Achieving the Right Balance – Preventing Harm When Indulging in Drugs and Alcohol

Partaking in drugs and alcohol can be fun and pleasurable. There are times and places where imbibing is enjoyable. However, overusing alcohol and drugs can also lead to a wide range of negative and even dangerous outcomes.

Dr. Margaret Fetting, a clinician in private practice and a faculty member at the University of Southern California has identified over a dozen specific types of behavior associated with alcohol and drug use.

“People have very robust relationships with substances of pleasure,” she says. We often times use them to stimulate the senses, to escape everyday reality and seek experiences on other levels. We seem driven to intensify the gratification we receive.”

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Since the beginning of history, we have always pursued intoxication with elixirs of all types — plants, drugs, alcohol and other mind-altering substances. This pursuit has as much force and persistence as the drive for hunger, thirst and sex and it is an important part of our culture.

“Indulging is an unstoppable fourth drive,” she says. “It is a natural part of our biology, a healthy drive and a right belonging to each individual. The challenge comes when we try to separate enjoyment from over-indulgence.”


Tips for people who want to help others avoid harming themselves and others from overdoing it this holiday season:

  1. Plan ahead and decide to be the one who stays sober. Volunteer to be the designated driver. Offer to take people to and from planned events.
  2. Let people at the event who are drinking know you are available.  Arrange with the host to take people home in small groups, if needed.
  3. Make the rounds and monitor how people are doing at the event.  Be kind and let people know it’s time to slow down or stop. 
  4. Be on the lookout for people who are getting too tipsy to drive themselves and others home safely.  
  5. Intervene when someone has obviously had more than they should. Tell them, “How about I give you a ride home”. Take the keys away if you have to. Keep them safe.


Dr. Fetting has designed 15 clinical sketches of our unique relationships with alcohol and other drugs. She developed these from decades of working with individuals who sought help in her private practice.

“Identifying the specific patterns of behavior helps people explore the freedom and enjoyment that is possible, and at the same time educates them about the problems they risk encountering.”

Here are some of the relationships she identifies along with specific advice on how to prevent harm and avoid overdoing it:

1. Voluntary Nonuser

These are people who choose not to include alcohol or drugs in their lives. They respond to this drive of human desire with a no, either emphatically from bad experiences, noninterest or derived from a value.

Harm Reduction Strategy:  As hard as it may be to understand, there are times when taking a drug is important for health or medical reasons. It may be assimple as taking aspirin or Tylenol for a headache, a glass of wine for your heart, or taking marijuana with low THC to reduce stress without the mind-altering effects. Be mindful of the proper times and use of drugs and alcohol, especially when prescribed or recommended by a doctor or physician, and other medical professional.

2. Experimental User

These are people who try drinking or drugs to discover whether they like them or not. They might try beer or wine to see if they enjoy the taste and experience pleasure with friends, family, fellow workers, or some other setting. Most people are introduced to alcohol and other drugs and experiment with them at one point in their lives, often in their teen years or twenties. People often experiment with more diverse substances as they get older. More recently, larger numbers of people after years or decade of abstinence decide to experiment again.

Harm Reduction Strategy:  To risk is a human strength, to measure risk is a learned skill. This is a very different message than just say no. Learn from your experiences and that of others.  Share your trials and errors. There is nothing to be ashamed of, and it may also protect you from your unhealthy enthusiasms.

3. Social User

These are people who enjoy drinking or smoking in the company of others. They look forward to sharing the experience with other people. They relish the relaxing effects, and they imbibe to enhance a social event. They know when to stop. They do not want to lose control or embarrass themselves. Social users may also occasionally indulge alone; they just don’t make a habit of it.

Harm Reduction Strategy:  Most people see themselves as social users. It’s best to rely on friends or fellow users to find out whether your social use is becoming problematic.

4. Misuser

These are people who have occasionally imbibed in ways that cause embarrassment and regret.  A person might have one too many drinks at a bar after work, at a party, or some other social event. Misusers learn from their experiences and improve their habits.

Harm Reduction Strategy:  A New York Subway signs reads, “Stop drinking while you are still thinking.”  Intervention by other people is usually the best way to protect a substance misuser from harming his or herself or others. They may need to have their keys taken away, be given a ride home, or be offered and taken to a safe space until the effects of the substance wears off.

5. Regular Misuser

These are people who repeatedly and recklessly misuse substances. If a person’s behavior hits a point where they lose control over what they say and do, how they walk, talk and function then they may need help to prevent physical harm or damage to themselves, other people, property or relationships. Chances are that the motivations for using are becoming more psychologically complex. Private monologues of worry begin to occupy the user’s mind.

Harm Reduction Strategy:  Drinking is a large part of modern life, but sometimes people just need to give it a rest. Go stone cold sober for a while.  Take a leave of temporary abstinence.  Learn what is causing the loss of control. Is using the substance a pleasurable experience or has it become a self-medicating habit used for something in life that is difficult to accept and face?

6. Problem User

Problem users no longer drink or use drugs for pleasure or fun, but they use them to cope with the daily difficulties or issues they face. It gives them a sense of imaginary intactness. Life has gotten away from them, demands are overwhelming, and over time, drinking/drugging has gotten sloppy. Binge drinking becomes a habit.

Harm Reduction Strategy:  Realize you are not alone.  Problem users are not always addicted. Get help. Seek out and participate in the meetings of on-going harm reduction or moderation management groups. These groups will be with people that also want to have substances of pleasure in their lives, but want to feel better about their choices and behaviors.

7. Mindful User

Mindful users want to imbibe, continue to learn from misusing experiences, and consider physical and mental health a priority. They manage their use and their decisions wisely.

Harm Reduction Strategy:  Recognize the power of the elixirs. Stay present and connected to your state of intoxication. Know your limits. Know when to stop. Plan your indulgent events with full protection for yourself and with the help of others-designated drivers, mix alcohol with food and water, and avoid combining substances.

8. Shadow User

These are people whose lives are going relatively well. They have jobs, pay their bills, and show up for life. They also drink or drug themselves nearly 365 days of the year. This oftentimes destructive preoccupation casts a shadow over their lives and prevents them from enjoying love and work as they might.

Harm Reduction Strategy:   It take curiosity, discipline and hard work to explore the underlying reasons for this habit, which was once enjoyable, but now feels like a harmful burden to your physical and mental health, and family and friends in your life. There is nothing shameful in finding a “weight watchers” type of support group or individual therapy or counseling to help reduce the reliance developed on the substance. With the assistance of a physician or professional therapist or counselor, prescriptions for contemporary medications that help to counter cravings may also be appropriate.

9. Watchful User

These are people whose patterns of problematic use have been identified and acknowledged by the user. After some period of exploration of his/her behavioral patterns and oftentimes a substantial period of abstinence, the user resumes with a watchful eye.

Harm Reduction Strategy:  It is likely his/her drinking and drugging will require on-going care and observation throughout a lifetime. This is but a part of the healthy management of a natural and pleasurable appetite that can sometimes cause distress.

10. Addiction

Addictive use results in physical and psychological reliance, tolerance, withdrawal, debilitating or life-threatening problems, and a loss of a healthy sense of self. An addicted individual uses alcohol or drugs 24/7.

Harm Reduction Strategy: These individuals need immediate help from professionals to prevent them from physically causing harm to themselves and others. They have lost the ability to control their own behavior and conduct and are a threat to themselves or others. Immediate intervention with the help of medical and other types of professionals is needed.

11. Discontinued User

Many times after continued debilitating problems and multiple treatments, individuals decide to stop using drugs and alcohol.  They have come to the conclusion that it is not a good or healthy thing in their lives. This initial decision usually involves a very robust commitment to abstinence. It may or may not be for a lifetime.

Harm Reduction Strategy:  On-going care and observation is required.

Professor Fetting says, “Drinking and using other drugs are inherently pleasurable activities.  The challenge we face is to understand our need, harness our desire and make the right decisions to avoid harmful behaviors and impacts.”


By Margaret Fetting, Ph.D, author of  Perspectives on Substance Use, Disorders and Addiction  (ISBN- 978-1-4833-7775-9) a philosophical and clinical text that suggests new ways to think about the relationships, enjoyment, and troubles with substances of pleasure. The book is designed for individuals who struggle with substance use and for students and clinicians who come in contact with and treat individuals and families struggling with the causes and consequences of substance use disorders and addiction. The second edition of Perspectives presents a refreshing blend of ancient and contemporary ideas on the natural pleasures and potential powers of alcohol and drugs in our everyday individual and collective lives.




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