Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol

by Patt Denning, Jeannie Little, Adina Glickman

Twelve-step programs that insist on abstinence are beneficial to many--but what about the millions of Americans who try to quit and fail, just want to cut down, or wish to work toward sobriety gradually? This groundbreaking book presents the Harm Reduction approach, a powerful alternative to traditional treatment that helps users set and meet their own goals for gaining control over drinking and drugs. The expert, empathic authors guide readers to figure out which aspects of their own habits may be harmful, what they would like to change, and how to put their intentions into action while also dealing with problems that stand in the way, such as depression, stress, and relationship conflicts. Based on solid science and 40+ years of combined clinical experience, the book is packed with self-discovery tools, fact sheets, and personal accounts. It puts the reader in the driver's seat with a new and empowering roadmap for change.



Winner--American Journal of Nursing Book of the Year Award

Genres: Addiction, Nonfiction, Psychology, Self Help, Drugs, Health

328 pages, Paperback

First published November 15, 2003

Reviews

[Pablo · Rating 2 out of 5]

As an introduction to the topic, it was ok. The presentation of the basic concept of harm reduction makes sense and is persuasive (yes, there's a 'but' coming). But, I just got the impression that the authors were pro-drug use to some degree. There was a little bit too much glorifying of the 'benefits' of drugs and alcohol, especially pot. Sort of "isn't it fun though!?" enthusiasm kind of stuff. Almost like pandering to drug using readers? Neutrality would be more effective in communicating the message. Treatment pros should generally strive for neutrality in their demeanor. Regarding pot, the authors skipped over some of the obvious negative consequences of using this drug like long term arrested emotional/intellectual development and relational dysfunction.

Harm reduction is unquestionably a good approach. The risk is using it as a cop-out. A cop out for treatment professionals and drug/alcohol clients to not hold/be held accountable.

[Derek Frasure · Rating 5 out of 5]

If I'd have found this book years ago I might have saved myself a lot of pain and one of my friends my still be alive. It's hard to give less than five stars to what is literally life-saving information. That's not to say the book is perfect, but it's damn close. This is great for explaining the principles of harm reduction, as well as how to implement those steps in your life or that of your loved one. There's something here for newcomers and people who've been thinking about substance use for years.

[Katharine · Rating 5 out of 5]

Just Say No is total BS and AA is helpful only to a small minority. I recommend learning about harm reduction. It's a concept that we all could use even if we don't abuse substances. ***This is a great book. Lots of ideas on how to deal with abuse. And it clarified for me why the word addiction is a smoke screen camouflaging the issues***

[Guida Brown · Rating 1 out of 5]

DNF. Ugh. The bias is so blatant in this book. This isn’t about harm reduction, it’s about selling books to people who misuse alcohol and/or other drugs and want an “expert” to say they’re fine just the way they are.

[Amber · Rating 5 out of 5]

Great info on harm reduction. A must read for therapists who want to use harm reduction in their practices and for people who would like to use harm reduction in their own lives.

[Caroline · Rating 5 out of 5]

I found this book very wordy and detailed - and for that reason sometimes quite boring, but on the other hand I'm extremely glad I read it. Its repetitive nature helped drum into me the rather counter-intuitive idea of harm reduction.

The authors are associated with one of the few places in America, which does therapy based on harm reduction instead of full abstinence (although that is sometimes suggested as a solution too.)

They say that problems with drugs develop from three scenarios.
1. A person's unique interaction between the drug and its compelling qualities. Person A may find drug X hugely more attractive than Person B, and their propensity to end up having a problematic relationship with it might therefore be that much stronger.
2. A person's unique needs and characteristics - eg one person may be infinitely more prone to anxiety than the next person, and will therefore find a calming and soothing drug that much more attractive than someone who doesn't suffer with anxiety.
3. The environment, with its combination of stressors and sources of supports. Obviously someone in a happy relationship, with a supportive family and a satisfying job is going to find drugs less attractive than someone whose life is full of loneliness, insecurity and stress.

I think a lot of recovery organisations treat their participants with a sort of one size fits all recipe for recovery. 'Whatever your problems, come into our organisation, follow our tools and ideas, and we will transform you into someone who leads a better, (abstinent) life."

This approach with harm reduction is the opposite - it goes into the minutiae of each person's life, and works with someone's specific personality and situation. It also has a much more generous attitude towards moderating (harm reduction), than do most of the traditional recovery approaches.

I found the life stories given in the book (an amalgamation of various clients' experiences) to be particularly interesting. One woman is shown to have stopped taking heroin, and she now just uses weed at weekends, to allow herself to relax. That is seen as a good example of harm reduction working well.

The book also give a chart listing a continuum of alcohol and drug use. No use...Experimentation....Occasional.....Regular.. ..Heavy.....Abuse.. ..Dependence... ...Chaos. If you are dependent on a drug you will probably need medical supervision to help you slowly taper off. At least 50% of heavy drug or alcohol users "mature out" of their using as they grow up, without any outside help. If you're a chaotic user it may well be that you do have to practise abstinence with that particular drug, although you may be able to continue with one or two other substances that don't affect you so badly.

This book sees little difference between legal and illegal drugs - it's well known that cigarettes cause great physical harm and alcohol can be abused in ways similar to the abuse of many illegal drugs. (This is not the same as saying that all drugs should be available without restriction.)

Time and time again, the book returns to the needs of each specific person, as they work towards leading their best possible life. It also emphasises the success of harm reduction - which something we seldom hear about in our society. For people who have had a problematic relationship with drugs or alcohol, most of us have been brought up with the idea of addiction versus total abstinence. However there are now various organisations showing an increasing interest in the idea of harm reduction.

I've had both in my life. I gave up smoking some years ago, and I'm convinced that complete abstinence was necessary (and still is), in order for me to do that. On the other hand I've had eating disorder issues which I stopped five years ago. Obviously I haven't been able to stop eating, instead, by using various strategies, I practise harm reduction - and the results have affected my quality of life immeasurably. The book has also made me think about other areas in my life where I might practise harm reduction. I could develop strategies for less screen time for instance....

All in all I found this book an eye-opening and useful read.

[Pamela · Rating 1 out of 5]

Książka niezbyt adekwatna do standardów polskich, opisywane metody terapii uzależnień są przestarzałe i odchodzą do lamusa. Jest kilka ciekawych pomysłów na ćwiczenia, które mają zachęcać do zastanawiania się nad sobą, ale jest też dużo elementów, które po prostu są szkodliwe i niezgodne z wiedzą naukową. Autorki mają podejście zniechęcające do terapii i grup samopomocowych, traktując je jako opresyjne, za to wyraźnie wychwalają zalety brania. Ważne jest to, co napisane jest w blurbie z tyłu książki - "to nie jest podręcznik naukowy", no i to czuć.

Nie zniechęcam do redukcji szkód, po prostu nie polecam tej konkretnej książki.

[Stuart · Rating 5 out of 5]

An easy read and a comprehensive introduction to harm reduction for anybody who is interested, whether that's due to wanting to change their own relationship with drugs, alcohol, or anything that's causing them to miss their own life, or knowing someone who does. Including exercises, suggestions, and perspectives that allow for the information inside to be applicable to a variety of situations and individuals, this book might not necessarily change your life, but could definitely set you on the path to changing it yourself.

[Leslie Nelson · Rating 5 out of 5]

Eye-opening! Highly recommended.

I read this for work because I work with homeless young adults, and some of them struggle with substance use. I don't deal with that directly, my role is to help them find employment, but I wanted to understand about this aspect of their lives. This book was truly eye-opening for me. I highly recommend it to everyone.

[Kyle Hart · Rating 1 out of 5]

Pretty traditional approach. Still has useful information but I prefer a systemic approach . This one relies a lot on religious beliefs, or the morality approach.

[Hannah Woods · Rating 3 out of 5]

Great entry level book for those looking to understand harm reduction.

[Alastair Fyfe · Rating 4 out of 5]

As a student studying addiction this book expanded my mind in that other options for recovery are visible. I did find myself frustrated at times throughout the book for lack of scientific evidence and merely based off ethos of "hope". Addiction is not a light issue to talk about or be ingested with, and i believe the disease model has many great benefits such as illustrating that addiction is an actual "disease", quantifiable in western medicine and deserves the same respect, kindness and non-discriminatory outlook at being diagnosed with diabetes, cancer or other such chronic diseases.
I do believe this book is great for reading after having a throughout understanding in behavioral medicine, substance abuse, since it provides opportunities for sobriety through an alternative approach. Yet, the underlining tone may seem apathetic and idealistic fantasy for those where this is there first encounters with understanding the recovery process of addiction.

A great book of providing alternative insights for dealing with a serious issue at hand, given harm reduction is very new and hot topic.

[Donna · Rating 3 out of 5]

Someone recommended I read this book to better understand the Harm Reduction approach to dealing with addiction. I appreciate learning about this different perspective compared with the 12 step programs. The book was really a handbook for people struggling with those issues, so it was slow going for me without those particular issues.

It could be really helpful for someone who is not ready for abstinence, but who is willing to think about some changes to add safety and less harm into their lives. I found it to be a good resource for looking up details about a particular drug. There were a few times when the authors seemed to bend facts to their perspective, but overall I found it reasonably balanced. There's also a chapter for family and friends of users that was helpful.

There's one quote they make that sums up a lot:
There are the facts, then there's the truth. And your facts are never going to change my truth. Rev. Edwin Sanders.

You have to meet people where they are.

[Andrew · Rating 4 out of 5]

What a great book this is! In "Over the Influence", Denning describes the Harm Reduction model of dealing with drugs and alcohol. This method is sharply juxtaposed with the sobriety, or the AA, model. Denning points out that, in America culture, we have a knee-jerk reaction to people who have drug and alcohol problems, to say "you need to quit that drug right now and never do it again for the rest of your life". This is easier said than done, of course, which explains why AA has such a notoriously low success rate. In this book, Denning argues, and quite persuasively I might add, that a person who has drug and alcohol problems, can make positive changes in their life to reduce harm, while still using the drugs. This is counterintuitive to what we have been taught all of our lives, but Denning puts forth such a strong case, that she has won me over! I would highly recommend this book to anyone dealing with drug and alcohol problems in their life. A really good book!

[Oresta · Rating 4 out of 5]

In my little exposure to services in addictions, many forget the harm reduction model... for many it is an either or proposition. I believe we have to be compassionate and patient and do the right thing. I am all for Harm Reduction while treating addicts and alcoholics. I really liked this book and should be required reading for all those in the addiction field.

[SGK · Rating 5 out of 5]

an excellent alternative to abstinence models. Great practical information on working with clients who abuse substances in a respectful, realistic way. A different way to conceptualize all addictive or harmful behaviors.

[Michael Thomas Angelo]

This is a must read for anyone who has ever doubted their own ability to fix themselves due to listening to the crap that 12 step cult spews out!!! 12 step is a cult!! This book will show you the way.

[Bobby · Rating 4 out of 5]

Lots of good delivered in digestible bites...they know what they're talking about.

[Matt Jorgenson · Rating 5 out of 5]

How refreshing to see a compassionate, nuanced approach to these issues making it's way into the mainstream.

[Marian · Rating 4 out of 5]

The new edition is a very good introduction to harm reduction for all audiences.