Harm Reduction Programs

Harm reduction (HR), a public-health approach to drug-related issues, emphasizes reducing the negative consequences of drug use. The emergence of AIDS, linked to drug use through needle sharing, was the primary catalyst for the surge of HR programs in Europe and the United States.

"At its heart," notes Dr. Patt Denning, Director of Clinical Services and Training at San Francisco's Harm Reduction Therapy Center, "harm reduction is a public health philosophy which uses a multitude of strategies to reduce drug-related harm, ranging from syringe exchange to drug substitution therapies, to abstinence, to controlled use. These methods have proven effective in helping people make lasting changes in a variety of health related behaviors" (Denning, 2005).

Reasoning that the spread of AIDS from needle-sharing drug users to the general population posed a greater health threat than the drug abuse itself, public health officials in western European countries (notably The Netherlands, Great Britain, and Switzerland) led the way in substituting this public health-based approach for the usual punitive model (see Denning, 2005, for a history of the harm-reduction movement).

"Dead addicts don't recover" is the clarion call of HR activists who avoid setting the threshold for addiction treatment too high. Respecting people's choices, HR offers such "low threshold treatment" as helping addicts obtain childcare and overcoming obstacles like requiring abstinence prior to entering treatment (Denning, 2005).

HR counselors accept addicted clients where they are and help them minimize the risk of their addictive behaviors. DanceSafe (dancesafe.org), provides information about "club drugs" and gives technical assistance to club owners by testing samples of the club drug Ecstasy to determine its purity. They also give instructions for "safe use" while dancing. Many club owners offer free water and a "cool down" room to prevent accidental deaths from overheating (Denning, 2005).

Harm reduction programs are an important option in the treatment of addictions, provided the client is a good candidate and the HR program suits the treatment goals (Wormer & Davis, 2003). Before recommending a HR protocol, always consider the severity of the client's addiction and the client's ability to adhere to any HR protocols (Gossop, Griffith, Powis, & Strang, 1993). Although HR protocols reduce harm, they are not for everyone, especially those with more serious dependency issues.

The Harm Reduction Coalition (HRC) in New York and Oakland, California, reportedly the world's largest peer-based, consumer-led, harm reduction group, promotes (1) policy and advocacy, (2) street outreach, and (3) treatment revision. HRC publishes newsletters and drug information brochures, and holds annual conferences to disseminate the latest research and policies (Denning, 2000, 2005). Visit www.harmreduction.org.

In some circles, the mention of "harm reduction," raises ire. "The very mention of harm reduction often causes more heat than light," Denning (2005, p. 491) notes, "with people taking sides for or against. But when you think about it, it is almost impossible to be against harm reduction. It's what we do every day. We all find ways to reduce the risks of life. When I drive to work each day, for example, I reduce my risk by wearing a seat belt. Abstaining behavior may sometimes be the best harm reduction strategy, and yet most of us choose, for a multitude of reasons, to practice other harm reduction methods."

Additional Resources

For a detailed analysis of current government policies and strategies congruent with HR models (e.g., drug courts), visit National Association of Drug Court

Professionals at www.nadcp.org. Also see Wormer and Davis (2003).

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