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principles of harm reduction

Understanding Harm Reduction

The key to the harm reduction model is to understand that the there are a wide range of overlapping factors which impact on the individual, making the problem of drug use all the more complex.  These overlapping factors can be biological (genetics, chronic pain, illness, psychiatric issues, withdrawal), psychological (depression, anxiety, isolation) and social (unemployment, racism, sexism, homophobia, poverty, lack of housing, lack of education).  However, as can be seen through this multitude of overlapping factors, the traditional interventions to deal with the “problem” of substance use are rather simplistic.  The traditional treatment problems have several factors in common:  
  1. Substance use is viewed as the problem itself, not as a symptom and an attempt to adapt and survive with greater and more complex problems.
  2. There is one method for treating the drug user (depending on the modality) and that method should be applied to all clients.
  3. Individuals who do not do well at treatment have “failed,” rather than the treatment program being the failure.
  4. The only measure of success is complete abstinence, which must be immediate on entering treatment.

These factors are disconcerting when one considers the statistics regarding traditional drug treatment.  The National Institute on Drug Abuse estimates an 80% drop out rate from therapeutic communities and an overall “cure” rate of less than 10% for drug treatment programs in the United States.  “Cure” is defined as no relapse for five years after treatment.  Clearly, the modalities for intervention with drug users are not working, and in light of the complexity of the problem, other modalities must be used.  Harm Reduction has become this alternative.

Harm Reduction is a modality which prioritizes the long-term permanent harm that substance use and a substance-using lifestyle may cause. It was developed in programs in Europe in the mid-1980’s to deal with the “harmful consequences of a large and growing population of people who use prohibited drugs. The programs were the result of two key issues: the recognition of the failure of traditional programs and the HIV epidemic.

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