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Harm Reduction Philosophy

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Harm reduction is a public health philosophy that seeks to lessen the dangers that drug misuse and our drug policies cause to society. A harm reduction strategy is a comprehensive approach to drug misuse and drug policy. Harm reduction's complexity lends to its misperception as a drug legalization tool. Harm reduction rests on several basic assumptions. A basic tenet of harm reduction is that there has never been, is not now, and never will be a drug-free society.1

A harm reduction strategy seeks pragmatic solutions to the harms that drugs and drug policies cause. It has been said that harm reduction is not what's nice, it's what works. A harm reduction approach acknowledges that there is no ultimate solution to the problem of drugs in a free society, and that many different interventions may work. Those interventions should be based on science, compassion, health and human rights.1

Problem drinkers vary considerably in terms of level of severity, configuration of antecedents which trigger heavy drinking, types of consequences which are of concern (e.g. legal, health, interpersonal) and individual goals and standards. Ideally, treatment for alcohol problems should begin with a thorough assessment of many variables so that a recommendation can be made as to the most potentially effective and least invasive approach which is most consistent with existing values. Some individuals can benefit from brief motivationally oriented contacts or involvement in self-help groups like Rational Recovery or Alcoholics Anonymous. Others require more intensive treatment, such as weekly individual therapy, partial hospitalization or inpatient treatment. Many individuals with drinking problems desire to learn how to moderate their drinking as opposed to abstaining. As stated, research strongly supports the efficacy of moderation training for non-physically dependent problem drinkers. Furthermore, many individuals who pursue moderation ultimately opt for an alcohol-free lifestyle. Moderation training, therefore, is appropriate and should be included in the spectrum of addiction treatments.2

A person may have a problem with alcohol without being an alcoholic. According to recent data, most people only have mild to moderate alcohol problems. Relative to alcohol dependent individuals, these drinkers have a shorter problem drinking history, more social and economic stability, and greater personal resources. The first step is to make the drinker aware of the situations that trigger his or her drinking behavior when confronted with those situations. This cognitive-behavioral approach is designed specifically for problem drinkers who want to reduce their drinking and who do not have a strong physical dependence on alcohol.3

The issue of controlled drinking still evokes violent debate. Most people don't know the facts regarding controlled drinking as a viable alternative for some problem drinkers. Popular press, driven by a strong 12-step coalition, has created an abstinence-only public mind set: Those with the disease of alcoholism (defined nebulously as "people with drinking problems") simply should not drink at all and that for professionals to advocate anything but abstinence and AA attendance is tantamount to malpractice.2

Harm reduction approaches to addictive behavior are based on three central beliefs. First, excessive behaviors occur along a continuum of risk ranging from minimal to extreme. Addictive behaviors are not all-or-nothing phenomena. Though a drug or alcohol abstainer is at risk of less harm than a drug or alcohol user, a moderate drinker is causing less harm than a binge drinker. Second, changing addictive behavior is a stepwise process, complete abstinence being the final step. Those who embrace the harm reduction model believe that any movement in the direction of reduced harm, no matter how small, is positive in and of itself. Third, sobriety simply isn't for everybody. Bold and radical, this statement requires the acceptance that many people live in horrible circumstances. Some are able to cope without the use of drugs, and others use drugs as a primary means of coping. Until we are in a position to offer an alternative means of survival to these folks, we are in no position to cast moral judgment. It is held that the health and well-being of the individual is of primary concern; if individuals are unwilling or unable to change addictive behavior at this time, they should not be denied services. Attempts should be made to reduce the harm of their habits as much as possible.4

A harm reduction strategy demands new outcome measurements. Whereas the success of current drug policies is primarily measured by the change in use rates, the success of a harm reduction strategy is measured by the change in rates of death, disease, crime and suffering. Because incarceration does little to reduce the harms that ever-present drugs cause to our society, a harm reduction approach favors treatment of drug addiction by health care professionals over incarceration in the penal system. A harm reduction strategy recognizes that some drugs, such as marijuana, are less harmful than others, such as cocaine and alcohol. Harm reduction mandates that the emphasis on intervention should be based on the relative harmfulness of the drug to society.1

Harm reduction seeks to reduce the harms of drug policies dependent on an over-emphasis on interdiction, such as arrest, incarceration, establishment of a felony record, lack of treatment, lack of adequate information about drugs, the expansion of military source control intervention efforts in other countries, and intrusion on personal freedoms. Harm reduction also seeks to reduce the harms caused by an over-emphasis on prohibition, such as increased purity, black market adulterants, black market sale to minors, and black market crime. A harm reduction strategy seeks to protect youth from the dangers of drugs by offering factual, science-based drug education and eliminating youth's black market exposure to drugs. A harm reduction approach advocates lessening the harms of drugs through education, prevention, and treatment. Finally, harm reduction seeks to restore basic human dignity to dealing with the disease of addiction.1


  1. Reducing Harm: Treatment and Beyond. Drug Policy Alliance.
  2. Robert W. Westermeyer, Ph.D. Harm Reduction and Moderation as an Alternative to Heavy Drinking.
  3. Treating Problem Drinking. Alcohol Research & Health. National Institute on Alcohol Misuse and Alcoholism. Vol. 23, No. 2, Page 67-68. 1999
  4. Robert W. Westermeyer, Ph.D. Reducing Harm: A Very Good Idea.

This page was last modified on : 10/28/2013

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