Whether you’re cocaine dependent or a recreational user, harm reduction makes sense for everyone. If you can’t or won’t stop, read through this list of 36 ways to stay healthier when you use and adopt those strategies that make sense for you.

Cocaine isn’t good for you, there is no safe way to take cocaine or crack, and you’d probably benefit from quitting your habit.

That being said, if you choose to use cocaine or you can’t stop right now, then make use of harm reduction strategies to reduce the potential damage and stay safe to live and play and maybe even quit another day.

Here are 36 cocaine-specific harm reduction strategies. Many are easily adopted, so consider which, if any, might help you stay safe and healthy. Adopting even one new strategy could safeguard your health and well being. Remember, cocaine isn’t only addictive, it also increases your cardiovascular incident risks, so if you take cocaine - whether you’re a causal user or cocaine-dependent - harm reduction makes sense for you.

36 General Cocaine Harm Reduction Strategies

Reducing Nasal Damage

• Make sure to insert the straw high up into the nasal passage before snorting. This reduces the amount of cocaine that gets trapped by nose hairs. Cocaine left in the nostril can lead to irritation and a damaged septum – and ultimately to a perforated septum.
• Alternate snorting sessions between both nostrils and after snorting, rinse out your nostrils to clean off any cocaine adhering to your septum. Try water or saline in a spray bottle for this.
• Make sure to chop up into a very fine powder.

Reducing Injection Risks             

If you don’t already inject, don’t start. If you already inject, switch to safer modes of administration, like smoking.

Cocaine injection is riskier than opioid injection since cocaine users inject more frequently (due to cocaine’s shorter high) because cocaine acts as a tissue damaging anesthetic and because since it’s an anesthetic, you can’t always feel the damage you do.

• If you choose to inject, to avoid re-using syringes and damaging veins, make sure you have enough injection equipment on hand. If getting from a harm reduction center or needle exchange, tell them you inject cocaine and therefore need a larger supply.
• Take care of your veins and maintain good injection practices to reduce infection risks. Read our harm reduction guide to heroin injection for a more complete list of safe injection tips.
• Switch from injecting to smoking or snorting - or at least avoid injecting in very risky sites, like the groin or neck. If you get to the point where you need to rely on very dangerous sites, it's time to stop injecting.
• Avoid skin popping. Cocaine isn’t easily absorbed into tissue and can lead to constricted blood flow and tissue damage. Under-skin tissue damage can lead to discoloration at the injection site.¹
  

Reducing Smoking Harms

• Don’t share pipes. Sharing pipes or stems can lead to the transmission of HIV, herpes, hepatitis and other diseases.
• To prevent cuts and burns, wrap stem ends with tape or rubber.
• To avoid hand burns, buy a good lighter. A burner type, rather than a flame type, may be preferable, since you’ll avoid inhaling the heat from a close flame.
• Treat lip cuts and burns with a water-based lip balm.
• Don’t smoke from drink bottles or cans. This can lead to lung damage through the inhalation of ash, paint and toxic dust (a glass pipe is a much safer alternative).
• Use a wire screen in your pipe to prevent the inhalation of hot particles.
• Let the pipe cool down between hits.
• If chasing, use real tinfoil and not foil from packaged foods like candy bars. This type of foil can have harmful contaminants.²
• Get medical attention at the first signs of lung damage (don’t wait until it’s too late). See a doctor if your breathing is wheezy or painful after a session. Because of crack’s anesthetic properties, you often can’t feel lung pain until after the drugs wear off.

Avoiding Infection

• Don’t share snorting straws. Minute (invisible) flecks of blood are often present and these can confer HIV or hepatitis C between users.
• It’s not just the syringe, you can’t safely share any injection gear; use your own cooker, cotton, tie and water too.
• Don’t use a rolled-up bill to snort with. These bills are far from sterile and can transfer many common infections when inserted against the mucous membranes of your nasal cavity.
• Carry and use condoms. Cocaine can increase sexual desire and reduce inhibitions, so plan in advance and stay safe.
• Get a hepatitis B vaccine or booster.

Avoiding Social and Psychological Harm

• You know you won’t feel great so plan an easy recovery day after a session or binge.
• After using, try to get plenty of sleep and make sure to drink lots of water and or juice.
• Think about how to ease the discomfort of the crash. Know that the worst part of the crash only lasts for 45 minutes to an hour. Try relaxation techniques to calm down during the crash. Some people find eating after a binge can help get you feeling better. Avoid using alcohol during the crash.
• If your binges tend to get out of control, limit your access to funds before you begin a session so you won’t end-up with nothing to pay the rent. You might try asking a loved-one to hold onto your money for a while or leaving with only a set amount of money and no ATM card.

Avoiding General Physical Harm

• One way to reduce your use is to set rules for yourself, such as never using before a certain time of day.
• Eat a good meal before you start using (since it may be a while before eating well again.)
• Mixing cocaine with alcohol and other drugs increases the risks significantly. People who use alcohol and cocaine together are at significantly elevated risk of heart attack (alcohol and cocaine combine in the body to form toxic cocaethylene).
• If you skin-pick when high, make sure to have something else to keep in your hands to play with, or if you chew on your lips or grind your teeth, try chewing gum instead.
• Cocaine is riskier for people with age-related cardiovascular disease, so get checked for cardiovascular heath, and if you have any degree of disease, strongly consider ceasing or at least reducing your cocaine use.³

Avoiding Overdose and Death

Cocaine kills more people than heroin, in fact, it’s second only to prescription drugs as America’s leading O.D. killer, so if you choose to use cocaine, you NEED to take precautions to stay alive.⁴

• Get a physical and be upfront with your doctor about your cocaine habits (if you don’t feel comfortable revealing the truth to your doctor, it’s time to get a new doctor!) As a cocaine user you need to take care of your cardiovascular health, so ask your doctor to test your blood pressure, circulation and whatever else she recommends. Again, if you have early warning signs of heart damage or cardiovascular disease, you should strongly consider stopping or at least reducing your cocaine use. Studies show that seemingly healthy young adult recreational cocaine users often display multiple cardiovascular risk factors, such as higher blood pressure, aortic thickening and heart scarring.⁵
  
• Cocaine overdose is not always dose-dependent; sometimes a small amount can cause dangerous symptoms. Variables which increase your likelihood of experiencing an overdose include your state of mind (feeling anxious), your state of sleep deprivation, your state of food deprivation or dehydration and/or using other substances with cocaine.
• When using new cocaine, always try a small amount first as a potency tester, especially if injecting.
• Avoid mixing cocaine with opiates for a speedball. Mixing cocaine with alcohol or other sedatives also increases fatal overdose risks.
• Cocaine overdose is often cardiovascular in nature (heart attack, stroke or serious arrhythmia). Naloxone injection will not reverse cocaine overdose so emergency medical attention is required. To avoid fatal overdose, you should avoid using cocaine alone, so you have someone on hand to call 911, if needed.
• Do not wait before calling 911. If you wait until the situation becomes critical, it may be too late.

Signs of Overdose

Anyone who uses cocaine or loves a cocaine user should know the warning signs of overdose:

Signs of cocaine overdose include:

• Nausea and throwing up.
• Passing out.
• An elevated body temperature and heavy sweating.
• Racing heart beat.
• Any signs of heart attack, such as chest pain (tightening in the chest).
• Intense headache.
• Muscle cramps.
• Being unable to urinate.
• Feeling short of breath or breathing irregularly.
• Experiencing tremors or convulsions or signs of seizure, like drooling or frothing or limb spasms or rigidity.
• Grinding teeth.
• Signs of stroke, such as: a sudden inability to talk coherently or understand what other people are saying, sudden weakness or loss of feeling in the face, arms or legs (usually on one side of the body), sudden loss of balance or coordination and or sudden vision difficulties.

Here are 50+ heroin harm reduction tips... because anything that prevents overdose and keeps you alive and healthy increases the odds of finding eventual lasting recovery.

Why harm reduction?

Many people find harm reduction ridiculous; after all, instead of promoting safer use shouldn’t we concentrate on helping people stop completely? Is it ever right to support heroin use?

But actually, harm reduction does help a person stop completely by keeping them alive and healthy until the day they're ready to quit:

1. Dead addicts can't quit - so we need to keep people alive and well until they're ready for treatment.
2. Seriously compromised physical, mental and cognitive health reduces a person's abstinence chances - so we need to help addicts stay as healthy as possible until they're ready for change.
3. Addicts already in regular contact with health workers learn about treatment options and have facilitated treatment access.

Basically then, if you support abstinence as the optimal goal, you should support harm reduction as a great vehicle for helping addicts get there.

So if you (or someone you care about) use heroin, delve into the following harm reduction ideas and consider making a few simple changes to safeguard health and well-being.

Read on to learn...

• why it makes sense exactly
• 50+ Harm Reduction Tips

The Philosophy Behind Heroin Harm Reduction

Consider some of the arguments behind harm reduction:¹

• It’s less judgmental. Society (and some treatment providers) may view people as ‘good’ when they abstain or use responsibly and ‘bad’ when they don’t or when they don’t want to quit at this moment. Under a harm reduction philosophy, people aren’t judged on their drug use. Each person is treated with the same dignity and respect – no matter what their situation or history. Each person is considered deserving of health and happiness, whether they choose to use heroin or not.
• It recognizes that sometimes improving a person’s quality of life is more important than insisting that person accept a goal of total abstinence (and not supplying services to people who don’t accept this goal).
• It empowers people to believe in the possibility of self-directed change.
• It meets people where they are now. This way every opioid user can benefit from harm reduction and better health right now – not just when they achieve some optimal state of motivation and readiness for abstinence.
• It recognizes that sometimes a bit of education can help opioid users minimize their risks of health consequences and fatal overdose.
• It recognizes that society as a whole benefits when drug users get healthier and more in-control.
• It recognizes that most change occurs as an incremental process – not a sudden lurch. By supporting a person as he makes small improvements we help him move steadily toward a chosen goal.
• Harm reduction programs tend to be evidence-based and science-driven.
• Small financial harm reduction investments cause major societal cost savings.

Heroin Harm Reduction Tips

Snorting

• Alternate nostrils. This reduces the odds of infection and tissue damage.
• Don’t share straws. Minute flecks of blood on a straw can transmit hepatitis B or C.
• Don’t use rolled-up money to snort with. Paper money is teeming with germs and you increase your risk of infections.
  
• Take some time before snorting to chop up very finely. If you need to snort black tar heroin, you’re best off dissolving this in water completely and then sniffing this water.
• Make sure you’re snorting on a clean surface (a plastic card from your wallet can work). This reduces the odds of sinus infections as well as cold and flu.

Smoking/Snorting

• Don’t hold it in your lungs. This won’t increase absorption but it will increase lung irritation and damage.
• If you have asthma, make sure you have your inhaler on hand. Inhaled heroin can lead to serious asthma attacks.

Injecting: Protecting Your Veins

• Try to work on a clean surface. If you’re not sure about your work area, putting down a sheet of newspaper can help a lot.
• If you mainline, use the smallest needle that you can find. Sharp needles reduce vein damage and every time you reuse a needle the point gets progressively duller.
• Don’t inject into muscle or skin-pop unless your heroin dissolves easily in water without needing to add an acid. Doing otherwise increases your chances of abscesses (black tar heroin may differ).
• Never inject against the flow of blood in your veins. Inject toward your heart.
• Never inject into an artery (this increases your risk of gangrene and other problems). If you can feel a pulse, it’s an artery.
• Inject slowly – don’t slam it in. The faster you inject the greater your risks of vein tearing. Take the needle out as soon as you are done to reduce bruising.
• Don’t flush the needle (pulling blood in to re-inject). This doesn’t get you any more heroin but it does increase vein damage by making the hole bigger, increasing bleeding and clotting and damaging vein linings.
• If you need to use an acid to dissolve your heroin, try to avoid using lemon juice or vinegar; opt for powdered vitamin C or powdered citric acid instead. Injecting lemon juice or vinegar can cause fungal infections. Use as little acid as is needed to completely dissolve your drugs.
• Don’t inject tablets. Tablets contain additives and these don’t dissolve completely. Injecting solids into veins increases the chances of vein damage/collapse.
• Rotate your injection spots. If you find you can no longer inject in lower-risk areas (like the elbow area) you should consider moving away from injecting rather than moving down to higher-risk areas. The risks of serious health complications and lasting pain and disability go up substantially once you move on to riskier injection sites, like the legs, groin, feet, etc.

Injecting: Reducing Bacterial Risk

• Wash your hands with soap and hot water before you start preparing your works.
• Heating your shot, even when not needed, may help to reduce bacterial infections. If your water isn’t sterile, heating it to a boil before mixing with dope can reduce bacterial risks.
• Don’t lick the needle!
• The tip of the needle picks up bacteria from your skin every time you insert through it. If you need to insert several times because you’re having a hard time finding a vein you may want to change your needle.
• Choose your water carefully. Consider the following water supplies, listed in order from safest - to - most dangerous: 1. unopened sterile water pack, 2. boiled water, 3. cold tap water, 4. bottled water (bacteria in bottled water pose no health risk when ingested into the stomach, but may cause infection when injected), 5. distilled water (though distilled water contains no minerals, it is not generally intended for human consumption and can be bacteria-rich), 6. hot tap water (hot tap water may not be hot enough to kill bacteria – this can make hot water riskier than cold), 7. toilet water, 8. puddle water, 9. shared sterile water pack, 10. shared cup of water.²
• Cleaning the injection site before injections can help to reduce bacterial infections. Wash with soap and water and then wipe with alcohol.
• Don’t save your cottons for the residue that accumulates. Used cottons are great bacterial incubators.
• Get a tetanus vaccine and stay up to date.
• If you get a skin infection or abscess, try not to pick at it, squeeze it or cut it open. This can spread infection and worsen the problem. A doctor might prescribe antibiotic treatment or perform a small procedure to open and treat the wound.
• As a much safer alternative to conventional injecting, you can prepare your works (use a syringe without a needle!) as normal but then insert the syringe into your rectum and gently squirt in the contents.

Injecting: Avoiding Infectious Disease

• Not only shouldn’t you share a needle, you also need to use your own water, cotton, tie, cooker or spoon. Sharing any of these increases your risk of infectious diseases.
• If you inject, you can greatly reduce your risks by using a new sterile needle each time you inject, as well as new cotton each time, a clean cooker and fresh sterile water. Keeping things clean and sterile reduces your odds of skin infections and abscesses, internal infections like endocarditis and transmittable infections like HIV and hepatitis C. If possible use sterile medical grade disposable cookers and syringes as well as sterile water.   
• If you absolutely need to reuse a syringe, learn how to safely clean with water – bleach – and water again.
• A drop of blood that’s too small to see can contain enough hepatitis or HIV to get you infected. Not only shouldn’t you share any injecting supplies, you also need to make sure that your heroin never comes into contact with another person’s needle, mixing water, cooker or filter.³
• Get a hepatitis B vaccine.
• Be flexible with your intake – if you can’t get a clean needle, you’re much better off snorting or smoking than using a friend’s.

General Health Preservation

• Work past constipation by having a bowel movement before you get high (using will make constipation worse). Also, eat a high fiber diet and stay hydrated.
• Have condoms on hand (to prevent STDs from unplanned sexual activity).
• Don’t rely on pain as a sole indicator for when dental or medical care is needed. Since heroin is such a potent pain reliever, serious problems can go unnoticed; If something looks like it needs medical attention – even if it doesn’t hurt - it probably does.
• If you get a sudden high fever and feel very unwell you may have septicaemia (blood poisoning). This is a potentially lethal condition so treat this as a medical emergency.
• A large skin infection, where the skin becomes tight, hot, red and painful over a large area is possibly cellulitis. This is also a medical emergency requiring immediate attention.
• Go see a doctor if any skin near an injection site becomes black or discolored, or starts weeping fluid.

Avoiding Addiction

• If you’re using but not yet dependent, avoid using more than 2 days in a row and take a break if you start feeling like you need drugs.

Avoiding Overdose

• Don’t use alone or behind locked doors.
• Try a small tester shot first.
• If you can, buy from someone you know and trust and ask them about potency before using.
• If using alone, try snorting instead of mainlining.
• If you’ve taken a break – even a short one - your tolerance can drop substantially and a hit that you could have handled easily before can become dangerous. After a break, use with caution, use less, and consider safer forms of administration, like smoking or sniffing.
• Feeling very run-down can increase heroin’s effects. Use less if feeling ill, very tired or dehydrated or if your liver isn’t working well.⁴
• Have naloxone on hand and know how to use it.
• Don’t mix heroin with benzodiazepines, alcohol, cocaine or other drugs. Mixing substances increases overdose risks. Some OTC and prescription drug can stay in your system for a day or longer, so you have to be careful even when combining heroin with medications you took the day before.⁵
  
• Learn CPR and rescue breathing to save a life.

Starting Methadone or Suboxone Treatment

• Getting involved with a methadone or Suboxone treatment program can help you stabilize, take breaks and improve your overall functioning.

Preventing Community Harm

• Dispose of injection equipment in a Sharps container to protect others from accidental sticks and infectious disease transmission.
• Get tested for HIV and hepatitis C.

Consider Treatment - Even if Not Abstinence-Ready

Harm reduction helps you safeguard your health while using, but nothing improves health as much as reducing or stopping altogether.

If you want to stop, then treatment’s a no-brainer. Suboxone or methadone can get you stabilized and rebuilding your life in a matter of weeks.

But even if you’re not sure you want to stop completely, treatment is still worth considering. Research shows that people getting heroin treatment...⁶

• Are less likely to overdose.
• Use less (or sometimes stop completely) – and longer periods in treatment generally equate to progressively reduced use.
• Get physically and emotionally healthier (a by-product of reduced use and increased contact with medical professionals).
• Commit fewer crimes.
• Are better able to hold onto a job and maintain satisfying intimate and social relationships.

Is moving from high-risk drinking to moderate-risk drinking a worthy goal? To learn more about harm reduction, here’s an interview with HAMS founder Kenneth Anderson.

Is abstinence a necessary goal?

Depends on who you ask – but whether you want to quit or just cut down, there’s room for you at harm reduction focused HAMS meetings, where baby steps of progress lead to longer journeys in the right direction and the motto of note is simply ‘better is better’.

Though AA gets most of the attention, you have other community self-help groups, such as SMART Recovery and also the alcohol harm reduction focused HAMS, a peer-led and free-of-charge support group. The acronym HAMS stands for Harm reduction, Abstinence, and Moderation Support.

There’s something unorthodox about a self-help group like HAMS that supports as much drinking as you seek (goals are all individual and never judged) but for advocates of HAMS and other harm reduction approaches, abstinence-only programs don’t meet all needs and too many people never find success or comfort within-abstinence only confines.

As an alternative, HAMS strives to meet drinkers where they are and to offer support and education toward any reduction in drinking, no matter how slight – because as they say in HAMS, better is better.

HAMS is a non-profit evidence-based program and centers around the working of 17 elements (CBT or behavior modification tools) and participation in support group meetings. The HAMS program is outlined comprehensively in Kenneth Anderson's manual ‘How to Change Your Drinking’.

Is HAMS right for you?

For more on the program, we asked HAMS' founder and executive director Kenneth Anderson, MA a number of questions on the workings and potential benefits of this newer option.

An Interview with Kenneth Anderson

Choose Help - Hi Kenneth, to get started with this, where can I find a HAMS meeting and approximately how many people are active HAMS users right now?

Kenneth Anderson - HAMS support groups function primarily online; HAMS has both an email support group and a real time chat. The email support group currently has 1,237 members and an average of about 20 messages are posted to the group each day. HAMS chat is scheduled at 9 PM Eastern time 7 days a week; scheduled chats are active and lively with up to a dozen people interacting at once. Many users also make use of the chat room outside of scheduled hours. People from all around the world make use of both the chats and the email group. There is also a live HAMS group in Brooklyn, NY and a professionally led group is facilitated by Cynthia Hoffman in San Francisco.

Choose Help - Don’t people seeking an alternative to AA and the 12 steps already have a viable alternative group with SMART Recovery? How is HAMS different from SMART?

Kenneth Anderson - SMART Recovery is an abstinence based group aimed at people whose goal is total abstinence from a problematic behavior or substance. HAMS is based on the principles of harm reduction; HAMS encourages any positive change from safer drinking to reduced drinking to quitting alcohol altogether. Aside from this difference, there are many similarities between HAMS and SMART: for example, both make use of a tool called a Cost Benefit Analysis (also known as a CBA or Decisional Balance Sheet). Both also make use of many tools borrowed from Cognitive Behavioral Therapy such as the ABC method developed by Dr. Albert Ellis.

Choose Help - OK, could I do HAMS and AA or SMART at the same time?

Kenneth Anderson - Yes. HAMS members are welcome to use whatever works to attain their goals vis a vis alcohol. A fair number of HAMS members eventually opt to quit drinking entirely and many of these people decide to be involved with both HAMS and SMART. SMART tends to be the most comfortable abstinence program for HAMS members because of its grounding in science, but it is not unheard of for HAMS members to attend AA as well. HAMS realizes that people know deep down what is best for themselves and hence HAMS encourages its members to think for themselves and make their own decisions.

Choose Help - How long do people usually spend working the HAMS system?

Kenneth Anderson - This varies widely depending on the individual; HAMS members are welcome to stay a lifetime if they find it beneficial or if they choose to stay to help others. Members are also free to come and go as they please; some will dip their toe in the water, leave for a few months or a year and then come back later and make a stronger commitment. There is no pressure and no one will say "I haven't seen you at meetings lately." However, it seems that many people manage to get their drinking under control in something like a year's time, although some people may move faster and get it together in a couple of months while others may take a couple of years. A saying we like is "This ain't no hoss race."

Choose Help - Does HAMS work? Do you keep any kind of outcome records?

Kenneth Anderson - It is fairly difficult to track outcomes on a loosely knit group like our own where people are very much free to come and go as they like, however, in the future we are looking at the possibilities of doing some more formal research on the group, possibly in conjunction with some of our academic colleagues.

Choose Help - You don’t try to persuade people to quit alcohol completely, but in your experience, do people tend to have better outcomes from quitting completely with the HAMS system or with moderating?

Kenneth Anderson - My guess is that about one fourth of HAMS members will eventually opt for quitting alcohol entirely or almost entirely. HAMS is the newest kid on the block and we don't have anywhere near the visibility of AA or even SMART. Since our members have to work pretty hard to find us they tend to be aware of all the other options out there because they have spent some time Googling. So it is fair to say that our self selected group is definitely skewed and very far removed from a random sample; I believe that people already have a good idea of what they want by the time that they find us. I think that the numbers might be very different if HAMS were as well-known as AA and I am waiting for that day to come.

Choose Help - Isn’t rock bottom necessary?

Kenneth Anderson - The notion that people have to "hit bottom" to overcome an addiction is one of the most damaging myths ever created and undoubtedly kills tens of thousands of people each year. The research tells us that the more resources a person has intact in terms of family, employment, housing, social life, etc., the better chance that person will have of beating an addiction. Stanton Peele discusses this research in depth. Moreover, the more trauma that a person suffers, the lower their chance of beating an addiction. Gabor Mate is a good source on trauma and addiction. Telling people who question AA dogmas that they need to go out and drink more and suffer more and that once they suffer enough they will come crawling back to AA on their knees has undoubtedly killed a lot of people. NESARC tells us that the majority of people who overcome an addiction to alcohol do it on their own without AA and without treatment. Our goal at HAMS is to help them get there faster with less damage on the way.

Choose Help - Some people might argue that a harm reduction approach might work for a person with a mild to moderate substance use disorder, but for someone with a very serious problem, an abstinence focused program is a better choice. How do you feel about this?

Kenneth Anderson - It would be great if there was some magic wand we could wave and make everyone with an alcohol problem abstain completely, but that doesn't exist. Trying to force AA on people against their will usually backfires and makes them drink more than ever. And we know what a dismal failure prohibition was and is. When we do needle exchange, we don't make moderate heroin use a prerequisite to getting clean needles. We don't tell those who are addicted to heroin that they need to quit if they can't moderate their heroin use. Quite the contrary, we recognize that the more dope a person shoots the more clean needles that person needs. Keeping drug users healthy and AIDS-free increases the chance of recovery down the road. Likewise, the more alcohol a person drinks and the more alcohol related harms a person has in their life, the greater the need of that person to practice harm reduction. It might mean selling your car and getting a bus pass if that is the only way you can stop drinking and driving. The important point is to stay safe and alive until you are able to either quit drinking or cut back to a point of no harm. Because dead addicts don't recover.

Choose Help - Why is it important to write down and talk about your CBA (Cost Benefit Analysis)? Why can’t you just keep it to yourself?

Kenneth Anderson - Did you ever have really good idea, fail to write it down, and the next day you can't remember what it was? Writing things down fixes them in one's mind, makes them real,, and keeps them accessible to memory. This is why students need to take notes in class--what they write down is what they will remember. There is also research by Richard Wiseman which shows that for many people, sharing a behavioral change goal in a safe environment can increase one's odds of success with this goal.

Choose Help - Let's talk about the health implications of continued drinking. Using your risk ranking, you define low-risk drinking as between 15 and 29 drinks per week for men and 8 to 24 drinks per week for women. This seems higher than what’s recommended by a lot of health agencies – for example, by SAMHSA definitions, having 7 drinks in a sitting 4 nights a week would be defined as 4 binge drinking sessions per week. Wouldn’t that level of drinking put a person at high risk for health problems?

Kenneth Anderson - What is actually bizarre is SAMHSA's definitions of heavy drinking and of binge drinking. SAMHSA defines anyone who drinks more than four standard drinks in a day in the past thirty days as a binge drinker. Anyone who on five days of the last thirty days exceeds the four drink limit is classed as a heavy drinker. In other words the man who has twenty five drinks a month is in the same category as the man who downs a liter of vodka per day, seven days per week. SAMHSA makes no distinction between the man who has twenty five drinks a month and the man who has over seven hundred drinks a month--according to SAMHSA they both fall into the category of heavy drinker and there is no distinction between them. Epidemiologists who have used these definitions to categorize drinkers have found that they lead to the bizarre conclusion that heavy drinkers live longer than non-drinkers.¹ Other epidemiologists who use more realistic criteria such as the DSM IV criteria for Alcohol Dependence, on the other hand, come to the far different conclusion that heavy drinkers die about 20 years sooner than the general populace.² This is why we at HAMS categorize those who exceed the SAMHSA/NIAAA limits for moderate drinking (4 daily and 14 weekly for men; 3 daily and 7 weekly for women) on a continuum which ranges from the very high risk drinkers who put away a quart or more of vodka daily seven days a week to those at much lower risk who may down a six pack on Saturday night and not drink at all for the rest of the week.³

Choose Help - Some of the instructions in your book differ from conventional best practices, such as using beer to taper with to avoid excessive alcohol withdrawal symptoms. Have you received any feedback on the beer taper concept from doctors or other medical professionals?

Kenneth Anderson - Some people are absolutely unwilling to check into a medical detoxification program, either because they do not want a diagnosis of alcohol dependence on their medical records, because they have no medical insurance, or because they have experienced horrific treatment at the hands of addiction treatment provides in the past. Since these people are at risk of death if they stop alcohol cold turkey, we have provided instructions on how to detox using alcohol. Doctors have used and continue to use intravenous ethanol as an alternative to benzodiazepines in some cases, so using alcohol to detox from alcohol is a medically accepted practice⁴.⁵ It is always safest to detox under medical supervision with a reputable provider, unfortunately many states lack regulations on addiction treatment and there are untold numbers of unscrupulous treatment providers who kill people with cold turkey lock down detox every year. There is unfortunately, no FDA for addiction treatment and no federal regulation to prevent this and require the use of evidence-based best practices. It is truly the wild west out there.

Choose Help - How suitable is HAMS for a person with a co-occurring mental illness? In some cases, isn’t it really necessary for a person to abstain from all drugs and alcohol for a while in order to make an accurate diagnosis of mental illness?

Kenneth Anderson - For people with a co-occurring mental illness who are not succeeding with abstinence, harm reduction is the only sane approach. Harm reduction is highly suited to this population as they tend to have far greater difficulty in achieving abstinence than those with addiction alone. We strongly recommend that those with dual diagnosis who are not succeeding with abstinence work closely with a harm reduction therapist. This is a topic which is dealt with in great detail in Patt Denning's book 'Practicing Harm Reduction Psychotherapy, Second Edition: An Alternative Approach to Addictions'. People with dual diagnosis are very welcome at HAMS but will generally find that therapy is a necessity as well.

Choose Help - So is HAMS appropriate for everyone then? Is there any ‘type’ of person or person in a certain situation that wouldn’t benefit from the HAMS program?

Kenneth Anderson - Everyone can benefit from reducing harm; no one benefits from increasing harm. That being said, Bill Miller's research demonstrates that people with a history of a lot of involvement with AA tend to do very poorly with controlled drinking programs. It is likely that ex-AA members will need to be very thoroughly deprogram from the AA ideology of "one drink means one drunk" in order to succeed with a controlled drinking program. Aside from this, many people find quitting completely to be far easier than controlled drinking. It is also interesting to note that Bill Miller's research found an inverse correlation between severity of alcohol dependence and success at moderate drinking; however, no such correlation was found between severity of alcohol dependence and harm reduction outcomes. In other words, even people with severe alcohol dependence were capable of reducing harm even if they did not achieve either abstinence or moderation.

Choose Help - How important is it to actually go to HAMS meetings? From reading the book, I get the sense that I could do the program pretty much on my own, if I wanted to.

Kenneth Anderson - Some people can benefit greatly from groups while others do better working on their own. In particular, people who are very uncomfortable in groups may find groups to be detrimental. It would be nice to see more research on this topic, but apparently little has been done--people just follow an assumption that groups are necessary with nothing but convention to back it up. As harm reductionists we always try to meet people where they are at, so we have groups for those who benefit from them and we are also completely accessible for those who choose to work on their own using just the book and web site. Since we have sold over 8,000 copies of our book while our online group has around 1,200 members, we assume that many people are using the book on their own without a group and we believe that many are successful since the NESARC data supports the idea that many people are able to overcome an addiction to alcohol on their own. This is not to downplay the fact that many people may find the support group the key element which spells the difference between success and failure. People know deep down what is best for them so we ask them to decide for themselves whether participating in the group will be beneficial or not.

Kenneth Anderson, MA is the founder and CEO of The HAMS Harm Reduction Network and the author of How to Change Your Drinking: a Harm Reduction Guide to Alcohol.

Mr. Anderson has worked in the field of harm reduction since 2002--his experience ranges from work in needle exchange to work in moderate drinking programs and everything in-between. He has served as Director of Online Services at Moderation Management, and has worked "in the trenches" of harm reduction by doing needle exchange in Minneapolis. He has presented at the National Harm Reduction Conference and has been a regular guest speaker at the Harlem Hospital Harm Reduction Program, The Lower East Side Harm Reduction Center, and many other venues. Mr. Anderson is a member of The International Center for Clinical Excellence, the Global Alcohol Harm Reduction Network, and the International Harm Reduction Association. He holds a masters degree in linguistics from the University of Minnesota and is currently pursuing a masters degree in psychology and substance abuse counseling at the New School for Social Research in New York City.⁶

Image Copyright: HAMS Network

Take a harm reduction perspective - if you choose to smoke marijuana, smoke the natural kind and pass on the synthetic varieties. Here are 5 great reasons to avoid synthetic marijuana.

Is it scaremongering or are the risks real? should you pass on synthetics like Spice, K2 and others...is a friend with (synthetic) weed really a friend indeed?

If you use synthetic marijuana, you should know the potential risks. Though synthetic products are marketed as marijuana-like and though they may cause a marijuana-like high, they are potentially far more dangerous. Read on for a list of differences between natural marijuana and its synthetic cousin (including comparisons of the high) and then decide for yourself if the benefits are worth the risks.

5 Dangerous Differences ...

Synthetics Have No Ceiling Effect

With synthetics, there’s no limit to how high you can go (not always in a good way)…

Both natural and synthetic marijuana stimulate the brain’s (and body’s) cannibanoid receptors. 

• In natural marijuana, the primary psychoactive substance is THC (delta-9-tetrahydrocannabinol). 
• Synthetic marijuana can contain one or more of a wide array of molecules that stimulate the brain’s cannibanoid receptors.

THC is a partial cannibanoid agonist, therefore there is an upper limit to its effects – a protective ceiling.

Synthetic marijuana contains full-agonist cannibanoids. There is no upper limit to the effects of these compounds and since potency variations can be extreme, this makes it much easier to take more than you meant to and easier to experience a negative or harmful reaction.

(As a comparison, methadone is a full opioid agonist and buprenorphine is a partial opioid agonist, and this is why methadone is more dangerous than Suboxone - it is far easier to overdose on a full-agonist drug.)

Differences in Metabolism

Metabolism differences increase the potency of synthetic marijuana, and this can also increase its toxicity.

1. When you smoke natural marijuana, the THC you ingest stimulates your cannibanoid receptors, you get high - and then you metabolize the THC into non-psychoactive substances.
2. When you smoke synthetic marijuana, you ingest synthetic cannibanoids, you get high, you metabolize these cannibanoids and then you produce additional metabolites that also stimulate your cannibanoid receptors to produce further effects.

Though this may sounds like a good thing, this likely increases the toxicity and the risks of a serious adverse effect.¹

Potency Differences

Huge potency swings between brands and even in-brand packages make it hard to predict what you’re going to get.

Though different strains of marijuana can have differing potencies, for a number of reasons, potency differences are much larger in synthetic marijuana preparations.

Biological forces limit maximal THC content in natural marijuana. However, since synthetic marijuana producers generally spray psychoactive compounds onto plant material, manufacturing processes and human error can lead to dramatically different strength preparations:

• If the spray is a little thicker than usual potency can increase substantially. If one area of plant material is sprayed more thoroughly, potency can increase substantially. If chemical sprays are prepared incorrectly, potency can increase dramatically. If a new chemical formulation is applied, potency can increase dramatically…

So when buying a synthetic, even if you have used a product before and liked it, you really have no way to predict what you’re going to get or what type of experience you’re going to have.

The Guinea Pig Factor

Do you really want to take part in human experimentation on a newly synthesized drug?

Scientists have only recently composed and synthesized many of the psychoactive chemical compounds you find sprayed onto synthetic marijuana products. Since these drugs are so new, no one can predict what the medium and long term consequences of use may be.

In contrast, when smoking marijuana, though you might have to worry about pesticides and possible contaminants, you are generally ingesting a substance that has been used by humankind for a long time and has a demonstrated safety profile.

Though marijuana and synthetic marijuana both look ‘natural’ and safe, one is a natural product, and the other is a harmless-looking delivery system for laboratory-concocted drugs.

Acute Toxicity Risks

Synthetics can do you huge harm, right away.

Though marijuana can worsen mental illness and may increase a person’s schizophrenia risks, there are few short term physiological risks associated with use.

• This is not always the case with drugs like Spice and other synthetic marijuana products. Short term synthetic marijuana ingestion is associated with possible toxic side effects like seizures, ischemic stroke and kidney damage.^{2 3}

Since the cocktail of psychoactive substances in synthetic marijuana is ever changing and since potency differences between batches can be significant, past experience with any given product does not predict your future response – every time you try a new package, you take a chance with your physical health.

It Isn’t as Pleasant (And It Might Harm You)

So is it worth it?

OK, well people will often take health risks and ingest dangerous drugs so long as the perceived rewards equal or outweigh the probable risks – but is this the case with synthetic marijuana; is it really worth the risks?

Researchers say no, it probably isn’t.

Study: How Does Synthetic Marijuana Differ from Natural Marijuana?

In one large study using survey data from 14000 subjects (2011), of the 980 who reported last-12-month use of synthetic marijuana:⁴

• Virtually all (99%) had also used natural marijuana.
• 93% reported preferring natural marijuana to synthetic cannabis.
• Users rated synthetic cannabis as having more negative effects, such as paranoia and next-day hangovers.

In another study, researchers found that synthetic cannabis users were more likely to report serious adverse incidents than users of natural marijuana; out of 950 past-year synthetics users, 2.4% reported seeking emergency medical attention after using synthetic cannabis.⁵

So not only is it more likely to do you harm, it’s not as fun either.

Though some people may choose to continue with synthetics to avoid drug testing sanctions and/or for reasons of availability, if you choose to use, make sure you understand the risks involved. 

Image Copyright: Wikipedia

If drinking’s a problem but you can’t or do not want to stop, consider taking small steps right now to minimize the harms associated with use. Here are some ideas to get you started.

Chronic heavy drinking isn’t good for you, nor is regular binge drinking. For your health (and happiness?) if you drink too much you should consider quitting entirely.

OK, but what do you do if you can’t quit or you just don’t want to quit right now? Does it have to be all or nothing? Are drinking less per session, drinking less frequently or minimizing the harms associated with drinking also reasonable goals for health and well-being promotion?

Well, according to the principles of harm reduction, there is a middle ground that doesn’t demand complete abstinence and that lets you develop a workable plan to reduce the harms associated with drinking, while you still continue to drink.

We often think of harm reduction initiatives as community-wide projects that target people with the most serious drug and alcohol problems, however, you can just as easily apply the principles of harm reduction to your own life and take active steps to reduce the negative consequences of your substance use.

Individual harm reduction measures can improve your health and quality of life. These measures are most appropriate for people:

• Who cannot or do not want to stop completely but wish to use less (possibly with a goal of eventually stopping completely) or drink with fewer adverse consequences.
• Who do not want to cut down but want to reduce associated harms.

Considering Harm Reduction

When considering a program of harm reduction it’s useful to take stock and think about what you’d like to change most and about what current behaviors cause you the greatest harms or risks of serious harms.

• Is your health at immediate risk?
• Are hangovers interfering with your performance at work or school?
• Do you have a problem with drinking and driving?

Next, think about some changes you could live with that might reduce or eliminate some or all of your most serious concerns?

• One useful tool you might consider to help with this process is called The Drinker’s Checkup.  This is a free online questionnaire tool that helps outline what changes you might want to make.
• You might also want to try a decisional balancing exercise, which helps you delineate exactly what you like and don’t like about your current habits.
  
• Or, ask yourself about your ‘ideal use situation’. If you could use alcohol in any way, what way would provide you the most pleasure/positive effects with the least pain/negative effects. Once you identify your ideal use situation, adopt harm reduction strategies to take you progressively closer to it.¹

Make Specific Goals

As a general rule, it’s helpful to set clear goals. Whatever you decide to do, make it specific and measurable – and then keep close track of your drinking to evaluate how well you stick to your plan. For example:

• Don’t just plan to ‘cut down your drinking’, plan to cut down from an average of 8 drinks a day to an average of 5 drinks a day. Or, plan to cut down from 7 days of drinking per week, to 6 and then 5 within a set period of time.

You can keep track quite easily via a number of free or low cost apps for your phone or tablet.

A Collection of Individual Harm Reduction Ideas

Here is a collection of ideas that may help you moderate your drinking or reduce the harms that are associated with your drinking.

Stay Home and Stay Safe

If you plan to get drunk, stay at home. By staying safely at home you avoid many possible negative consequences and dangers associated with public intoxication.²

Don’t Pre-Drink

Don’t pre-drink (preload) before social events, before going out for the night or to places where alcohol is more expensive or less available.

In one study, English young adults who preloaded were 2.5 times more likely to get into a drunken fight than young adults who drank only once out for the night. Other studies have found that preloading leads to greater negative outcomes and higher overall consumption.³

Watch Your Vitamins

If you drink more than a few drinks daily then you are likely vitamin-deficient. Take extra supplementary vitamins and/or ensure that your diet makes up for the losses.  According to the National Institute of Health, between 30% and 80% of heavy drinkers are thiamine deficient, and this can lead to Wernicke’s Encephalopathy and Korsakov’s Syndrome. If you are very deficient, you can’t always get enough absorption via oral ingestion and you’ll need to talk to your doctor about a thiamine injection. It’s a largely side-effect free intervention that could save your health or even your life.⁴

Drink Less per Session

You can reduce the health consequences of excessive drinking by consuming less alcohol in each drinking session, such as by:

• Alternating between alcoholic and non-alcoholic drinks.
• Switching to lower-alcohol drinks, such as from regular strength beer to light beer.
• Waiting until later in the day than normal to have your first drink (plus avoiding pre-drinking before going out).
• If you drink at home, buy just enough for your session and keep no additional alcohol at home.
• Foregoing the hair of the dog hangover cure.

You will likely need to have a concrete plan for your reductions, especially considering how intoxication erodes will-power and judgment.

Research demonstrates that people who follow harm reduction programs can effectively reduce consumption and alcohol-related problems.⁵ If you find that a solo harm reduction program isn’t workable, consider getting involved with a group of like-minded individuals such as through HAMS Harm Reduction for Alcohol or Moderation Management.

Take One or More Days Off

As an alternative to reducing the amount you drink per session, you could instead (or also) reduce your weekly drinking days.

Taking days off cuts down your total weekly drinking, gives your body time to recover between sessions and lets you plan your drinking so you can take a day or days off before important work or school commitments.

• If you’ve been drinking daily for a while, you should talk to your doctor about your readiness for a full day of abstinence. In some cases, people with serious alcohol dependencies can experience dangerous withdrawal symptoms when trying for sudden abstinence.
• You should expect cravings and temptation – taking a day off isn’t easy, especially for people with a long habit of daily drinking. Plan enjoyable no-alcohol activities to help keep your mind off alcohol, and plan for how you'll deal with the cravings you’ll likely experience.

Taking a day or days off is hard at first, but it gets much easier with practice.

Reward Yourself

The rewards of reduced drinking accumulate slowly, but the pleasures of a drink arrive immediately, and when you’re trying to cut-down, this pleasure-delay makes things difficult.

To circumvent our natural human preference for immediate gratification, use the principles of contingency management and reward yourself for your successes with small treats or self-gifts (use the money you’d have spent on drinking on something fun for yourself).⁶

If You Go Out, Arrange in Advance for Safe Transport Home

Plan for how you’ll get home before you go out drinking. If drinking and driving is a problem for you, take steps before you have your first drink to reduce the odds that you’ll be in a position to drive. Walk, take public transport or travel with a designated driver. If you tend to reach for the keys at home once drunk, have someone else hold them for you or keep them off site in a location you can’t easily access.

Consider Drug Substitution

Some people find harm reduction success by switching from alcohol to marijuana on some or all drinking occasions. You will have to evaluate for yourself any potential legal or other risks associated with this harm reduction method.

Eat before You Start Drinking

Food in your belly helps delay the rush of alcohol into your bloodstream and keeps you from getting too drunk too fast.

Continue to eat slowly as you drink - and also consume hydrating fluids while drinking alcohol to prevent excessive dehydration.

Also, try to avoid drinking when you’re feeling tired or run-down.

Pour and Measure Your Own Drinks

It’s hard to keep tight control over your drinking (and therefore stick to your drinking goals) unless you pour your own drinks and measure each one carefully.⁷

Stop Emotional-Drinking

If you plan to only drink on certain days or only certain amounts on any given day, don’t allow your emotional state to alter your good intentioned-plan.

• Use alcohol when you’re angry or upset and you’re likely to drink too much and derail your good efforts.
• Some harm reduction therapists go so far as to recommend a brief period of mindfulness prior to drinking, as a way to get in touch with your current emotional state and to make sure that your drinking won’t exacerbate a negative head-space.⁸

Change in Incremental Steps

Remember, change doesn’t have to happen as a sudden 180 degree turn. Rather than thinking of change as an all or nothing phenomenon, it’s entirely reasonable to work through manageable small steps of progress – after all, as the saying goes, the longest of journeys begins with a single step.

If you want to improve your health and well-being, but you don’t feel ready or able to quit entirely, maybe you should consider taking small steps of harm reduction today.

Six guidelines for marijuana harm reduction, from the Canadian Society for Addiction Medicine.

Concerned about your marijuana habit? Wondering if you should cut down but not sure you’re ready to quit yet (or ever?)

Well, there are different schools of thought, and those from the abstinence-only camp don’t think much of harm reduction methods, but if you're not ready or willing to quit completely right now, then maybe harm reduction makes sense for you.

Read on to learn 6 easy harm reduction principles to live by. All minimize your risks, so incorporate any or all that make sense to you (some won’t likely be relevant to your situation).

Marijuana Harm Reduction

According to the Canadian Society of Addiction Medicine, 6 key components of marijuana harm reduction are:

1. Don’t start using marijuana until you’re 18 or older.

2. Don’t smoke every day or even almost every day. The more frequently you smoke the more likely you are to develop an abuse or dependency problem. Try to limit your total weekly intake to 5 joints or less (The European Monitoring Centre for Drugs and Drug Addiction harm reduction guidelines suggest not smoking more than once a week to minimize your risk of addiction and marijuana-associated mental illness).¹

3. Do not use tobacco in joints and avoid deep inhales/holding it in. Most of the THC is absorbed within seconds but holding in the smoke substantially increases tar and particulate absorption. Use a vaporizer as a preferable less lung-damaging alternative to bongs, joints or pipes.

4. Don’t drive for 3 or 4 hours after you smoke, or for longer if still feeling it.

5. Don’t use at all if you’re a middle aged or older man with cardiovascular problems, a pregnant woman or if you have a history or family history of psychosis.

6. Get help if you can’t control your marijuana habits.

More Sensible Marijuana Harm Reduction Ideas

• Use as little as possible to get the desired effect.
• To avoid illness, be wary of sharing joints or pipes with others. Saliva from other smokers can transmit flu, meningitis, colds and other infections.²
• If you use a water pipe or bong, be sure to clean it and replace the water frequently, otherwise you risk breeding bacteria and viruses – and then inhaling them.

If you decide to use, make sure you stay in control and try to reduce your risks. If you can’t stay in control and you can’t control the ‘harms’ then think hard about whether pot gives more than it takes, and if it doesn’t, have the courage to get help and get back in control.

Also check out "Marijuana: 20 Practical Tips for Cutting Down"

Image Copyright: Aldo Tapia A.

Club drug harm reduction - what’s in those drugs? European researchers tested over a 1000 samples of cocaine, MDMA and amphetamine to find out. Learn about common adulterants and about how to stay safer with club drugs.

Is club drug harm reduction really necessary? Well, here's an unsettling fact that argues for caution: if you take an MDMA tablet you have a roughly 1 in 3 chance of that your tablet will contain no MDMA, and instead be a mystery psychoactive substance.

You don't always get what you expect - so you need to be careful out there.

1. Clubbing harm reduction groups in three countries did drug testing analysis on a total of 1690 samples at party sites across Europe during the period from January to May 2012.
2. While some drugs were often pure (such as crystal MDMA) other drugs, like cocaine and amphetamines, were highly adulterated.

Read on to find out:

• What’s commonly added to club drugs like MDMA, cocaine and amphetamines.
• How to test your drugs for purity.
• Some general club drug harm reduction techniques
  

What in Those Drugs?

A breakdown of what researchers found in common club drugs.¹

Cocaine

Based on an analysis of 413 samples:

• The average purity level was 49%. 5% of samples were pure cocaine, 4% had no cocaine at all and 91% were a mixture of cocaine and adulterants.
• 40% of cocaine samples contained 3 or more adulterants.
• 29% of samples contained levamisole (a veterinary drug).
• 21% contained phenacetine (a once common pain reliever now banned for linkages to certain cancers and kidney damage).
  
• 19% contained caffeine.
• 18% contained local anesthetics like lidocaine, teracaine and procaine.

If you can't control your cocaine use, learn what's happening in your brain with cocaine addiction.

MDMA Pills

Based on an analysis of 196 samples:

• The average MDMA dosage in a pill was 102 mg.
• 61% of samples were pure MDMA, 11% contained MDMA and adulterants and 28% contained no MDMA and were composed of other psychoactive substances.
• 34% of samples contained at least one of: 4-MEC, mephedrone, methylone, alpha-PPP and dimethylcathinone.
• 20% of samples contained caffeine.
• In samples that contained no MDMA, the psychoactive substances most commonly observed were m-CPP, PMA*, methylone and mephedrone.

*PMA Risks

PMA is a drug that works similarly to MDMA, and so it’s sometimes sold as MDMA to unsuspecting users. Unfortunately, PMA is more toxic than MDMA and has a lower lethal dose, and to worsen this situation, PMA takes longer to kick in than MDMA, leaving people at risk of re-dosing when not feeling high-enough at first.²

Amphetamine

Based on an analysis of 407 samples:

• The average purity level was 14%. 9% of samples contained pure amphetamine, 80% contained amphetamine plus adulterants and 11% contained no amphetamine.
• 68% of samples contained caffeine.
• 5% contained unknown substances.
• 3% contained paracetemol.
• 3% contained 4-methylamphetamine.

If use has become addiction, learn about meth withdrawal and meth addiction treatment.

Testing Your Drugs – Benefits and Drawbacks

Reagent testing can reassure you that drugs contain the correct active substance – but they will not identify possibly dangerous adulterants.

If you take drugs like MDMA and if legal in your area (in some jurisdictions drug testing kits are considered drug paraphernalia) you may want to consider investing 20$ or so toward the purchase of a drug testing kit.³

To use a reagent drug testing kit you mix a small tablet scraping or quantity of the powder drug to be tested with a reagent liquid, and based on the color the liquid turns, you will know which chemicals are present.

However, although these kits can help you identify a pill’s primary substance, they may not help you identify unknown adulterants added to the pill – so just because a pill tests positive for MDMA, for example, this doesn’t mean that it doesn’t also contain a dangerous adulterant.

Staying Safe with Club Drugs

Beyond testing your drugs, the following ideas may also decrease your odds of serious problems:⁴

• Don’t take a new drug unless you know what to expect from the high. Educate yourself first.
• Before you take drugs, have a plan for getting out and getting home safely.
• Be cautious taking drugs, especially drugs you aren’t familiar with, in loud and intense settings, such as at concerts or clubs. If things get uncomfortable in your head the surroundings can exacerbate the situation.
• Be cautious when mixing drugs. This increases the odds of an adverse reaction.
• Think twice before taking drugs when feeling unsure or anxious about it - this can increase your odds of a bad trip and an unpleasant or even dangerous experience.
• Use with friends you trust and don’t leave while high with people you don’t know
• Give it time to kick in before taking more. Some drugs can take 45 minutes or longer to start showing effects. You can always take more down the road if you choose to, but you can’t un-take what’s already in your body. Re-read the section on PMA above to emphasize the importance of this point!
• Take regular dancing breaks and get enough non-alcoholic drinks.
• Never share injection or sniffing tools.

If you can’t or won’t quit, here are 6 questions to answer when making a plan to cut down your substance use.

Looking to cut down your drinking or drug use, but not ready or willing to quit entirely?

In some situations, choosing to cut down rather than quit entirely is a valid approach – and preferable to doing nothing when substance use gets problematic.

If you have no substance abuse or dependence issues, then you can probably cut-down fairly easily, just by setting your mind to it.

However, if you have any degree of substance use disorder, to successfully cut down – you probably people need to plan ahead and set explicit guidelines and limits. Good intentions are a start, but vaguely deciding to 'just drink or use a bit less or a bit less often' rarely results in lasting behavioral change.¹

Use your answers to the following 6 questions as a framework for your cut-down plan, and then once you get started, stick to your plan!

By setting clear rules:

• You are more likely to achieve behavioral change.
• You have a framework to evaluate your ability to cut-down. If you cannot stick to your cut-down plan, then you may have to consider abstinence as your only workable option.

Making a Cut-Down Plan

1. How many days a week will be drug and alcohol free days?
2. On days when you drink or use, what’s the most you will drink or use?
3. On drinking or drug use days, what time of day will you start using at (and not before)?
4. What high-risk places or situations will you avoid using or drinking in completely (since you these situations tend to lead to a loss of control?)
5. If you use drugs, are there any modes of administration you won’t use (for example, you may choose snorting over injecting.) If you have a drinking problem are there any types of alcohol you will abstain from?
6. What is the maximum amount you will spend on drugs or alcohol in a week? Will you keep drugs or alcohol in your home? What is the maximum amount you will keep in your home?

Sticking to Your Plan

Choosing to cut down, rather than abstain completely, is a sensible option for a lot of people.

Cutting down probably doesn’t make sense if after trying for a while:

1. You aren’t actually reducing your consumption.
2. You are still having significant health or life problems related to your drinking or drug use.

If you find that you can’t stick to your plan, you may want to try an abstinence based approach. Many people actually find complete abstinence easier than the discipline required for controlled use.

Looking at the scientific evidence for and against marijuana as a substitution medication for alcoholism.

Marijuana maintenance - should you use marijuana as a substitution ‘medication’ to help you quit drinking?

The idea may surprise you, but researchers at the School of Public Health at the University of California at Berkeley recently evaluated marijuana as a substitution medication (marijuana maintenance) across 7 criteria, and though they don’t outright recommend the idea (they call for further research) they don’t condemn it either, while noting that alcohol is more harmful than marijuana and far more dangerous in overdose situations.¹

The 7 domains used to rate the acceptability of an alcohol substitution medication are:

1. It reduces alcohol related harms.
2. It is free of harm or less harmful than alcohol.
3. Its misuse should be less than what is seen with alcohol.
4. It is an adequate substitution for alcohol. It is not used along with alcohol.
5. It is less dangerous in overdose than alcohol.
6. It doesn’t potentiate the effects of alcohol.
7. It results in significant health economic benefits.

Read on for their conclusions across 7 comparison domains – and then make up your own mind on this contentious issue.

Marijuana as an Alcohol Substitution Medication

According to UC Berkley Researchers:

Supporting Evidence

• Reducing alcohol harms  - There is some evidence that marijuana substitution can reduce alcohol damage.
• It is free of harm or less harmful than alcohol – There is significant evidence that marijuana is safer than alcohol.
• Safer in overdose – When looking at the safety ratio, we see that alcohol is 10 times more dangerous in overdose situations.
• Health economics – there is some evidence that at the macro level, substituting marijuana for alcohol results in community health economic benefits.

Mixed or Contradictory Evidence

• Alcohol potentiating - Some studies suggest that marijuana potentiates alcohol, while other studies suggest that it does not.
• Its misuse should be less than what is seen with alcohol – Though percentage dependence rates are far lower for marijuana than for alcohol, marijuana dependence rates among alcohol abusers are significant.
• Complement or substitute – There are studies showing that marijuana is used as a substitution for alcohol but also as complementary substance with alcohol.

Is Marijuana Maintenance Common?

Whether or not addiction experts decide to back marijuana maintenance – research results from California and B.C. Canada show that many medical marijuana patients already use cannabis as a replacement for alcohol.

People with substance use disorders – whether alcohol or other drugs – commonly try substituting a less harmful substance for their drug of choice.  

• In a study of medical cannabis users from 4 dispensaries in British Columbia Canada, 75% of those polled admitted to at least sometimes using marijuana to substitute for other substances, such as other prescription drugs (68%), alcohol (41%) and other illicit drugs (36%).²
• In a study of medical cannabis users from California, researchers from the University of California Berkley attained very similar results, observing that 66% of patients reported sometimes using cannabis to substitute for prescription drugs, 40% used it to substitute for alcohol and 26 % used it to replace other illicit drugs.³

Potential Drawbacks

• In some areas there are potential legal issues.
• While intending to use cannabis as a replacement medication, there is a risk that you’d use it as a complement or additive substance – just worsening your problem.

Further Reading

Beyond alcohol, people fighting addictions to other substances, such as opioids, may also benefit from marijuana as a treatment ‘medication’.

Research published in the American Journal on Addictions demonstrates that people who use marijuana during the methadone stabilization phase experience milder withdrawal symptoms that people who do not. The use of cannabis during methadone induction had not negative impact on the process.

What Do You Think?

If you were able to switch from uncontrolled alcohol use to uncontrolled marijuana use, is this a significant improvement?

Please leave a comment below to share your opinion, experience or expertise!

Twenty effective tips for moderating your marijuana habit.

Smoking too much but not ready or able to quit entirely?

Well, maybe instead of quitting completely or suffering negative consequences from over-indulgence, you can learn to moderate your marijuana habit. Read on for 20 tips on how to cut-down successfully.

Will Cutting Down Work for You?

Well, you won’t know until you try – some people can moderate and some people just can’t. If you make a serious effort to cut-down and find that you always wind up smoking as much ever, then you’re left with a decision between:

• Continuing with heavy smoking.
• Stopping completely.

Though many people find complete abstinence easier than moderation, if you can’t stop on your own you may need to learn new skills that help you overcome cravings and stay marijuana-free while dealing with stress, boredom and relaxation-needs.

Marijuana: 20 Practical Tips for Cutting Down  

1. Buy in smaller quantities. Though you may pay a bit more, it’s easier to cut down when you don’t have a huge bag to dip into. Try buying just enough for a few days and trying to make what you have last.
2. Make a plan for how much you want to use and try to stick to your plan. Don’t just ‘try to smoke less…’ If you normally smoke a gram a day, decide you’ll only smoke three quarters and then a half gram a day.
3. Keep a written record of how much you smoke every day. This helps you monitor your actual progress and keeps you motivated.
4. If you normally use a bong or pipe, switch to joints instead. The small added effort in rolling-up may keep you from taking that last hit you don’t really need anyway.
5. Make a decision to start later in the day. For example, if you normally start smoking at 5pm, decide to hold off until 7 pm or 8 pm instead.
6. Tell your friends (those you smoke with) of your decision to cut down. Ask them to respect your wishes.
   
7. Make a decision to take one or more days off per week (start with one and add more days as you get comfortable with reducing.) If you’ve been smoking daily for a while, going marijuana-free for a day takes a little determination, but it gets easier with practice. To get started, try planning other activities to keep you busy and engaged during the times you’d normally be getting high.
8. Each time you get an urge to smoke, try waiting for 10 or 20 or even 30 minutes before smoking.  Since you know you’re going to have a smoke it’s not hard to manage, but a few 20 minute delays a day can add up to a good sized reduction in daily consumption.
9. Don’t pre-roll joints – even when you know you’ll need/want them later.
10. If you usually smoke socially with friends, while starting off with moderating, try reducing your exposure window by meeting-up a little later and heading home a little earlier than normal.
11. Have someone you trust hold onto your marijuana. Tell them how much you want each day and when, and have that person dole it out to you on schedule.
12. Avoid situations where you know you’ll smoke really heavily.
13. Don’t leave everything out on the coffee table. When you’re done smoking, clean up and put everything away somewhere out of sight.
14. Spend time with people who don’t smoke, or people who you don’t like to smoke around.
15. It’s easy to get into a habit of smoking whatever gets passed around, so before you smoke, ask yourself if you really even want any/any more. If you’re trying to cut down, save your reduced smoking for the times when you’ll enjoy it most.
16. Don’t smoke on anyone else’s schedule. You don’t have to keep up.
17. Don’t carry cash or your ATM card around.
18. If you smoke marijuana to relax at the end of the work/school day, try finding alternative forms of (active) relaxation for days off or for days when you want to delay your first smoke. After work, instead of light-up right away, go for a walk, hit the gym, do yoga, meditate, etc.
19. If you smoke marijuana to relieve boredom, take action to find a hobby or alternative activity to try – something to keep you engaged. Try taking up painting or drawing, Muay Thai, cooking…or whatever sounds interesting to you.
20. Reward yourself for your successes. For example, add up the money you’re saving by reducing your use, and after a couple of weeks or a month, use that money to treat yourself/ buy something fun. Having something to look forward to can help you stay determined during difficult times.¹

Hopefully this list of 20 ideas gives you something to work with. If you’ve managed to cut-down your habit using a strategy not listed above, please leave a comment below to share your technique.