Author: anonymous

The following is a guest post, composed by Julia Hammid. I’m grateful to Julia for her thoughtful and sensitive reflections…..

Judging by the volume and intensity of the discussion around Harm Reduction (HR), both here and in many other venues, it seems to be a flashpoint for identifying some of the core issues driving policy, research and personal opinion in regards to addiction (even as the term addiction is still being defined). In the spirit of promoting an illuminating and productive conversation around addiction, recovery and treatment, here are some of my thoughts on HR. Just for the record, I am in favor of HR as a concept, though I may not agree with every version of how it’s provided.

So, why the brouhaha around HR? Doesn’t it just describe a broad variety of strategies to counteract the damage of addiction, short of complete abstinence? The question is not so much whether HR should exist. It’s going to exist no matter what we say. The question is whether or not we like it and support it. For example, we dispute whether the powers that be should fund programs that provide clean syringes, safe spaces to use, and even the (uncontaminated) substances themselves.  In my mind, HR includes a lot more. In fact, I would claim that most, if not all, recovery includes some form of HR, even if complete abstinence is the goal.

While addiction includes a vast array of substances and behaviors, abstinence can only be applied to selected substances, mostly illegal ones. How are we to define abstinence from addictions that are not measurable with a blood test? And even where abstinence is the only goal, where HR is most controversial, those who are abstinent from the identified substance often end up substituting or relying on (dare I say becoming addicted to?) other substances or behaviors, which fly under the radar. For instance, there’s a joke around AA about being addicted to the donuts and coffee that are ubiquitous at meetings.

I am not saying that addiction cannot be overcome or that one thing is always replaced by another or that any of the above is bad. I am just saying that I think, with few exceptions, recovery is always a continuum and always includes some form of HR, in the fullest sense of that term. More often than not, there is a period of shifting of dependence from the target bad thing to other less harmful (or simply legal and more easily obtained) things. Even seemingly positive things can be pursued with some of the same desperation that the original addiction carried, including socially approved addictions such as, coffee, sugar, TV, running, the internet, or even “dependence” on therapeutic treatment, religion, etc. I  know some people who are so immersed in their 12-step community that their whole lives revolve around meetings, the literature and the people they know in that community. I’m not saying that’s a bad thing. I’m just saying that it should be recognized as a form of HR.

To some, HR connotes state-supported addiction. But that is nothing like the actual goals of HR proponents. The controversy is kept alive by discrepancies such as these. In contrast, I think the word “abstinence” carries its own social and psychological baggage and may misrepresent what the opponents of HR are arguing for. Abstinence is not a term I personally find appealing. For me it connotes ascetic monks trying to rise above earthly existence by denying themselves much of what makes life worth living. Abstinence puts the focus on what one is not doing, rather than looking forward to what is truly worthwhile. In some ways, full blown addicts are abstinent from life, foregoing all its richness in pursuit of their addiction. Most agree that abstinence from a particular drug or behavior is far more precious.

A story was shared in response to a post on this blog, about a relative being instructed to just apply a cool cloth  to the addict’s forehead and in a few weeks they would “be good as new.” As any recovering addict will tell you, it takes a lot more! And much of what it does take I would classify as HR. Even if you quit the identified addiction, there are still a mountain of other issues that need to be addressed, such as recovery from the trauma that may have been driving the addiction, employment, reputation, how to create/repair a life, a family, a community. From the addict’s point of view, support for those tasks is as essential as stopping using.  And much of that work can begin while engaging in “official” HR services.

Society sees addiction as a drain on its resources (unproductive individuals sucking up services) and a source of harm to others (crime, disease, embarrassment, etc.). So, from society’s perspective, fully abstaining from the addiction removes all the above negative consequences. But from the perspective of addicts (and those who are able to step into their shoes, whether family or treatment providers) it’s not at all that simple.

Abstinence and recovery are not one and the same. As opposed to simply stopping using the target substance, “complete” recovery is as varied as are humans. Life is, by its very nature, imperfect, and applying definitions of things such as addiction, abstinence, sobriety, and recovery to real people will always be approximate.

The core arguments I’m hearing are about who pays for what services and strategies, what the authorities endorse, and what is socially and ethically acceptable.  We can, and should, argue about specific programs, policies and laws, but trying to agree on one “correct” way to recover from addiction ignores the valiant struggles and triumphs of so many who have recovered, one way or the other. I was bulimic for over 15 years (many years ago), which was as intractable, self-abusive and life threatening as addiction to any drug. And I am quite certain it would have killed me had I continued. As with other less clear-cut addictions, recovery for me is a continuum, one which involved plenty of what I would certainly call Harm Reduction.

Julia Hammid

PS. I (Marc) highly recommend this Time article by Maia Szalavitz.  It is just excellent, and it provides some very dependable statistics that argue for the value of various Harm Reduction programs and policies.

Rather than one of our typical mind-bending dialogues, here’s some very practical information. If you are actively or recently addicted, live in the U.S., and are low on funds, this may be of use. I see it as getting the most out of the “disease model”. Thanks to Ram Meyyappan for offering to post this to our community.

Drug Addiction and Social Security Disability Benefits

Drug addiction can wreak havoc on an individual’s life and can often prevent an individual from working. What many people do not understand is that drug addiction is actually considered to be a disability by the Social Security Administration (SSA). If you are struggling with drug addiction or drug addiction recovery, you may be able to qualify for Social Security Disability benefits.

Qualifying for Social Security Disability Benefits with a Drug Addiction

It is important to note that even though the side effects of drug abuse can prevent an individual from performing gainful work activity, addiction alone is not enough to qualify a person for Social Security Disability benefits. If, however, the addiction results in other medical conditions, you can qualify for disability benefits due to the resulting conditions. According to the Social Security Blue Book (SSA’s manual on conditions that qualify for benefits), you can qualify for Social Security Disability benefits due to drug addiction if the drug addiction results in one or more of the following:

• Organic mental disorders, which will be evaluated under Section 12.02 of the Blue Book.
• Depressive syndrome, which will be evaluated under Section 12.04 of the Blue Book.
• Anxiety disorders, which will be evaluated under Section 12.06 of the Blue Book.
• Personality disorders, which will be evaluated under Section 12.08 of the Blue Book.
• Peripheral neuropathies, which will be evaluated under Section 11.14 of the Blue Book.
• Liver damage, which will be evaluated under Section 5.05 of the Blue Book.
• Gastritis, which will be evaluated under Section 5.00 of the Blue Book.
• Pancreatitis, which will be evaluated under Section 5.08 of the Blue Book.
• Seizures, which will be evaluated under Sections 11.02 or 11.03 of the Blue Book.

For more information on qualifying for benefits with a drug addiction, visit: http://www.disability-benefits-help.org/disabling-conditions/drug-addiction-and-social-security-disability

Applying for Social Security Disability Benefits with a Drug Addiction

You can apply for Social Security Disability benefits online (http://www.ssa.gov/pgm/disability.htm) or in person at your local Social Security office. When applying for benefits due to drug addiction, you will want to explain to the Social Security Administration how your drug addiction has resulted in one of the qualifying conditions in the Social Security Blue Book. For example, if your drug addiction has resulted in an irreversible personality disorder, you will want to provide the SSA with evidence documenting that you have been diagnosed with the associated personality disorder and proof of treatment. This means providing copies of your clinical records and treatment history.

The Technical Criteria for Social Security Disability Benefits

In addition to proving that you are disabled according to the SSA’s criteria when you apply for disability benefits, you will also need to prove that you meet the technical criteria. If you are applying for SSDI benefits, this means proving that you have earned enough work credits to qualify for the program. The SSA will determine if you have enough work credits to qualify when they pull your work history. For each year that you have worked, you will earn a maximum of four work credits. Depending on your age, a certain number of work credits will be needed to qualify for the SSDI program.

If you do not have enough work credits to qualify for SSDI benefits, you may still be able to qualify for SSI benefits. SSI is a needs-based program. In addition to meeting the SSA’s disability criteria, you must also meet the program’s financial criteria. As of 2013, in order to qualify for SSI benefits you cannot earn more than $760 per month as an individual or $1,060 per month as a couple. Your household assets must also not exceed $2,000 as an individual or $3,000 as a couple.

For more information on SSDI and SSI, visit: http://www.ssa.gov/disability/

Appealing a Denial of Benefits

You will receive notice regarding the SSA’s decision of your disability claim within three to six months of the date of your application. If the SSA decides to deny your application, you have 60 days from the date of the denial notice to file an appeal. The first stage of appeals is a Request for Reconsideration. It takes approximately two to six months to complete this appeal. Unfortunately, most appeals are denied at this level. You have the best chance of overturning the SSA’s denial of your benefits during the second stage of the appeal process, the disability hearing. During the disability hearing you will have the chance to present evidence to an Administrative Law Judge (ALJ) and explain why you need disability benefits. It is in your best interest to hire a disability attorney or advocate prior to attending the disability hearing.

Article by Ram Meyyappan
Social Security Disability Help