson - For people with a co-occurring mental illness who are not succeeding with abstinence, harm reduction is the only sane approach. Harm reduction is highly suited to this population as they tend to have far greater difficulty in achieving abstinence than those with addiction alone. We strongly recommend that those with dual diagnosis who are not succeeding with abstinence work closely with a harm reduction therapist. This is a topic which is dealt with in great detail in Patt Denning's book 'Practicing Harm Reduction Psychotherapy, Second Edition: An Alternative Approach to Addictions'. People with dual diagnosis are very welcome at HAMS but will generally find that therapy is a necessity as well.

Choose Help - So is HAMS appropriate for everyone then? Is there any ‘type’ of person or person in a certain situation that wouldn’t benefit from the HAMS program?

Kenneth Anderson - Everyone can benefit from reducing harm; no one benefits from increasing harm. That being said, Bill Miller's research demonstrates that people with a history of a lot of involvement with AA tend to do very poorly with controlled drinking programs. It is likely that ex-AA members will need to be very thoroughly deprogram from the AA ideology of "one drink means one drunk" in order to succeed with a controlled drinking program. Aside from this, many people find quitting completely to be far easier than controlled drinking. It is also interesting to note that Bill Miller's research found an inverse correlation between severity of alcohol dependence and success at moderate drinking; however, no such correlation was found between severity of alcohol dependence and harm reduction outcomes. In other words, even people with severe alcohol dependence were capable of reducing harm even if they did not achieve either abstinence or moderation.

Choose Help - How important is it to actually go to HAMS meetings? From reading the book, I get the sense that I could do the program pretty much on my own, if I wanted to.

Kenneth Anderson - Some people can benefit greatly from groups while others do better working on their own. In particular, people who are very uncomfortable in groups may find groups to be detrimental. It would be nice to see more research on this topic, but apparently little has been done--people just follow an assumption that groups are necessary with nothing but convention to back it up. As harm reductionists we always try to meet people where they are at, so we have groups for those who benefit from them and we are also completely accessible for those who choose to work on their own using just the book and web site. Since we have sold over 8,000 copies of our book while our online group has around 1,200 members, we assume that many people are using the book on their own without a group and we believe that many are successful since the NESARC data supports the idea that many people are able to overcome an addiction to alcohol on their own. This is not to downplay the fact that many people may find the support group the key element which spells the difference between success and failure. People know deep down what is best for them so we ask them to decide for themselves whether participating in the group will be beneficial or not.

Kenneth Anderson, MA is the founder and CEO of The HAMS Harm Reduction Network and the author of How to Change Your Drinking: a Harm Reduction Guide to Alcohol.

Mr. Anderson has worked in the field of harm reduction since 2002--his experience ranges from work in needle exchange to work in moderate drinking programs and everything in-between. He has served as Director of Online Services at Moderation Management, and has worked "in the trenches" of harm reduction by doing needle exchange in Minneapolis. He has presented at the National Harm Reduction Conference and has been a regular guest speaker at the Harlem Hospital Harm Reduction Program, The Lower East Side Harm Reduction Center, and many other venues. Mr. Anderson is a member of The International Center for Clinical Excellence, the Global Alcohol Harm Reduction Network, and the International Harm Reduction Association. He holds a masters degree in linguistics from the University of Minnesota and is currently pursuing a masters degree in psychology and substance abuse counseling at the New School for Social Research in New York City.⁶