The Harm Reduction Model of Life

I was reading some great articles over at Greta Christina Blog. I came across this great one on harm reduction and thought I would share it with you. She makes a lot of interesting points I believe and practice. Enjoy.

The Harm Reduction Model of Life

200909120918.jpg Due to both chance and temperament, I have a lot of friends who work (or have worked) in public health. (Including, of course, my darling wife.) As a result, I hear a lot about the concept of harm reduction. And once I started learning about harm reduction, I found that it isn’t just a useful model for public health and public policy. It’s an unbelievably useful model for life in general.

It’s a concept that I think a lot of people would be interested in. Humanists especially, but not just them. So I thought I’d take a moment and gas on about it for a bit.

Let’s talk about public health for a moment first. For those who aren’t familiar, here’s the basic idea. When dealing with a public health problem, the harm reduction model says that you don’t necessarily have to completely solve or eliminate the problem in order to make important improvements. It’s a worthwhile goal to simply reduce the degree of the problem, reduce the harm done by the problem, and improve the quality of life for people experiencing the problem.

200909120917.jpg In fact, harm reduction proponents often don’t see “problems” the way society as a whole typically does. Rather than making moral judgments about drugs or sex or whatever, the harm reduction model accepts these things as basic human behaviors that have been part of life for as long as we’ve been around. It doesn’t see these things as problems per se, but as elements of human life that can sometimes cause problems. And rather than passing judgement on where people need to be in their lives before they can use or deserve help, it aims to “meet people where they are” — whether that’s regarding drug use, sex, or whatever — and to give everyone who wants them the tools they need to reduce harm in their lives.

(It’s essentially the opposite of a “zero tolerance” or “abstinence-based” model. If you’re curious, the Harm Reduction Coalition has a more detailed explanation — as it relates to drug use, which is where the concept originated, but the principles can be applied to many other public health and public policy issues.)

In other words, you don’t have to make problems disappear. You just have to make them better. (And in some cases, trying to make problems disappear can actually do more harm than good.)

200909120916.jpg The classic example of harm reduction is needle exchange. Needle exchange programs are a response to the high rate of HIV transmission among injection drug users: they give clean needles to users in exchange for used ones, so users aren’t sharing dirty needles. Now, a “zero tolerance” policy would say that illegal drugs are, well, illegal, and bad, harmful to the users and to society, and society can’t condone their use in any way — including giving clean needles to users.

Harm reduction, on the other hand, says that:

a) it’s good to reduce HIV transmission in injection drug users, since that will reduce HIV transmission in the general population;

b) it’s good to reduce HIV transmission in injection drug users, so that more of them can have healthy lives when and if they do get sober (“you can’t get clean if you’re dead” is a classic needle-exchange saying);

c) it’s good to reduce HIV transmission in injection drug users, because they’re, you know, human beings. Their lives have value. The fact that they’re injection drug users doesn’t change that. It is worth helping them stay alive and stay as healthy and happy as possible… as much as it is for anybody.

200909120915.jpg Another example is sex education. Zero tolerance says that underaged sex is an unequivocal evil that cannot be tolerated by society, and the only appropriate response is to try to stop it entirely. The harm reduction model says that, even if you don’t love the fact that minors are having sex, you not loving it is not going to stop it from happening… and we therefore need to find the most effective ways to stop its harmful effects, such as teenage pregnancy and STIs. (Abstinence- only sex education is a zero- tolerance approach… and it’s a classic example of zero-tolerance not only being ineffective but actually doing harm.)

Take a wild guess which model I support.

Okay. Enough with the public health. What do I mean by the harm reduction model of life in general?

What I mean is this: Even if you can’t completely solve a problem or make it go away, it is still worthwhile to work on making it better. Sometimes better is enough.

200909120915.jpg Voting, I think, is a good example. And the coming Presidential election is an excellent one. We don’t have to elect a perfect candidate, or even one we’re wildly enthusiastic about. We just have to elect a President who’s a whole lot better than the current one. It won’t make things perfect… but it’ll make things better.

200909120914.jpg And the harm reduction model can be applied to all sorts of political and social problems. Can you personally solve the global warming crisis? No — but you can help reduce its effects (driving less, buying energy-efficient appliances, voting for candidates who support strong environmental policies, etc.). Can you personally stop the waste and poor health caused by industrialized food production? No — but you can buy more of your food from local sources, and push for the same in your schools and restaurants. Can you personally eradicate racism, sexism, homophobia? No — but you can try to be conscious of it in your own life, and speak out against it when you see it, and pay attention to it when you vote. Can you personally halt the spread of obscene American consumerism? No — but you can cut back on the amount of pointless crap you buy. Etc., etc., etc.

And if enough people take enough of these steps, it’ll make these problems better. It won’t eliminate them, but it’ll reduce their harmful effects. And it may even help change the culture that cultivates them. Especially if you apply the harm reduction model, not just in your personal life, but in political and cultural action.

But the harm reduction model doesn’t just apply to politics and social change. It can be applied to almost any area of life.

200909120914.jpg Diet, for instance. I have long ago given up on trying to have a perfect diet, or to lose a significant amount of weight. Instead, I’m focusing on having a better diet, a good enough diet, a diet that most of the time consists of fruits, vegetables, whole grains, and low-fat proteins with minimal animal products. I’m trying to have a diet that keeps me reasonably healthy and still lets me relax and enjoy life. And instead of trying to lose weight, I am instead trying to not gain weight… and to stay as healthy as I can at the weight that I am.

Ditto exercise. I don’t need to get the ideal recommended amount of exercise in order to feel obvious improvements in my life and health. I just need to get more exercise than I’d been getting before I started working out.

Or take housecleaning. Savings and money management. Not reading enough. Watching too much TV. If there’s an area of your life that you’re not happy with, you don’t necessarily need to completely re-structure your life so that you can perform the task in question to your complete satisfaction. You just need to moderately re-structure it, so you can do more of what you like and think is important, and less of what you don’t.

So that’s the idea.

And here’s the thing I really like about the harm reduction model of life, the thing that transforms it from a helpful hint into a defining philosophy:

It lets you be both an optimist and a realist.

200909120913.jpg I hate the idea that optimism is somehow a form of delusion, and that pessimism and cynicism are somehow equivalent to realism. And I don’t just hate it because I enjoy being an optimist. I hate it because I think it’s bullshit. I think pessimism and cynicism are often just a weak-ass rationalization for being lazy or cowardly, irresponsible or selfish. Realism doesn’t just mean being aware of problems and limitations and obstacles. It also means being aware of what can and cannot be done about problems and limitations and obstacles.

200909120912.jpg And that’s where the harm reduction model of life comes in. It gives us room to be positive about life and hopeful about the future, without being deluded or willfully ignorant about limitations and harsh realities. It transforms the Sisyphian experiences of life, the rocks that get constantly pushed up the hill only to roll back down again: it keeps them from feeling frustrating and pointless, and instead lets us see them as positive accomplishments. It doesn’t let us off the hook about doing what we can for ourselves and for others — IMO, it does the exact opposite — but it lets us feel okay about not doing it perfectly.

Realism doesn’t give us an excuse for irresponsibility and inaction. It gives us the moral obligation to be responsible, and to take whatever action is possible. And the harm reduction model gives us a model for doing exactly that. It gives us a framework for dealing with problems that seem appalling, enormous, and fundamentally unsolvable… without succumbing to apathy, cynicism, or despair.

200909120911.jpg Now, the big downside of the harm reduction model of life is that it can easily become an excuse for doing a half-assed job. It can act as a justification for doing the least you can do; for taking only those actions that don’t inconvenience you; for making token gestures towards personal improvement or social responsibility while still being fundamentally lazy and selfish. “Hey, I changed all my lightbulbs to fluorescents — I don’t have to get rid of my SUV!”

And believe me, I speak from personal experience here. I’ve spent fifteen minutes picking up the tornado of books scattered all over our living room and piling them into neat little piles, as a “half-assed harm- reduction” form of housecleaning. I’ve given twenty bucks to political causes or candidates as a “half-assed harm- reduction” form of political action, when I was too busy or lazy to write letters and make phone calls and go to demonstrations. And more seriously, I’ve used the fact that I recycle and use fluorescent lightbulbs as a “half-assed harm- reduction” rationalization for the fact that I don’t really do that much about global warming, even though I think it’s by far the single most pressing problem facing our generation.

200909120910.jpg But as my friend Laura Upstairs (one of my many friends in public health and public policy) pointed out, one of the whole points of the harm reduction model is that a half-assed job is often better than none. Piling the books into neat squares isn’t a very good form of housekeeping… but it’s better than leaving them lying around everywhere. Donating twenty bucks to candidates or causes isn’t the most powerful form of political activism in the world… but it’s better than taking no action at all. Using fluorescent lightbulbs isn’t really a sufficient response to global warming… but it’s a better response than not using them.

And in my experience at least, a half-assed job is often a step towards a more completely-assed job. It can get you started with good habits — habits of thinking, as well as habits of action — that can eventually get you doing more than you’d ever imagined.

200909120907.jpg Here’s what I mean. Going to the gym once a week may not improve your health that much… but it can get you into the habit of paying attention to exercise and health, and can be a step on the way to eating better, and being more active in your everyday life, and eventually going to the gym two or three times a week. Recycling may not make a huge dent in our planet’s diminishing resources… but it can get you into the habit of thinking about waste and conservation and what the planet can and can’t sustain, and thus inspire you to drive less, and not buy as much disposable crap, and vote for funding for solar power and public transportation. Etc., etc., etc. Yes, a harm reduction approach to life can get you feeling complacent and smug when you’re not actually doing very much… but it can also nudge you in the direction of doing more.

dr_nick_riviera.gif Dr_nick_rivieraThe harm reduction model isn’t always appropriate. There are, for instance, times when perfectionism is exactly what you want. I don’t want a brain surgeon who thinks, “Oh, we got most of the tumor, I’m sure that’s good enough.” I don’t want an air traffic controller who thinks, “Well, one crash a week is better than five crashes a week.” And when it comes to major public issues like global warming, it is well worth asking whether moderate harm-reduction steps are actually going to make a significant dent: whether they actually will reduce harm enough to keep disaster at bay, or are really just a way of making ourselves feel useful while we collectively walk off a cliff.

So the harm reduction model of life isn’t a cure-all. But I’ve found it to be a singularly useful philosophy. It’s given me a way to reconcile my native optimism with my native hard-assed realism, without sending me into a cognitive- dissonance headspin. It lets me be optimistic without being deluded; it lets me be realistic without being a buzz-kill. And it’s given me a way to not feel overwhelmed by enormous, seemingly impossible tasks, both personal and political. It lets me do the small amount that I can do in this world, without feeling like it’s pointless.

And that rocks.

[From Greta Christina’s Blog: The Harm Reduction Model of Life]

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