Harm reduction is a proactive approach to reducing the damage done by alcohol, drugs, and other addictive behaviors, as well as addressing broader health and social issues, such as HIV transmission. The term harm reduction can be used to describe the philosophical beliefs that underlie strategies and programs, or it can be used to describe the strategies and programs on which it is based. Often, harm reduction strategies are used in conjunction with other approaches, which require abstinence.
Does Harm Reduction Encourage Drug Use?
A common misconception about harm reduction is that it condones or encourages drug use. Many advocates of harm reduction also support the goal of people working towards abstinence from alcohol, drugs and addictive behaviors, but recognize that for many people, this process takes time, and in the interim period while the person is still drinking, using drugs, or engaging in other addictive behaviors, both they and the people around them are vulnerable to harm.
Examples of Harm Reduction in Action
Drinking and Driving Laws
While it is well known that even small amounts of alcohol can affect people's ability to drive safely, driving and driving laws allow drivers to have a small amount of alcohol in their bloodstream. The focus is not on eliminating alcohol use from drivers completely, but setting a limit over which the greatest risk of causing a serious accident is defined.
Drinking and driving laws do not encourage drinking; they actually discourage it. But they accept the reality that many people will drink to some extent before driving, and that the overall harm to society is lessened by focusing attention on the worst offenders.
Needle Exchange Services
Injecting drugs such as heroin is illegal, yet harm reduction advocates for clean needles to be provided to drug users free of charge. This is because there is more harm caused to individual drug users, the health care system, and society as a whole if injection drug users pass HIV and hepatitis to each other through sharing needles.
Needle exchange programs do not encourage drug use. In fact, they are usually the first point of contact for drug users to access addiction treatment services. But they accept the fact that many people will inject drugs whether they have clean needles or not, and prefer that they do not get ill and die as a result of infection.
Safe Injection Facilities
Safe injection sites go a step further than needle exchange services by providing a safe space in which people can inject drugs, clean needles and injection equipment, and supervision of the injection process by medical staff. In addition to the harm reduction goals of needle exchange services, i.e. reducing transmission of HIV, hepatitis and other infections, and damage caused by unclean equipment being used for injecting, safe injection rooms offer a safe space and immediate help if an overdose occurs.Safe injection facilities do not encourage drug use -- they provide a connection between the most vulnerable drug users and treatment services, such as detox. And they save lives that would otherwise be lost to drugs.
Sex can be an addictive behavior, and it can lead to unplanned pregnancy, but the main reason that free condoms are sometimes provided as a harm reduction service is to reduce the transmission of STDs, specifically HIV.
Free condoms are not distributed to encourage people to have sex. Programs that distribute them recognize that people have unprotected sex for many different reasons, and that factors such as embarrassment and poverty may get in the way of purchasing condoms. They prevent a lot of illness and problems associated with unprotected sex.
Denning, P., Little, J. and Glickman, A. Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol. New York: Guilford. 2004.
Miller, W. and Munoz, R. Controlling Your Drinking: Tools to Make Moderation Work For You. New York: Guilford. 2005.