Term Paper: Harm Reduction and Substance Abuse

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Harm Reduction and Substance Abuse

About 200 million people, or 5% of the global population are estimated to have used drugs at least once in 2006. Around 2.7% of the global population use drugs at least once a month, and around 0.6% are recognized as drug addicted or problem drug users. It is estimated that currently around 13 million persons worldwide inject drugs and that there is an increasing trend in the numbers of persons abusing cannabis and amphetamine-type stimulants (United Nations Office on Drugs and Crime, 2006). It can be seen from these figures substance abuse is an important issue which needs addressing. However alongside the concerns relating to the number of illegal drug users around the world are a barrage of other concerns. There are many problems which drug addiction causes to both individuals and societies. This includes disease transmission, most notably HIV / AIDS. The connection between the two is often a direct result of sharing unsterilized injecting equipment among injection drug users. It can also be indirectly a result of drug use, where injecting drug users transmit the disease through sexual intercourse to non-users (Schumacher, Fischer and Qian, 2007). It is estimated that injecting drug users have contributed to more than 10% of HIV infections worldwide (UNODC, 2006). The nature by which these types of infections can be spread from drug users indirectly to non-users signify one of the many dangers which can arise in a community as a result of those choosing to use illegal drugs. Therefore it could be argued that the prevention of such problems is equally, if not more important than addressing the number of people who currently use illegal drugs.

Harm reduction is a theoretical model which has been proposed to address the harm which is caused by the behavior of an individual, not only to themselves, but also to the wider community. This model has been developed into many practical applications, ranging from tobacco and alcohol addiction to weight loss. The model has also provided a potential framework for dealing with substance abuse, and has been adopted in practice in many countries around the world. This paper will examine the principals behind the theoretical model, and how these can be applied to successfully treat substance abusers. Specific applications of the model will be examined to determine how successful certain strategies have been in reducing harm, and how any limitations could be overcome to improve future implementations.

Theoretical model

There is some disagreement in the literature with regards to the actual components of harm reduction theory. There is no agreement as to the definition of harm reduction as many other terms such as risk minimization and risk reduction are used interchangeably with harm reduction. There is also disagreement between advocates of harm reduction as to whether imprisonment of drug users for possession is harm reduction, or even whether laws prohibiting drug possession contribute to harm reduction.

However there are certain principles to the theory of harm reduction which are generally agreed. Harm reduction is an approach or strategy rather than an actual goal, the aim of which is to reduce or eliminate the negative consequences of drug use rather than eliminate the actual drug use itself. There is an emphasis on the aim of reducing the adverse consequences among individuals who cannot be expected to cease their drug use at the present time for various reasons (Riley et al., 1999). The underlying philosophy to harm reduction is that the practitioner approaches the client in a nonjudgmental manner and works to help the client meet goals which have been established personally by the client (Bradley-Springer, 1996). In the harm reduction model, the rights of the individual are of prime importance, which include the client's rights to dignity and the right to make personal decisions. Harm reduction includes a holistic, incremental and multidimensional approach to decreasing risks for individuals and communities (Bradley-Springer, 1996). Although the model of harm reduction is contradictory to the traditional abstinence model, it may however be compatible with the eventual goal of abstinence. The model proposes that social support, health assistance, education and disease prevention measures should be maximized for all. It also emphasizes that repressive and punitive measures should be minimized (Bradley-Springer, 1996).

Harm reduction contrasts to the prohibition philosophy, also known as the abstinence model. This model concentrates on increasing interdiction, treatment and prevention efforts, combined with keeping mind altering drugs illegal (DuPont and Voth, 1995). Advocates of this theory often refer to the dramatic decrease in the use of dangerous drugs in the early 20th century which coincided with a substantial tightening of drug laws. Prohibitionists see the drop in the use of illegal drugs in the U.S. over recent years as evidence that prohibition may help reduce drug use and therefore drug harm (DuPont and Voth, 1995).

The basic process of harm reduction consists of providing the client with a continuum of options for their consideration, ranging from the riskiest behavior to the least risky behavior. Presenting the client with this continuum is dual-purpose. Firstly, it allows the client to assess their current behaviors in comparison to both more and less risky behaviors, which may help the client to see where they need to make changes. This is particularly true where a client may perceive their behaviors not to be very high risk, when in reality they rank very highly on the continuum. It may also help clients to assess where their behaviors have improved or degenerated over time, giving them a means of measuring the changes in their behavior. The continuum also provides the client with a range of behaviors so that they can choose for themselves the most suitable changes based on their personal circumstances (Bradley-Springer, 1996). In order for a continuum to be utilized effectively it is essential that health and social care professionals are able to adopt pragmatic tactics rather than absolute solutions.

Environmental effects on the individual

The theory of harm reduction acknowledges that there are various external factors which impact upon an individual and may affect their behaviors in ways which they cannot control, or are difficult for them to control. It is for this reason that one of the underpinning criteria of the harm reduction model is that the individual is allowed to choose their own targets based upon what they feel is achievable under their current circumstances. These environmental factors may take a variety of forms, for instance there could be family related issues or peer related issues which would impact upon any change that the individual tried to make. There could also be a wide array of socio-economic factors, such as the background or occupational history of the client which must be considered. However as the emphasis of the harm reduction model is based on changing behaviors, the process used will assist the individual in identifying areas of their life which are causing a potential conflict of interest. Use of the harm reduction model would also assist them in forming strategies to enable them to make changes which would facilitate changes to their behavior. For instance, if it were identified that the client's behaviors were influenced negatively by their work environment, the client may choose to implement strategies which would reduce this influence, or even end it altogether. However the emphasis would be on the client to choose these changes rather than the professional to insist that these changes are made.

With regards to the particular case of substance abuse, advocates of using the harm reduction model acknowledge that there are many environmental factors which influence the behavior of a substance abuser. Des Jarlais (1995) claims that the use of non-medical, mind-altering drugs is unavoidable in societies which have access to these drugs. He also states that it is inevitable that drugs will cause harm at both individual and societal levels. Des Jarlais claims that drug users form an integral part of the larger community and therefore must be included in measures to protect public health. This view of the substance abuser themselves as an integral part of the community is the basis for harm reduction applications. Harm reduction emphasizes that all humans have intrinsic value and dignity (Bradley-Springer, 1996). Harm reduction strategies aim to protect substance abusers along with all other members of a community. This is in contrast to prohibition models in which the substance abuser is viewed as an individual who must be punished rather than protected. These prohibition models have been described as 'a simplistic moral solution to complex human problems' (Griffin, 1998). Harm reduction accepts that some harm is inevitable but that the ideal of zero tolerance excludes compromise and sets goals which are not achievable (Riley, 1998).

Time orientation of model

The time orientation of the model is not concentrated in one particular area of time, but instead utilizes the concept of a continuum. This continuum allows the client to view their behaviors in comparison to a whole spectrum of behaviors, both more and less risky than those currently performed… [END OF PREVIEW]

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