Dr. Norman Sinberg

Harm Reduction May Have Saved My Life

I didn’t hear about harm reduction until I had more than a decade of 12-step recovery. Like many 12-steppers I found the idea of harm reduction scary and threatening. Still, I strived to be open-minded and to avoid contempt prior to investigation, so I read several books on the topic. In doing so I found that I had actively practiced harm reduction as a young drinker and drugger and that it probably saved my life.

According to Wikipedia, the central idea of harm reduction is the “recognition that some people always have and always will engage in behaviors which carry risks, such as casual sex, prostitution, and drug use,” and the main objective of harm reduction is “to mitigate the potential dangers and health risks associated with the risky behaviors themselves.”  Dangers and risks are considered in terms of affect on the individual, the family, the community, and society at large.

Dr. Norman Zinberg’s model of Drug, Set, and Setting.

Drug Set Setting.jpg

One of the important things I learned while reading about harm reduction was Dr. Norman Zinberg’s model of Drug, Set, and Setting. Zinberg did not believe that drug effects are simply a function of biochemistry. He believed that problems with drugs and with drug experiences result from interaction between the three areas. Solutions can be found by making positive changes in these areas. Let’s look at each of these areas and then I’ll describe the choices I made that kept me alive.  

Drug refers to the type of drug itself, potency, purity or what it is cut with, route of ingestion, legality.

Set (originally “mindset”) refers to the person, including characteristics of race, culture, support, mood, beliefs, emotional strengths or weaknesses, coping skills, motivation, health, gender, body size, etc.

Setting refers to when, where, and with whom one uses, what sort of support exists, stresses in one’s life, attitudes of others toward use - including political and cultural.


Let’s start with Drug.  I was 14 years old the first time I saw someone passed out with a needle in his arm. He was in a friend’s apartment and I remember looking carefully to see if he was dead. When I saw he was breathing I wondered if I should call an ambulance, but that might not be the right thing to do. Fortunately he woke up moments later. Even so, I decided that I would not shoot heroin or use needles.

I came to the same conclusion about methamphetamines, then called “speed,” which I rubbed into my gums a few times and liked the effects. Several of my friends got strung out on speed. I watched them lose weight and develop paranoia. I quit using speed after my friend Eddie, a splendid fellow, got so crazy he thought we were being followed. We were taking a walk together and he took me through so many alleys and roundabout detours that I got lost. When we got to his friend’s apartment I had no idea where I was. Eddie split soon after and I was in the embarrassing situation of having to ask for a ride home. I wasn’t old enough to drive.

One time when I was eighteen or so, I was drinking in a downtown bar that had an upstairs disco dance floor. Sitting at the bar, I watched a friend climb the spiral staircase only to see him pause halfway up then fall backwards down the stairs. I spent the next twenty minutes asking his friends what he had taken. I wanted to make sure I never took what he had taken. It turned out he had taken “sopers” also known as Qaaludes, a barbiturate-like drug so destructive it was actually taken off the market.   

The one drug I didn’t know to be afraid of was alcohol, though a friend died choking on his own vomit - his friends didn’t know to lay him on his side.


Set, especially mindset, was something I considered when using LSD. The first time I tripped was at a Janis Joplin concert, and while I had a pleasant experience I could see how it could be awful if you weren’t in a good mood. After that I was selective about when, where and with whom I tripped on LSD. I only used LSD occasionally and with careful planning. I didn’t like to drink when I was tripping and I wanted to be in a safe place for the whole experience.  The last time I took LSD I was on a beach in Florida with a friend. Our plan to spend the night in a tent ended around 4 a. m. when the no-see-em bugs invaded our tent and bit us until we left. My friend had been drinking and so I drove until we got onto a very long bridge. Looking ahead, the converging lines of the bridge narrowed down to a pinpoint. I was afraid to drive into the nothingness and came to a stop in the middle of the bridge. I was shaking. My drunk and tripping friend had to take over the wheel. I would be afraid of driving on bridges for the next decade and never used LSD again.


Setting, especially with whom and where I drank and drugged, was an important part of how I avoided harm. As William White describes in his new book, Recovery Rising, I was aloof “from all but a small circle of friends with a high threshold for deviance.” My friends over the years were an interesting assortment of artists, musicians, bikers, lawyers, gays, and hippies. They were typically four to ten years older than me and a bit protective. They didn’t want me to get in trouble (especially when I was a minor) for their sakes as well as mine.

Setting, in terms of where I drank, became a problem for me as I got older.  I was a daily drinker by the time I was seventeen. Men began trying to pick me up in bars and often succeeded. I solved that problem by changing the setting of where I drank. I started drinking in gay bars because the men weren’t interested in me and I wasn’t interested in the women. I had standards for those I chose to drink with. If they couldn’t hold their liquor, if they slurred their words, if they got obnoxious or violent, and especially if they were bad drivers when under the influence, then I wanted nothing to do with them.  Despite those standards I would drink heavily and harmfully until I had drunk myself into early late-stage alcoholism by the age of twenty-nine.

It never occurred to me that it would be alcohol that would take me to my knees. I didn’t think of it as dangerous. I didn’t make sensible rules for myself such as “don’t drink when you’re angry or tired.” That said, I’m lucky to be alive. My drinking buddies (except for two) are either dead or in AA. My drug-using buddies are mostly dead also, including my sister. They died of overdoses, suicide, Hep C, etc. Still, somehow, despite my excesses and the company I kept, I was able to survive. I believe its because I practiced harm reduction—even though I had never heard the words.