And This Makes Sense?

This was on the Addiction and Recovery News blog last Tuesday:

‘Harm Reduction’ refers to policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption. Harm reduction benefits people who use drugs, their families and the community.
--International Harm Reduction Association

They point out at the IHRA web site that the idea of "harm reduction" came out of the HIV/AIDS crisis in the early to mid-80s. The purpose was to reduce the potential for contracting AIDS by handing out condoms and clean needles. The thinking- and correct thinking in most ways- was that people were going to be having sex and/or shooting up. Why put them at more risk? Reduce the potential harm.

It makes a lot more sense with AIDS than it does with alcohol and drugs. The answer is in one simple word- addiction. No matter how much harm reduction education you do, an addict or alcoholic will still be an addict or alcoholic. By definition they are not able to control their drinking. Sure, they might be able on any one occasion to stop, to reduce potential for harm. But an alcoholic or addict does not know how or when that will break down.

In fact, harm reduction, as defined above, doesn't seek to reduce drug consumption. It simply seeks to reduce the consequences and allow them to keep using. That doesn't make sense. Not as a general policy. Not as a public health approach to addicts and alcoholics. No, it doesn't make sense.

But I will be willing to say that there are times and places when elements of "harm reduction" might very well be socially helpful. There are places called "wet houses" where truly "incurable" alcoholics can live in a supervised environment and continue to drink, controlled by the house. I have not seen a great deal of information on this, though some say it has shown some success at reducing crime and homelessness.

Methadone treatment is another "harm reduction" model. This one has been around a long time now and has shown mixed success. There has been significant abuse of methadone maintenance programs but some evidence does point to reduction in negative consequences. Some programs in other countries are also using a harm reduction program that gives heroin addicts their heroin. In other words, it keeps them addicted so they don't have to go out and beg, borrow, buy, or steal to get it.

The IHRA is an international, not-for-profit NGO, incorporated in the UK. It has offices in London and Melbourne, Australia.

The IHRA website says:

Harm reduction ... is based on the recognition that many people throughout the world continue to use psychoactive drugs despite even the strongest efforts to prevent the initiation or continued use of drugs. Harm reduction accepts that many people who use drugs are unable or unwilling to stop using drugs at any given time. Access to good treatment is important for people with drug problems, but many people with drug problems are unable or unwilling to get treatment. Furthermore, the majority of people who use drugs do not need treatment. There is a need to provide people who use drugs with options that help to minimise risks from continuing to use drugs, and of harming themselves or others. It is therefore essential that harm reduction information, services and other interventions exist to help keep people healthy and safe. Allowing people to suffer or die from preventable causes is not an option. Many people who use drugs prefer to use informal and non-clinical methods to reduce their drug consumption or reduce the risks associated with their drug use.

My guess, anecdotal and based only on personal observations, is that very few people who are not alcoholic or addict die from these "preventable" causes. We are talking about allowing addicts and alcoholics to continue to use their drugs of choice, although hopefully at lower levels.

As a social policy, this sounds dangerous, to be perfectly honest. It opens up all kinds of "official" abuse and control of people deemed hopeless by the society or government or whoever. The social costs of drug and alcohol use is high, yes, and prevention and reduction programs are important. But as a policy of supporting negative behavior, "harm reduction" is not a preventative measure, as it is with HIV/AIDS. It may, if we are not careful, simply hide more of the social consequences and be more costly than we think.