The Differences Between Moderate Drinking Programs and Harm Reduction Programs, pt 2

The Differences Between Moderate Drinking Programs and Harm Reduction Programs

Part 2: Harm Reduction Programs, and How and Why I Created HAMS

By Kenneth Anderson, MA

The Backstory

I first attended an MM meeting in Minneapolis, Minnesota in June of 1998; this was immediately after the great storm of May 30, 1998, which had knocked out power lines and even traffic lights throughout the Twin Cities area and had hit the suburbs even worse. I was the only one to show up at this meeting, but I tried again the following week. The following week there were only two people at the Minneapolis MM meeting: me and Audrey Kishline. I actually did not realize that I was talking to the founder until the end of the meeting when she lent me a copy of the MM handbook and I saw her picture on the back cover. Audrey had come to Minneapolis because her husband had been transferred there; she stayed in Minneapolis for about one year.

I had decided to cut my drinking back to one day per week some months prior to attending my first MM meeting in order to finish my master’s thesis in linguistics at the University of Minnesota. I had decided to drink a fifth of whiskey one day per week and abstain the other six days instead of drinking a fifth four days per week because I knew that drinking four fifths a week was interfering with me completing my thesis. Of course, Audrey objected that drinking a fifth (17 standard drinks) in one day was not moderation, but I countered that drinking one fifth per week was a heck of a lot better than drinking four fifths per week, and Audrey acquiesced. I finished my master’s thesis and graduated on July 31, 1998.

I had begun working part time at the Minneapolis Public Library as a shelver while I was finishing my master’s; after graduating, I went to full time since I had no way to fund a PhD. I wasn’t very challenged by this work and eventually started drinking a lot several nights a week and coming into work hungover. This led to trouble, and I was given an ultimatum to join AA or else. When I explained that I had tried AA before and the only result was that AA made me drink more, I was fired. This was in September of 2001, right after 9/11. After a few months, I ran out of money and wound up moving into the St. Anthony Residence for chronic inebriates, a “wet house” located in St. Paul. I had actually requested to be placed in chemical-free housing, but when I stated that I needed a place with no 12 steps, the county worker I was speaking to exploded into a rage, stating that he was going to punish me by putting me in the drunk house until I came crawling back to him on my hands and knees, begging for the 12 steps.

St. Anthony Residence wasn’t too bad, I got along with most of the guys, and, with one exception, the staff were pretty nice, although not very informed about harm reduction. The one staff member who was a bad apple had been one of the founders of Eden House, a notoriously harsh Therapeutic Community in Minneapolis. This staff member let one of the residents die of alcohol withdrawal and let another die in a diabetic coma because he refused to call for medical help for either, saying that it would cost too much. He also said that it didn’t matter if any of us died because we could always be replaced by another drunk off the street. I managed to get a good roommate at St. Anthony after being there about a month. He was a Quaker, and I was a socialist, which meant we agreed on most issues.

I decided to do a 30-day period of abstinence from alcohol the day that I moved into St. Anthony Residence because I didn’t want alcohol dragging me down. There were no longer any live MM meetings in Minnesota at the time, so I got involved with the online MM groups using the public computers at the St. Paul and Hennepin County Public Libraries.

Catching Up After Time Away

A lot had happened at MM since I had been away from it. On January 20, 2000, Audrey Kishline posted to the MM listserv that she was resigning as president of MM because she had been unable to stay within MM’s moderate drinking limits, and that she was going to go to AA and other abstinence-based support groups instead. In an interview with Audrey which I recorded on August 3, 2013, she said that she had maintained moderate drinking limits pretty well for about the first two years of MM, but then had started drinking heavily in response to personal issues. After leaving MM she had not engaged with any program at all. Instead, in a move which was the opposite of harm reduction, she began hiding out from her family, chugging vodka in her truck.

On March 25, 2000, two months after leaving MM, Audrey Kishline got in her truck in a drunken blackout, and driving the wrong way down the freeway, crashed into a car, killing two people, Danny Davis and his 12-year-old daughter LaShell. On August 11, 2000, Kishline was sentenced to four and a half years in prison; she was released after serving three and a half years. Kishline died by suicide on December 19, 2014.

Kishline’s Resignation and Subsequent Reorganization of Moderation Management

After Audrey Kishline resigned, MM was reorganized: the headquarters moved to New York City, where the New York City group took charge of the organization. James Cannon became the executive director, Ana Kosok the program director, and Andrew Tatarsky the board chair.

After my first month of abstinence at the drunk house, I made it a rule to drink only on Saturday nights–Minnesota still had blue laws in those days and the liquor stores were closed on Sundays which meant that I wouldn’t be able to buy more booze if I was tempted to continue drinking the next day. The other six days a week I spent eight hours a day online with the MM listserv.

A New Director of MM’s Online Groups

In December of 2002, I was made director of MM’s online groups with a stipend of $200 per month. The only catch was that I was not allowed to ban any trolls from the listserv. Ana Kosok stated that banning people would be like Nazism, and that no one would ever be banned from the MM listserv. Finding ways to try to jolly people into behaving well was sometimes a formidable task. During the time I was director of MM’s online groups I created the MMabsers Yahoo group, a subgroup of MM offering support for members who had opted for total abstinence from alcohol.

A New Concept: Harm Reduction

One day I was speaking with one of the directors of MM, and he referred to my plan of drinking a fifth of liquor safely one day per week and abstaining the other six days as a perfect example of a harm reduction plan. Harm reduction was a new concept to me, and I decided to learn more about it. With some trepidation about meeting those “scary” heroin users, I showed up at Access Works, the Minneapolis needle exchange, to try and apply for a job. I was told that they had just lost a major grant and had laid off a lot of people, but that they were looking for volunteers if I was interested. So, in May of 2004, I began volunteering at Access Works.

Volunteering at Access Works was probably the most amazing and eye-opening experience of my life. I found out that heroin users weren’t so scary after all. I learned that harm reduction meant encouraging “any positive change,” a slogan originated by the late Dan Bigg. I learned that the more substance related harms a person has, the more that person needs harm reduction. The more heroin a person uses, the more clean needles that they need. I learned that early needle exchanges had tried to put conditions on accessing clean needles, such as a counseling requirement, and that these exchanges had failed miserably because no one came back. I learned to always thank our participants for using clean needles. I learned that harm reduction means “meeting people where they are at.” I learned that harm reduction means unconditional acceptance and unconditional love. For the first time in my life, I had come home, with people who “got me.” I also read everything I could get my hands on about harm reduction, and I was particularly impressed by Denning, Little and Glickman’s book Over the Influence. In short, I fell in love with harm reduction.

I began introducing harm reduction concepts into MM’s online groups where they were received by many members with great enthusiasm. Even before this, MM’s online groups had begun to deviate significantly from the material found on MM’s website and in its books. MM’s online members told newcomers that the nine steps were optional and could be done in any order and that the 30-day abstinence period was not required. I suggested to the MM staff and board that the MM website and written materials should be updated to reflect actual practice; however, this suggestion fell on deaf ears.

In the online groups, I introduced the idea that any positive change should be celebrated, no matter how small. I pointed out that needle exchange participants were not required to be moderate heroin users in order to get clean needles, and that people who were addicted to heroin were not turned away and told to join NA. Likewise, the more alcohol-related harms that a person experienced, the more that person needed harm reduction. Telling people who were unwilling or unable to abstain from alcohol to leave and join AA was both cruel and useless. Moreover, AA was no magic bullet, in fact, it made some people drink more in quantity and more riskily. I encouraged people to identify what aspects of their drinking were most harmful and to prioritize reducing those harms. I suggested to the MM staff and board that harm reduction ought to be incorporated into the MM program on its website and in its written materials, but once again, these suggestions fell on deaf ears.

In December of 2004, I managed to get a minimum wage job as a clerk at the Salvation Army store in Little Canada, Minnesota, and moved out of the St. Anthony house of drunks into an apartment in Little Canada. In December of 2005, right before Christmas, the local Salvation Army captain decided to fire all the employees at this store and hire new ones to replace them. I moved to New York City in February of 2006.

More Turbulence

In April of 2006, Ana Kosok ousted James Cannon and appointed herself executive director of MM in what was essentially a hostile takeover. This took place in an emergency board meeting at which I was present. Kosok’s justification for this was her claim that Cannon was failing to remain within MM’s moderate drinking limits. I was removed as director of MM online groups and made into Ana’s personal gopher. I was replaced as director of online groups by Kurt Schnakenberg. Although Kurt had a degree in computer science, he had never participated in MM’s online groups and had no grasp of their culture. Kurt issued a set of rules which forbade swearing but did nothing to address trolls. In fact, there was a major troll on the MM listserv at this time who was constantly inciting flame wars and was actually encouraged by Ana and Kurt. I had requested both Ana and Kurt that he be banned and was ignored. Meantime, Ana was making it quite clear that only people who maintained the MM limits were welcome in MM, and those people who were practicing harm reduction were not. All of this was a complete disaster with a huge pushback from the members of the online groups, who wanted trolls to be banned, and who did not want to be censored by Kurt.

Another Resignation and the Birth of HAMS

Finally, on September 13, 2006, I resigned from MM, and with Ana’s permission, I created an MM subgroup called ModsAbsHR; the idea was that we would support each individual in their choice of a goal, whether that goal was moderate drinking (mods), abstinence (abs), or harm reduction (hr). It did not matter how much a person drank or how little they drank, anyone who wished to change their drinking habits was welcome. Likewise, if a person wanted to quit drinking and driving but still wants to get drunk every day, they were welcome at ModsAbsHR, where every positive change was celebrated, and each person made their own plans, and chose their own goals.

Within 24 hours of establishing ModsAbsHR, the number of posts to the MM main listserv fell from 200 per day to 20 per day. The number of posts to ModsAbsHR increased from 0 to 200 per day. Nearly all the active online members of MM were overjoyed to leave the incredibly toxic place that the MM listserv had become, and to have a safe place to talk to each other instead. One of our members suggested that we adopt the name HAMS as an acronym for Harm reduction, Abstinence, and Moderation Support, and we did. Our members also decided to call themselves HAMSters. On January 1, 2007, I created the original 14 elements of HAMS. They were called elements and not steps because they could be done in any order, and all were optional.

The Growth of HAMS

On January 15, 2007, the HAMS website was launched, and a new HAMS Yahoo group was created which was completely independent of MM; the ModsAbsHR group was shut down sometime thereafter. HAMS was incorporated as a 501(c)3 in the state of New York on August 21, 2007. HAMS received tax exempt status from the IRS on November 15, 2007. HAMS is organized as a constitutional democratic republic in order to prevent abuses of power by administrative staff. Essential issues are decided by a majority vote of the membership.

In August of 2008, I began a master’s degree in psychology and addiction counseling at the New School for Social Research in New York City. I also began writing the HAMS handbook around this time. I tried streamlining the 14 elements of HAMS into 11 elements, but the membership hated this version and said that I had taken out the best parts. Additional revision led to the 17 elements of HAMS, which everyone liked and agreed was the best version.

The first edition of the HAMS handbook, How to Change Your Drinking: A Harm Reduction Guide to Alcohol, was published on June 22, 2010. Since the first edition had a lot of typos and an ugly cover, a revised second edition was published on October 5, 2010.

Interestingly, in 2016, MM changed the way the MM program appeared on their website. Kishline’s nine steps had been replaced by a new seven step program. It was stated that, ” The order in which you undertake these steps isn’t critical, but it’s a good idea to spend at least a little time working with each of them.”

HAMS Today

Yahoo groups are no more. The HAMS support groups currently consist of a Facebook group with 12,448 members and several Facebook subgroups as well as an online forum with 11,051 members.

HAMS is aimed at anyone who wants to change their drinking habits for the better, including those who are unwilling or unable to abstain from alcohol. In HAMS, every positive change is celebrated: if one reduces from 17 drinks per day to 16 drinks per day, one is celebrated for making an improvement, instead of being shamed for exceeding some arbitrary moderate drinking limit. Our motto is “Better is better.”

The low-threshold nature of HAMS is intended to attract people who would never consider engaging in a high-threshold program such as AA or MM. The only requirement for membership is to be kind to and respectful of other members. Intoxication is not forbidden in HAMS groups since we realize that some people would not be able to participate at all unless they were intoxicated. All that we require is that everyone be kind and respectful, whether they are intoxicated or not.

Respect for the autonomy of the individual is the heart of harm reduction. I have heard some people say that moderate drinking programs should be considered to be harm reduction because “these programs let people use.” This statement is quite inimical to the spirit and philosophy of harm reduction. We harm reductionists are not authoritarians who assume that we have power over other people’s behaviors, rather, we respect the right of individuals to make their own choices and provide them with tools and information to help them make these choices.

HAMS finds that pejorative and unscientific labels such as “alcoholic” are actively harmful and discourage personal growth; it is not our intent to keep people trapped in HAMS forever, but rather to move on and get a life. Rather than identifying oneself with a diagnostic label such as alcohol use disorder, HAMS encourages people to say, “We are people who have chosen to change our drinking habits for the better–HAMSters for short.”

HAMS members are welcome to use anything that they find helpful, including medications such as naltrexone, supplements, seeing a professional therapist, or getting additional support in other groups. Vitamins are recommended as most heavy drinkers are low on vitamins, particularly B1 (thiamine). I only offer input if something is horribly overpriced or likely to cause harm. All of HAMS is based on science, not my personal opinions.

An unpublished preliminary survey of HAMS found that HAMS members were attracted to HAMS because of its low-threshold, non-authoritarian nature. This survey further found that members reduced their drinking from an average of 43 US standard drinks per week to an average of 18 US standard drinks per week, a large and significant reduction (p < .001, r = .779). Reduction in risky drinking behaviors was also reported by 78% of respondents. This study showed that a low-threshold, harm reduction-based program such as HAMS can attract people who would never consider becoming involved in a high-threshold program such as AA or MM and can lead to major reductions in alcohol consumption and alcohol-related harm among this population. We will be using this preliminary survey as a springboard for a more refined study which we intend to publish in an academic journal.

Parting Words

Some people want a highly structured program with clearly defined limits like MM, others want a harm reduction program where they are in charge of their own lives like HAMS. Thanks to the internet, there is a place for everyone.

Liked this article? Read part 1 here!