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Harm reduction is an approach to treating those with alcohol and other substance-use problems that does not require patients to commit to complete abstinence before treatment begins. Instead, an array of practical strategies are deployed to reduce the negative health and social consequences of substance use, and psychotherapy aims to change behavior according to the goals of each patient, whether that means moderation of use or complete abstinence.

What Is Harm Reduction?
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The harm reduction approach values incremental steps. During the course of treatment, evidence demonstrates, many patients shift their goal to complete abstinence, a target that is often unimaginable or undesired at the outset.

Harm reduction is considered revolutionary in the field of addiction treatment, where abstinence is the traditional requirement for entry and continued participation in treatment programs. But many practitioners point out that harm reduction is simply in keeping with basic principles of good clinical practice, including the use of the client-therapist relationship as a motivational lever for positive change.

Harm reduction is in many ways analogous to weight-loss programs that do not require patients to commit to an ideal body weight before beginning a regimen of dieting and/or lifestyle change. In harm reduction, complete abstinence is a choice to be made by the patient, not a condition imposed by a treatment program. A basic tenet of harm reduction is respect for patients and their capacity to change.

What is the harm reduction approach?

Many addiction programs, such as Alcoholics Anonymous (AA), espouse an abstinence-only approach. This works for some people who are struggling with addiction, but others aren’t ready to commit to complete abstinence and avoid seeking professional help as a result. The harm reduction approach gives them a path forward. The highly individualized nature of harm reduction enables people to minimize the destructive consequences of substance abuse while meeting personalized goals.

What are the principles of harm reduction?

Instead of judging, shaming, or punishing a person for their addiction, harm reduction programs believe in compassion and acceptance. They try to “meet the addict where they are at” by developing individualized programs to reduce the negative consequences of substance use. Harm reduction drug treatment takes a realistic view of addiction, while simultaneously acknowledging the individual’s ability to change for the better.

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Harm Reduction Strategies

A clinical philosophy more than any one set of treatment interventions, harm reduction draws on psychodynamic, cognitive, and behavioral psychotherapies to help patients moderate drug use. In addition to individual psychotherapy, group therapy with peers and family therapy may be used when deemed beneficial. One underlying assumption is that most drug users want to make positive change, but don’t take action—just like most people want to exercise but do not.

Harm reduction recognizes that people often resort to alcohol and other drugs to cope with difficult feelings, depression, loss, or other problems in their lives, and therapists aim to first help patients develop effective coping mechanisms for their problems of living. The approach also acknowledges that relapse is a natural part of the process of changing behavior and an opportunity for learning behaviors that could prevent future relapses.

What are some examples of harm reduction?

“Harm reduction” is an umbrella term that covers a wide range of health and social concerns. Some notable examples include needle exchange services (which first appeared in the 1980s to combat the dangers of HIV and hepatitis), safe injection sites, drinking and driving laws, and free condoms. In addition, harm reduction programs are available for many different substances, such as alcohol, stimulants, ecstasy, marijuana, and opioids.

Is harm reduction evidence-based?

Yes. Not only are many harm reduction approaches considered to be evidence-based, but they are also saving lives. Some proven harm reduction practices include medical marijuana, heroin-assisted treatment, and drug checking.

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