Harm Reduction Model

. Harm reduction is referred to as a “pragmatic” approach because it starts with accepting that individuals have and always will, use drugs and engage in high-risk behaviors in ways that pose a threat to both themselves and their community. While the focus is placed on reducing consequences, not decreasing or eliminating unsafe behaviors, harm reduction does not preclude abstinence from being a goal as long as it is one which the affected individual identifies, thus rendering it compatible with a number of preexisting treatment modalities. Due to its multidisciplinary involvement, various definitions of harm reduction exist and “reflect a diverse movement that values contributions of both individuals and communities, of scientific discovery and human rights advocacy, and of grassroots and public health movements” (Marlatt, Larimar, and Witkiewitz, 2012, p. 27).
As opposed to being a strict set of policies, harm reduction has been frequently described as an “an attitude” (Marlatt, Larimar, and Witkiewitz, 2012, p. 8) founded on human rights, social justice principles and the desire to reduce health care

disparities where they exist. Its proponents purposefully refrain from making moralistic judgements about the nature of substance use and other high-risk behaviors. Instead, focus is placed entirely upon reducing the adverse effects dysfunctional patterns of behavior have on the affected individuals, their communities, and society at large. In turn, this philosophical approach has been effectively extended to many prevention, intervention, advocacy, education, and public policy-oriented efforts aimed at better serving individuals engaged in high-risk behaviors.
While the expressed goal is to reduce the negative consequences associated with unsafe behaviors, as a pragmatic approach, harm reduction recognizes that there will be members of society who continue to engage in injurious activities regardless of the potential harm associated with them. Therefore, clients who are unwilling or unable to participate in programs which require abstinence or treatment adherence as a condition for receiving care, are accepted “wherever they are” in terms of their current behavioral patterns. For these individuals, harm reduction provides an alternative, low-threshold means of gaining access to quality treatment, support, and medical care.
Principals of Harm Reduction
Harm reduction “presents an expanded way of thinking about treatment” (Tatarsky and Marlatt, 2010, p.

137) that emphasizes a personalized approach which centers on meeting the specific needs of the affected individual and their community. Practioners believe one of the harm reduction model’s strengths is that it facilitates engagement and encourages consumers to interact with treatment providers while they are still using substances or engaged in high-risk behaviors. Because helping marginalized populations “stay alive and healthy” (Tatarsky and Marlatt, 2010, p.118) is the foremost goal of the movement, offering low-threshold services lays the foundation for providing other therapeutic interventions when the client is finally receptive to them. Marlatt, Larimar, and Witkiewitz (2012) have identified eight fundamental principles which characterize harm

reduction:
1) “High-Risk Behaviors” Exist as a Social Construct
Our perception of high-risk behaviors is informed by the time and sociocultural setting in which they occur, rendering them neither fixed nor unconditional (Goode and Ben-Yehuda, 2009). By “viewing beliefs about high-risk behaviors as fluid and dynamic social constructs” (Marlatt, Larimar, and Witkiewitz, 2012, p.8), it may assist service providers in reserving personal judgements and developing more constructive relationships with their clients.
2) High-Risk Behaviors are an Inescapable Part of the Human Condition
While they may vary, high-risk behaviors are characteristic and immutable expressions of the human experience. Attempts to eliminate them, such as prohibition of alcohol in the 1920s and the drug prevention-education program D.A.R.E. in the 1980s, “have not only failed but have been associated with higher levels of crime, large public expenditures, and sometimes, increases in the targeted high-risk behaviors” (Marlatt, Larimar, and Witkiewitz, 2012).
3) High-Risk Behaviors can be Both Adaptive and Maladaptive
Harm reduction proponents recognize that high-risk behaviors occur for reasons. In addition to the conventional explanations provided by behavioral economics and self-control theories, it has also been proposed that some high-risk behaviors may be part of a functional adaptive process (Glautier, 2004). Research conducted on chronically homeless individuals with alcohol use disorders demonstrated that the act of drinking together fosters a sense of social cohesiveness and reduces the intensity of some psychiatric symptoms (Collins, et al., in press). By recognizing the complexity of an individual’s unique relationship with substance use and high-risk behaviors, the development of more personalized, effective interventions can be promoted.