Harm Reduction for Alcohol Abuse Treatment

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 methadone maintenance treatment, but also extend into psychotherapy for alcohol and other drug abuse and other arenas. Pragmatism, compassion, low-threshold requirements for participation, and efforts to meet participants “where they are” are at the core of harm reduction programs.

Although difficult to define, harm reduction can be considered a philosophy, treatment framework, intervention, and social movement. According to Tatarsky the majority of those with substance use problems in the United States do not receive treatment (2003, p. 249) and many avoid treatment because long-term abstinence is not their goal (Rotgers, 1996). Because of low-threshold requirements and cost-effectiveness, harm reduction programs have the potential to reach many whom traditional programs fail to reach.

It is in the lives of these individuals—whom traditional programs fail to reach— that the emergence of harm reduction is so potentially significant. In the United States, many are familiar with the cliche of the substance dependent individual who “fails” in treatment. “Failure” signifies lack of ability to become abstinent and is typically attributed to one’s unwillingness to “work the program” of Alcoholics Anonymous or other 12 step based programs.

In turn, the individual is seen as unmotivated to change, with little capacity for self-determination. This commonly told story is substantiated in research through low rates of program completion, low rates of abstinence, and high recidivism rates. It is also couched in a loaded national discourse rendering addiction as a “baffling, cunning disease” (Tatarsky, 2002). This discourse critiques the individual but is less willing to interrogate the treatment system or larger society.

The disease model (which focuses on the physiological aspects of addiction and views addiction as metaphorical to a disease) and the 12 step based approach have dominated treatment approaches since the According to Denning, the disease model privileges abstinence-based interventions as the basis of “public policy, professional intervention, and societal understanding” in the United States (1997, p. 13).

Given this history, harm reduction meets much resistance in the United States while receiving wider acceptance in several European countries. Differences in values, social solidarity, and less polarization of social policy issues have perhaps left Europeans less likely to view harm reduction as condoning alcohol use and abuse—a view taken by many in the United States. Overview of Harm Reduction While a standardized definition of harm reduction is yet to exist, Riley et al. refer to it as: “..

.a public-health approach to dealing with drug-related issues that places first priority on reducing the negative consequences of drug use rather than on eliminating drug use or ensuring abstinence” providing assistance to people with drug problems even if they are not willing to give up their use (1999, p. 10). Noting the prevailing conceptual fuzziness, Riley et al. (1999) report that abstinence-based practitioners sometimes consider their work to be harm reduction. While most social interventions contain some element of reducing harm, Riley et al.

distinguish between harm reduction as a goal versus a strategy, to stay true to its intent. When considering harm reduction as a goal, all drug policies and programs might be considered harm reduction because they all arguably aim to reduce harm. However, as a treatment strategy it is considered: “A policy or program directed toward decreasing the adverse health, social, and economic consequences of drug use without requiring abstinence from drug use” (1999, p. 21). Consequently, abstinence requirements—given their high-threshold nature—conflict with low-threshold services which harm reduction provide.

In defining “harm” Riley et al. say that “Most harms are directly attributed to drugs and behaviors related to their use. Other harms may result as unintended consequences of efforts to deter use” (1999, p. 19). For example, in some instances abstinence may indeed be harmful (e. g. , one becomes a risk for suicide upon removal of self-medication). Whether or not advocates of harm reduction view drug dependence itself as a harm, it generally is not of primary concern in harm reduction programming.

An abstinence based approach to problem alcohol use among the homeless would predict that treating or punishing men for problem alcohol use would result in decreased alcohol use and a resultant reduction in the problems that lead to increases in …

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 …

Prevention is better than cure. Truly, it is more advantageous if the problem against drug and alcohol abuse should be prevented much earlier rather than finding ways on how it can be cured. With the mentioned ill-effects and consequences of …

Several substance abusers have the perception that they can stop their drug utilization but majority of them fail. Studies have shown that drugs are responsible for changing the function of the brain and fortify cravings for drugs. Because of these …

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