American Medical Association

In hospitals, treatment facilities, community clinics, and private practices, clients with AOD problems are seen regularly. While the numbers vary from setting to setting, the prevalence of problematic alcohol and drug use in clinical settings is said to be much higher than in the general population (Denning et al. , 2004). Research indicates that over 25% of individuals presenting in clinical settings have diagnosable alcohol problems (Schuckit, 1995).

Another study concluded that roughly one quarter to one half of all patients being treated by health care workers for medical or psychological problems, also revealed problems related to alcohol and/or drug abuse (Kiesler, Simpkins, & Morton, 1991). Due to the prevalence of alcohol disorders in both the general and clinical population, it is important that all mental health workers become adept at screening for Alcohol & Other Drug (AOD) problems, so as to reach out to the substance abusing person when he/she presents for treatment.

However, approximately 90% of Americans in need of treatment specifically for substance abuse are not receiving care (Prochaska, DiClemente, & Norcross, 1992). In addition, there are few treatment models available to meet the needs of individuals who would benefit from learning to moderate alcohol and drug consumption, eliminate harmful drinking practices such as binge drinking and reduce negative outcomes from substance use such as health problems, domestic violence while intoxicated, drinking under the influence arrests and the deleterious impacts of substance use-related fetal damage during pregnancy.

The numbers of individuals in need of treatment for alcohol and drug abuse disorders indicates an urgent need for brief, low cost and easily accessible interventions to meet this need. This study is narrowly focused on individual outcomes of harm reduction programs. It does not take a stance on the causes of addiction. However, a working understanding of the theoretical models on which the alcohol abuse treatment system rests is crucial in understanding the social context in which harm reduction programs operate.

A thorough history of addiction treatment in the United States is provided by White (1998). Harm reduction originated in Holland and England in the 1970s as a public health response to intravenous (IV) drug use and focused on providing clean needles and in some cases, prescription heroin to heroin users in order to reduce the negative social, medical, and legal consequences related to IV drug use for these individuals and the larger community.

Harm reduction emerged in the United States about 15 years ago as a public health response to the HIV/AIDS epidemic. The focus in the U. S. was originally on providing clean needles, promoting condom use and encouraging methadone treatment for heroin users. In the past several years, harm reduction principles have begun to be more actively employed in substance use treatment in the U. S. with the emergence of harm reduction-based psychotherapy for substance users (Denning, 2000).

Harm reduction psychotherapy integrates theoretical aspects of cognitive-behavioral therapy, dialectical behavior therapy, and psychodynamic-based relational analysis (Tatarsky, 2002, 2003). The techniques utilized in harm reduction interventions are based on interventions developed in the relapse prevention model often used in substance treatment (Marlatt & Donovan, 2005) and motivational interviewing (Miller & Rollnick, 2002).

Well-known are the moral and disease models of addiction. The moral model sees alcoholism, for example, as an issue of moral failing where drinking is a sinful act. The disease model speaks back to the moral model, informed by an understanding of “addictive behaviors as based on an underlying physical dependency and attention is focused on physiological predisposing factors, presumed to be genetically transmitted, as the underlying cause of addiction (Denning et al. , 2004, p. 45).

” Traceable back to the early nineteenth century, E. M. Jellinek introduced the current version of the model. It has since been sanctioned by the American Medical Association and other prestigious organizations such as the World Health Organization. It is believed to have dominated scientific inquiry and treatment approaches during the 20th century dating back more than 200 years (Denning et al. , 2004).

Methadone maintenance treatment provides the heroin addict with individualized health care and medically prescribed methadone to relieve withdrawal symptoms, reduces the opiate craving, and brings about a biochemical balance in the body. Important elements in heroin treatment include comprehensive social …

I. Discussions and Conclusions In a general consideration, the guidelines set by the JCB working group are all acceptable and justifiable. Nevertheless, it is less reliable than a clear code of conduct. The suggestions made by the JCB working group …

Originating with the desire to prevent the spread of HIV through injection drug use, harm reduction emerged as an intervention for alcohol problems. Classic examples of harm reduction programs include syringe exchange programs, safe user sites for heroin use, and …

Harm reduction rests on the principles of pragmatism, humanistic values, a focus on immediate and long-term harms, the balancing of costs and benefits, and the priority of immediate goals. It is pragmatic in its view of drug use as ubiquitous …

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