What are the implications of harm reduction ideologies on the
future of treatment for substance use disorders?
A Review of the Literature
A review of the literature reveals no clear-cut definition of harm reduction. Most experts are in agreement, however, that the primary emphasis of harm reduction strategies is to reduce the health, social, and economic consequences associated with alcohol and drug use. Implicitly or explicitly, complete abstinence is the goal of the vast majority of substance abuse service providers (MacMaster, 2004). Although harm reduction strategies value completely refraining from addictive substances, the approach embraces a wide range of goals not limited to abstinence. The harm reduction model employs strategies for extending the scope of treatment to substance users for whom abstinence oriented treatment may not be appropriate. When people are unwilling or unable to embrace abstinence, alternatives to abstinence based treatment have been shown to increase the well-being of both individuals and communities.
This literature review considers whether the practice of harm reduction strategies is a promising alternative to traditional substance abuse interventions that employ abstinence orientated strategies by addressing the following:
1. What is harm reduction?
2. Drug- and alcohol-related harms.
3. Harm reduction interventions.
4. Criticisms of harm reduction
Together, traditional substance abuse services and harm reduction approaches can be incorporated to provide a comprehensive sequence of care—from safer substance use to reduced use to maintaining total abstinence.
What is harm reduction?
A review of the literature on the term "harm reduction" reveals that no universal definition exists. The concept of pragmatic acceptance and compassion seems to be the overriding theme of harm reduction. The approach is based on acceptance of the fact that, for better or for worse, people will use drugs in a fashion that will bring about harm to themselves and their communities. According to Lushin and Anastas (2011), “The main principle of the harm reduction model is a belief that in dealing with such complex and harmful human behaviors as substance abuse, the primary goal is to avoid or minimize further dangers such as contracting HIV and hepatitis, or death due to drug overdose” (p. 97). Instead of focusing on the prevention of risky behaviors, the focus is on minimizing the harmful effects created by people who continue to abuse psychoactive substances.
Pauly (2008) discusses five principles associated with harm reduction that highlight the philosophy and underlying values of harm reduction. Pragmatism as a principle recognizes that total elimination of alcohol and drug use is not attainable. The principle of humanistic value underscores the dignity and worth of all people without judgment of substance use. The value of utilizing a comprehensive approach to lessening the negative consequences of substance use for...