Harm Reduction


I’m grateful to Harm Reductionists for introducing me to the concept of “stability”. Harm Reductionists suggest that stable drug use is better than chaotic drug use and that any changes in the direction of stability are worth acknowledging and celebrating.

 Though I chose a path of abstinence years ago, I recently started to consider stability in my own life. What am I finding stressful and what could I do to make things better? Who or what things throw me off balance? What choices would add to my stability? I’ve also begun to use the concept of stability in my coaching practice with clients recovering from addiction. I ask, “What can you do that would increase the stability in your life?” I’ve begun to see stability as a guiding light.

 When I joined a 12-step program years ago I was introduced to the Serenity Prayer. The prayer was useful to me—I could understand the advantage of accepting things I cannot change and having the courage to change the things I can—but serenity itself never appealed to me. I really didn’t understand what serenity was, or why I should want it. Serenity seemed rather like complacency and that sounded dangerous or boring. I’m quite sure that if I had been introduced to the Stability Prayer when I quit drinking it would have been a much better prayer for me. Maybe because I was a child of chaos.

I grew up with neglect and trauma and I knew what chaos was. When I left home I eventually figured out that drinking and drugging added to the chaos in my life. I knew that drinking too much led to having sex with men I didn’t know, which added to shame, which added to misery. I knew that having a boyfriend who spent the rent money on drugs resulted in chaos. I knew that having a boyfriend who tried to kill me was more chaos and misery.

 I still remember when my best friend asked me if I would help her raise her son. I told her that we both drank too much and were too fucked up to raise a child. She turned her boy over to her parents, which was the better choice though she hated it. And I hated it too.

 It was my growing dislike of chaos that eventually got me to stop drinking and drugging. I didn’t quit when things were at their worst. I quit when I had a good opportunity to improve my life and was afraid my drinking/drugging would ruin it. 12-step recovery did a lot to help me stabilize. I worked all the steps and learned the Serenity Prayer.

Yet I think a Stability Prayer would have been way more practical for me to orient around. As it was I floundered in recovery for many years. It took me a good ten years to learn how to be a functioning self-supporting adult. It might not have taken so long if I had set my sights on stability. These days, I say the Stability Prayer while others are reciting the Serenity Prayer. Just one word is different, and yet for me that one word keeps me heading in the direction of positive change. Here it is. Try it—you might like it.


God, grant me the stability

 to accept the things I cannot change,

courage to change the things I can,

and the wisdom to know the difference.


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.

Waiting for Good Enough


I’ve finally noticed a pattern that I have had for my 30+ years in recovery: waiting to get my shit together before I take action. That’s a problem for me because the truth is I may never become the idealized person I’d like to be. I haven't yet. What I know at long last is that if I put off opportunities I may miss my chance. I can think of two people that I wanted to meet and could have met, but didn’t because I wasn’t ready, because I wasn’t good enough, because I didn’t have my shit together–yet. Both those people died while I was waiting to be a better person.

Thomas Leonard, pioneering how to coach “restoratives”

One was Thomas Leonard, the “father of coaching.”  I knew people who could have introduced me to Leonard. I wanted to talk with him because he knew a lot about coaching those he called “restoratives,” people who have experienced problems with addiction, trauma or mental health—the very people I work with as a professional coach with expertise in addiction. Thomas Leonard died in his forties of a heart attack. I missed my chance to hear his thoughts about how best to coach restoratives. I regret that. And there’s another person I missed, G. Alan Marlatt.

G. Alan Marlatt, pioneering prevention with Harm Reduction

I would have liked to have met G. Alan Marlatt. He did ground-breaking research on addiction at the University of Washington. I lived in Washington for twenty-one years, twelve of them in Seattle, nine in Port Angeles. I had a friend who knew Marlatt well and offered to introduce me, but I turned her down because I wasn’t ready. I’d gotten sick doing hospice work and didn’t have my shit together. I would have liked to talk about harm reduction with him. I would have liked to have talked about brief interventions with him. He was a pioneer in prevention, bringing Harm Reduction (HR) concepts to reducing campus drinking.  

Change is always an inside job.

I’ve missed my chance with Leonard and Marlatt. And I will miss other chances unless I change my thinking. I may never become the woman I want to be (darn it!) but I do have opportunities and need the courage to show up for them imperfectly. I need to be willing to show up as I am and let that be good enough.

No time like the present. I am more than good enough.


There is one person I have wanted to meet for almost twenty years, another addiction professional. He is currently alive and well. I’m going to make a plan to meet him. Let’s face it, I may never feel like I have it all together. But rather than waiting until I’m a better, healthier, more ideal person, I need to recognize that I am good enough now to have a cup of coffee, good enough to have a conversation, smart enough to learn something and to contribute something. Just plain fine enough while the opportunity exists. Because opportunities are time-limited, and I don’t want to waste anymore of them waiting to be a better person.