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 in societies for which their eradication is neither feasible nor desirable. Humanistic values accept one’s drug usage without approval or moral judgment.
The focus on harm renders the actual use of AODs of secondary importance. The balancing of costs and benefits identifies, measures, and assesses drug-related issues, their harms, and the cost and benefits of interventions so that issues can be prioritized (Denning et al. , 2004). The priority of immediate goals signifies that most programs hierarchically pursue immediate and realistic goals first, placing ideals aside (Riley et al. , 1999).
Finally the International Harm Reduction Association recommends an understanding of harm reduction as “policies and programs which attempt primarily to reduce the adverse health, social and economic consequences of mood altering substances to individual drug users, their families and their communities” (www. ihra. net). Philosophically, harm reduction is rooted in John Stuart Mill’s harm principle. Mill’s 1859 treatise On Liberty argues that restricting liberty is only justifiable in preventing persons from harming others.
Although a polarized debate exists between some supporters and opponents, many accept that harm reduction is not necessarily antithetical to abstinence of drug use as an outcome; it can be an incremental approach to it as an end goal (tatarsky, 2002). Marlatt (1998) lists the following principles, assumptions, and values which underlie harm reduction: 1. Harm reduction is a public health alternative to the moral/criminal and disease models of drug use and addiction. 2.
Harm reduction recognizes abstinence as an ideal outcome but accepts alternatives that reduce harm. 3. Harm reduction has emerged primarily as a “bottom-up” approach based on addict advocacy, rather than a “top-down” policy promoted by drug policy makers. 4. Harm reduction promotes low-threshold access to services as an alternative to traditional, high-threshold approaches. 5. Harm reduction is based on the tenets of compassionate pragmatism versus moralistic idealism, (p. 49-56) Harm reduction programs operate in a variety of ways.
The HRC stresses the importance of tailoring programs to local needs resulting in diverse programming. Inciardi and Harrison (2000) identify the following categories of programs: broader alcohol treatment outcomes; alcohol abuse management for those who wish to continue using alcohol; and ancillary interventions. The Prevalence and Impact of Alcohol Abuse/Dependence The prevalence of problematic drinking in the United States is reported to be quite high and its effects are far reaching (Milhorn, 1990).
According to a national survey in 2001, approximately 11.0 million Americans were found to have serious problems related to their alcohol use and found to meet the criteria of either abuse or dependence, as per the DSM-IV (Wright, 2003). Alcohol alone is involved in approximately 100,000 premature deaths per year and causes significant health care costs annually. Epidemiological studies since the 1980’s have consistently demonstrated that half of all motor vehicle accidents, violent crimes, and alcohol-related mishaps, such as falls, fires, and suicides, have been linked to alcohol intoxication (NIAAA, 2000).
The economic cost of alcohol abuse in 1998 was estimated at $184. 6 billion dollars (Harwood et al. , 2000) and is associated with a multitude of medical, psychological, and systemic problems. In the medical domain, liver disease is one of the greatest health hazards resulting from alcohol abuse, and cirrhosis of the liver is the ninth leading cause of death in the United States (Milhorn, 1990). With chronic and heavy alcohol use, the cardiovascular system, gastrointestinal tract, autoimmune system, and central and peripheral nervous system is susceptible to damage (NIAAA, 2000).
Additionally, cancer, fetal alcohol syndrome, and organic brain disease are linked with severe and prolonged use and nearly 20,000 deaths per year are associated to medically related alcohol problems (Milhorn, 1990). The psychological problems resulting from alcohol abuse or dependence are associated with anxiety, depression, insomnia, short-term memory loss, amnesia, difficulties with productivity, absenteeism, legal difficulties, and difficulties associated with employment, home, and school (DSM-IV, 1994).
Moreover, the problem drinker puts him or herself in hazardous situations and can adversely affect the lives of others (Denning et al. , 2004). A recent study by Grant (2000) concluded that one in four children is exposed to alcohol abuse or dependence in the family and 25% of all violent crimes are carried out by offenders who have been drinking alcohol.