'Harm Reduction' is the term used to describe a realistic approach to substance abuse problems on both individual and societal levels. All human societies across time and culture
have engaged in the use of mood altering substances. Fundamentalist, absolutist approaches such as the "war on drugs" and the "just say no" campaigns have proven to be unrealistic and ineffective. The
harm reduction movement coalesced and came to pubic attention with the June 1998 letter to the United Nations (signed by 11 Nobel prize winners, 7 heads of state, and 13 Canadian member of parliament, among others) stating that the global
war on drugs, emphasizing criminalization and punishment was causing more harm than drug abuse itself. The letter advocates "Realistic proposals to reduce drug related crime, disease and death", rather than "rhetorical proposals to create a
drug free society". There has been a great deal of controversy about these ideas. Many European countries as well as Canada and Vancouver have harm reduction policies and this is very different to the "zero tolerance" approach taken in the
United States. This causes some difficulties. Because Canada is very economically tied to the United States, trying to maintain harmonious relations with them restricts our ability to embrace harm
reduction policy as fully as might be helpful. From a larger perspective we have to consider the harm of having more poverty because of being economically "punished" by the United States, so it is a balancing act requiring careful
consideration and diplomacy. Disagreements about harm reduction approaches continue in our own community. Psychologically, people tend to cope with pain and trauma by denial or by projecting blame,
"badness" onto problematic groups. Thus, 'not in my back yard' attitudes arise, expressing the wish to rid ourselves of the pain of addiction by splitting ourselves off from, dehumanizing, and demonizing addicted people. Harm reduction has
also been seen as conflicting with abstinence based programs such as the 12 step programs, which have been so influential in treatment, but this is changing. Although abstinence can be included in harm reduction, harm reduction cannot be included in abstinence. In 12-step programs abstinence is a fundamental principle. From a 12-step
viewpoint harm reduction can be seen as 'enabling' that prevents the addict from 'bottoming out' and reaching that point of desperation which will drive him or her to seek treatment. On the other hand, harm reduction is not dissonant with
many 12-step principles like that people will come into a program when they are ready, and that the program is one of suggestion and that people need only take the parts that are helpful to them. When
someone on Methadone is seeking treatment this conflicts with the rules of most of the 12-step based recovery houses. These types of rules involve some hypocrisy since other doctor prescribed medications, such as benzodiazepine to deal with
withdrawal symptoms, are tolerated. Some fear that methadone maintenance programs, needle exchanges and safe injection sites are just the thin edge of the wedge and the ultimately goal of harm reduction is drug legalization.
Mark Haden's work on harm reduction gives persuasive statistics about the ineffectiveness of the "war on drugs" and the criminalization/punishment model. This model did not work with alcohol prohibition in the thirties and led to more
negative effects such as the development of organized crime, the Mafia, etc. Also criminalization and punishment just aggravate other social injustices such as the oppression of racial minorities, poor people, and other marginalized groups.
G. Alan Marlatt (Harm Reduction: Pragmatic Strategies for Managing High-Risk Behaviors ) describes harm reduction as a humane and practical pubic health alternative to both the moral model and the medical model in his description of various presentations at a harm reduction conference. The idea is to meet drug
users "where they are at" and to address the complex issues involved from many directions, from providing safe injection sites, needle exchanges, HIV prevention, a variety of treatment options (not only 'take it or leave it' abstinence) to
dealing with housing, poverty, employment, to compassion clubs, medical marijuana, decriminalization of some drugs, making them available by prescription or as controlled substances, to drug courts where people can get treatment rather that
incarceration. Harm reduction looks to reduce harm to individual drug users and to society as well by reducing crime and social costs. I support harm reduction with some reservations. I have concerns
that when the focus of harm reduction is on reducing the societal costs (and guilt), we appease our guilt with programs that slightly improve the quality of life of addicts, but on a deeper level we abandon them to the ravages of chemical
soul murder. The challenge is to find ways to discern between "meeting them where they are at" and keeping them where they are at.
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