Harm reduction is a public health philosophy that seeks to lessen the dangers that drug misuse and our drug policies cause to society.

A harm reduction strategy is a comprehensive approach to drug misuse and drug policy.

Harm reduction's complexity lends to its misperception as a drug legalization tool.

Harm reduction rests on several basic assumptions.

A basic tenet of harm reduction is that there has never been, is not now, and never will be a drug-free society.1

A harm reduction strategy seeks pragmatic solutions to the harms that drugs and drug policies cause. It has been said that harm reduction is not what's nice, it's what works.

A harm reduction approach acknowledges that there is no ultimate solution to the problem of drugs in a free society, and that many different interventions may work.

Those interventions should be based on science, compassion, health and human rights.1

Problem drinkers vary considerably in terms of level of severity, configuration of antecedents which trigger heavy drinking, types of consequences which are of concern (e.g. legal, health, interpersonal) and individual goals and standards.

Ideally, treatment for alcohol problems should begin with a thorough assessment of many variables so that a recommendation can be made as to the most potentially effective and least invasive approach which is most consistent with existing values.

Some individuals can benefit from brief motivationally oriented contacts or involvement in peer support groups like Rational Recovery or Alcoholics Anonymous.

Others require more intensive treatment, such as weekly individual therapy, partial hospitalization or inpatient treatment.

Many individuals with drinking problems desire to learn how to moderate their drinking as opposed to abstaining.

As stated, research strongly supports the efficacy of moderation training for non-physically dependent problem drinkers.

Furthermore, many individuals who pursue moderation ultimately opt for an alcohol-free lifestyle.

Moderation training, therefore, is appropriate and should be included in the spectrum of addiction treatments.2

A person may have a problem with alcohol without being an alcoholic (alcohol dependent).

According to recent data, most people only have mild to moderate alcohol problems.

Relative to alcohol dependent individuals, these drinkers have a shorter problem drinking history, more social and economic stability, and greater personal resources.

The first step is to make the drinker aware of the situations that trigger his or her drinking behavior when confronted with those situations.

This cognitive-behavioral approach is designed specifically for problem drinkers who want to reduce their drinking and who do not have a strong physical dependence on alcohol.3

The issue of controlled drinking still evokes violent debate. Most people do not know the facts regarding controlled drinking as a viable alternative for some problem drinkers.

Popular press, driven by a strong 12-step coalition, has created an abstinence-only public mind set: Those with the disease of alcoholism (defined nebulously as "people with drinking problems") simply should not drink at all and that for professionals to advocate anything but abstinence and AA attendance is tantamount to malpractice.2

Harm reduction approaches to addictive behavior are based on three central beliefs.

First, excessive behaviors occur along a continuum of risk ranging from minimal to extreme. Addictive behaviors are not all-or-nothing phenomena. Though a drug or alcohol abstainer is at risk of less harm than a drug or alcohol user, a moderate drinker is causing less harm than a binge drinker.

Second, changing addictive behavior is a stepwise process, complete abstinence being the final step. Those who embrace the harm reduction model believe that any movement in the direction of reduced harm, no matter how small, is positive in and of itself.

Third, sobriety simply is not for everybody.

Continued on AlcoholAnswers.org

Image from book: High Society: How Substance Abuse Ravages America and What to Do About It, by Joseph A. Califano.