Harm reduction is a set of strategies that encourages an individual to reduce the harm caused by a high-risk behavior. Harm reduction is not a new concept in public health since high-risk behaviors—also known as “bad habits,” depending upon the era—have always existed and will continue to exist. What changes is how society views the behavior and societal responses to it.
Although harm reduction can be a very powerful means through which to modify high-risk behaviors and risk of disease, it is not without detractors who feel that harm reduction may undermine prevention and cessation programs. However, evidence of the success and long-term benefits, including cessation or abstinence, of harm reduction approaches for high-risk behaviors such as smoking, drinking and driving, and drug use is increasingly evident. While there has been little research devoted to the development and evaluation of their efficacy, the potential of microbicides to prevent the transmission of HIV and other sexually transmitted diseases has been described as a harm reduction approach for women with little control over whether their partner uses a condom. Again, fears have been raised that developing microbicides would reduce the focus on condom use, in spite of evidence that unprotected sexual intercourse continues to be a major risk behavior 20 years after AIDS was first described.
Harm reduction emphasizes the individual’s input into the therapeutic process to ensure (a) that the client sets goals that are relevant to her/his social and environmental contexts and (b) that there is motivation to work toward reducing the harm caused by the behavior. The goal could be to reduce the harm experienced by the individual, the harm experienced by their families, or the harm experienced by the community in general. However, in order for harm reduction to be successful, barriers that inhibit individuals from seeking assistance must also be addressed (such as stigma, lack of access to services, lack of health insurance, fear of disclosure of the behavior), not just the behavior.
A very successful example of a harm reduction approach to a public health problem is the “designated driver” campaign targeting people who drink and drive. While it is against the law to drive a vehicle under the influence of alcohol (or other drugs), it is also recognized that people drink in social settings, that they on occasion drink too much, and that the person still needs to find a means to get home. The campaign encourages people to identify one member of the group to be the “designated driver,” with this person preferably not drinking or drinking very little (one or two drinks over the entire evening). The designated driver is responsible for driving the other members of the group to their homes. While the designated driver campaign does not reduce individual harm resulting from alcohol intoxication, it significantly reduces the risk the drunk person faces should they get into a car and drive home. More importantly, the designated driver campaign reduces harm to the community should the drunk person be involved in an accident in which grievous harm (i.e., death or permanent disability) results to the drunk driver or an unsuspecting victim.
Another successful harm reduction approach has been the use of the nicotine patch to help smokers quit smoking or significantly reduce the number of cigarettes smoked when they are unable or unwilling to quit. The harmful effects of smoking are well documented. The challenges faced by smokers who wish to quit but are unable to do so are also better recognized and smoking cessation programs offer a variety of therapeutic approaches in order to manage both the physical dependency on nicotine and the psychological contexts that trigger a desire to smoke. One of these approaches is continued nicotine administration through a “patch” that is applied to the upper arm.
Using the nicotine patch allows the smoker to slowly reduce the amount of nicotine in their system over time, while dealing with the psychological contexts of their smoking habit. Thus, although there may be continued harm to the individual as a result of the ongoing exposure to nicotine, the harm to the individual is substantially reduced since the nicotine, along with tar, is not inhaled and it is expected that use of the nicotine patch will eventually cease. Harm to the individual’s family and community is almost eliminated since exposure to secondhand smoke ceases. In some ethnic communities where rates of smoking for females are low, women could be the primary beneficiaries of harm reduction for smokers because their exposure to cigarette smoke would be significantly reduced; benefits would also accrue to children in the household.
HARM REDUCTION AND ILLICIT DRUG USE
Harm reduction, in the context of illicit drug use, has been defined as a “… pragmatic and humanistic approach to diminishing the individual and social harms associated with drug use,” while others view harm reduction as “… a peace movement [that] is aligned with the humanistic values around which social work is organized.” Although harm reduction has been successfully applied to reducing alcoholand smoking-related harm, it becomes especially controversial when applied to reducing the harm caused by illicit drug use. The development of drug policies not founded on public health principles has resulted in long-term harm to women and their families, ethnic minority women in particular, by separating families through increased jail sentences for nonviolent drug-related crime. These communities often have the least access to drug treatment and other health and social service programs, and the greatest barriers to sustaining behavior change as a result.
SEE ALSO: Acquired immunodeficiency syndrome, Sexually transmitted diseases, Substance use, Violence
- Brocato, J., & Wagner, E. F. (2003). Harm reduction: A social work practice model and social justice agenda. Health and Social Work, 28(2), 117-125.
- Open Society Institute. (2002). Harm reduction news. New York: Author. http://www.soros.org
- harm reaction