The late Greg D. used to remind his fellow addicts about the “insanity” of relapse: that “every time I make the decision to use, I’m in a sober state of mind.” What he did not mention is a kind of converse. Many addicts have a transformational “moment of clarity” when they are loaded.

I mention this because I have heard many psychotherapists and counselors say that it’s pointless to work with people unless they’re clean and sober. (There’s even a sort of rationale for that notion, having something to do with state-dependent learning, which I shall not get into.) I don’t buy that for at least three reasons.

First, the moment when I recognized and said to my innermost self – with absolute clarity, certainty, and conviction – that “I can’t do this anymore” occurred about a week before my last brain-addled, month long speed trip ended. I had been traveling with a similarly tweaked friend at the time. When our folie à deux road trip ended, I was done and I knew it. It had a lot to do with a conversation I had with someone who was the closest I have ever had to a spiritual adviser. As I talked about my “can’t live with them, can’t live without them” relationship with drugs, he said “it makes complete sense why you’d want to use” and then elaborated. And I immediately trusted him. He did not promise butterflies and rainbows if I got clean (even though we are both gay). He didn’t really promise anything. But he listened as I talked about my own ambivalence and said, with a neutrality and acceptance that I find remarkable to this day, “you just need to make a decision.” I knew he was right, and I knew what the decision had to be. I needed to be able to tell the truth, all of it, to someone who would not judge or preach or heap on platitudes or sanctimony. Of course, for many addicts, it’s far from that simple. But there’s a lot to learn from 12-step fellowships, where the doors – and the hearts – remain open to anyone whether they’re still using or not.

Second, as a wet-behind-the-ears drug counseling trainee, my internship allowed me to work with people who were still drinking and using (and who were also often homeless and always diagnosed with a concurrent major mental illness). One day, I was doing a home visit with a 50-something year old woman who could not stop drinking. Her health was failing. She couldn’t eat. She wore the same clothes day after day. I walked into a castle of beer cans stacked up on her dresser. She looked at me, pointed at them, and said “isn’t that terrible?” I replied, “well, if you don’t want them here anymore, I can help you bag them up and put them in recycling.” The next time I saw her – for the first time in many, many months – she had not had a drink for several days. She continued to sober up. She got some clean clothes and was able to keep them clean. She started to deal with high blood pressure. She began to eat. Food. She started going to meetings, even ones that required a 45 minute bus ride. She was willing to try psych meds to help manage the anxiety that she drank to assuage.

And eventually she drank again. She could not tolerate the recurrent bouts of loneliness and hopelessness. She had support, but not enough soon enough. Which brings me to the third reason.

Third, whether or not you buy into Johann Hari’s catchy phrase that “the opposite of addiction … is connection,” it can be understood as an attachment disorder. Here, the “anonymous people” coincide with the psychologists when, with Chuck C., they recognize that addiction is a condition of “conscious separation” from oneself, from others, and from a sense of connection or unity with the cosmos, with creation, in whatever way that is experienced.

Oh, actually, there’s a fourth reason. Harm reduction is not about enabling. It’s about keeping addicts alive and keeping the door to recovery open. Yes, it’s not easy: people who are actively using can be manipulative, dishonest, disappointing, frustrating, nerve-wracking, unreliable, abusive, exploitative. And more. And yet, at least for me, there’s no better reminder to be grateful for the gift of being clean and sober than to bear compassionate witness to the pain experienced by the suffering addict. And there’s nothing like being around if and when a miracle happens.