06/28/2013 02:05 pm ET Updated Aug 28, 2013

So Much of What We 'Know' About Addiction Treatment Is Wrong

Showing addicts how to inject drugs safely preserves addicts' health and saves lives -- while alcoholics follow brief advice to drink less. Can this be true?

Here is some information that might make us believe these things.

There's something very powerful about saying "I want to save your life, I don't want to fix you.". . . . [It] often opens the door for larger transformations because people start to feel more valued and feel more worthwhile and feel like "well, somebody thinks I deserve to live.". . . People who show up for services are like well, "How did you quit?". . . . Even if they never get into recovery, a lot of times people who become engaged in needle exchange will dramatically reduce the harm around their addiction because they feel more valued and because they have the tools that they need to protect themselves. -- Maia Szalavitz

Kenneth Anderson, at the Lower East Side Harm Reduction Center (LESHRC), has created a remarkable hour-long documentary, the premier of which I screened last Wednesday, to show what harm reduction services actually look like. Everybody has heard about clean needle and needle exchange programs. But a miniscule number of people have visited such centers, and almost no one besides the participants have seen how these services -- injection instructions, clean needle preparations, overdose prevention and resuscitation, nonjudgmental psychotherapy for active drug users, AIDS testing, outreach workers dealing with street addicts -- are actually delivered. This documentary allows everyone to see the inner workings of harm reduction for injecting drug users. And it is an impressive show of the necessary services LESHRC and similar programs provide, activities outside the pale of -- in fact forbidden by -- usual American treatment, even as provision of these services is self-evidently necessary, beneficial, and humane.

Along with the center's and staff's activities, this documentary interviews a group of seminal harm reduction theorists in the New York area, including Ethan Nadelmann, Maia Szalavitz, Scott Kellogg, Andrew Tatarsky, and myself. The views expressed by the speakers dovetail with the nitty-gritty street work being done by a team of selfless, idealistic professionals whose rewards are their awareness that they are helping needy human beings to help themselves. Also interviewed are center participants who, after learning to care for themselves, quit their addiction altogether.

The experts make these points (among others):

Ethan Nadelmann (and I) discuss how harm reduction is simply common sense policy for preserving the lives and health of the large range of ongoing drug users in America;

Maia Szalavitz movingly describes how standard treatment "tough love" practices of denigrating people and their capacity for change has the opposite effect from reducing drug use and addiction;

Andrew Tatarsky tells how he gradually realized that his work within the disease, abstinence-only model was useless -- a ritualistic, self-satisfying activity whose impact is counterproductive;

Scott Kellogg insightfully details how people leave addiction behind through assuming new roles in the world that take them beyond their addict lifestyles and identities;

I speak about how the medical model channels money away from the kinds of changes in people's lives -- housing, health, work, community -- that lead to real recovery, as opposed to taking vows of abstinence.

NOTHING will change your mind about the drug addiction problem and how to address it in America as much as this one hour of video.

While we're talking about how everything we know about addiction and our response to it in America are being questioned, another study has been added to the pile of research showing that brief interventions, even with alcoholics, reduce their drinking:

Brief intervention works with alcohol-dependent hospital patients*: Commonly presumed unsuitable for dependent drinkers, the evidence is stacking up that brief advice after screening can lead even these drinkers to cut back. This study of heavy drinking Taiwanese hospital patients provides one of the most convincing demonstrations yet that brief intervention can work in this setting, and the drinking reductions were particularly steep among dependent patients.

As I often note in these pages, so much of what we accept about addiction is changing beneath us. How can we deal with and incorporate these new ideas, findings, and techniques? Will we? When?

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*This summary is provided by Drug and Alcohol Findings Effectiveness Bank via