The War on Drugs' has traditionally had total abstinence as its target. The contributors to this book take a new and challenging approach to problem drug use, arguing that abstinence is not the only solution. They believe that existing methods of treatment and control have been inadequate in controlling or improving drug problems and they propose a radical alternative: reducing the harm associated with the use of illicit drugs. International in scope, the book covers a broad range of drugs, and of social and individual problems. The spread of HIV infection, which has been described as a greater threat to individual and public health than drug misuse is also considered. The contributors give an overview of the current theories and practices that have helped to minimise the harmful effects of drugs and describe national and city-level strategies towards drug problems. They also cover the drug policies of several agencies and organisations world-wide, including police, doctors, community groups and local authorities. Concentrating on reducing drug-related harm, this in an important contribtuion to the debate on the future shape of drug control systems. It questions the role and function of existing drug laws and discusses how harm reduction will shape day-to-day work with drug users. Provocative and persuasive, it should be read by all policy-makers and practitioners faced with drugs problems, and will do much to help establish new strategies for dealing with drug use, strategies that minimise rather than exacerbate drug-related harm.

Since the First International Conference on the Reduction of Drug-Related Harm, held in 1990, the term 'harm reduction' has gained wide currency in the areas of public health and drug policy. Previously the field was characterized by heated struggle between prohibition and legalization of addictive substances, and this debate tended to obscure practical, collective approaches. Harm reduction, an approach which encompasses various policy directives and program initiatives was inspired by the positive outcomes of such public measures as needle-exchange programs for reduction of HIV risk, methadone maintenance programs, education on the risks of tobacco use, and programs designed to limit alcohol consumption. The essays in this book illustrate the scope and vigour of the emerging harm reduction model. The essays, drawn from seven international conferences on harm reduction, cover a wide variety of topics, including public policy, women and reproductive issues, the experiences of special populations, human rights; defining and measuring harm, and intervention. Researchers and practitioners will benefit from the varied papers in the volume, which combine insights into policy-making and front-line outreach efforts with comprehensive conceptual and empirical approaches. Harm Reduction represents an important initiative in making academic work accessible and useful to a larger community, and provides guidance for the development of effective policies and programs.

All across the United States, individuals, families, communities, and health care systems are struggling to cope with substance use, misuse, and substance use disorders. Substance misuse and substance use disorders have devastating effects, disrupt the future plans of too many young people, and all too often, end lives prematurely and tragically. Substance misuse is a major public health challenge and a priority for our nation to address. The effects of substance use are cumulative and costly for our society, placing burdens on workplaces, the health care system, families, states, and communities. The Report discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment so that they can address a person's overall health, rather than a substance misuse or a physical health condition alone or in isolation. It also provides suggestions and recommendations for action that everyone-individuals, families, community leaders, law enforcement, health care professionals, policymakers, and researchers-can take to prevent substance misuse and reduce its consequences.

This volume addresses the interface of two major national problems: the epidemic of HIV-AIDS and the widespread use of illegal injection drugs. Should communities have the option of giving drug users sterile needles or bleach for cleaning needs in order to reduce the spread of HIV? Does needle distribution worsen the drug problem, as opponents of such programs argue? Do they reduce the spread of other serious diseases, such as hepatitis? Do they result in more used needles being carelessly discarded in the community? The panel takes a critical look at the available data on needle exchange and bleach distribution programs, reaches conclusions about their efficacy, and offers concrete recommendations for public policy to reduce the spread of HIV/AIDS. The book includes current knowledge about the epidemiologies of HIV/AIDS and injection drug use; characteristics of needle exchange and bleach distribution programs and views on those programs from diverse community groups; and a discussion of laws designed to control possession of needles, their impact on needle sharing among injection drug users, and their implications for needle exchange programs.

Harm reduction programs accept the reality of drug use while attempting to reduce its harmful consequences to individuals and society. This term, coined about 15 years ago in the U.K., has become a policy paradigm increasingly explored throughout most of the industrialized world. An example of a harm reduction program is the widely accepted substitution of methadone for the more "harmful" heroin. Programs that divert drug-involved offenders into treatment are another example of the operationalization of harm reduction policies. In these 10 original chapters, international contributors discuss the philosophical basis and history of harm reduction policies and examine their outcome. They also cover controversial topics related to harm reduction, especially conflicts between the public health system where most programs are located, and a worldwide criminal justice system that further marginalizes drug users. Included in this book are descriptions of programs in the United States, the United Kingdom, Canada, Brazil, the Netherlands, Switzerland, and Australia. The editors provide the context with a substantive introductory chapter focusing on the nature of harm reduction. The first part contains five chapters presenting the American perspectives on harm reduction; Part II includes five chapters presenting international perspectives from countries with particularly innovative harm reduction programs and policies.

Harm Reduction is a philosophy of public health intended as a progressive alternative to the prohibition of certain potentially dangerous lifestyle choices. Recognising that certain people always have and always will engage in behaviours which carry risks, the aim of harm reduction is to mitigate the potential dangers and health risks associated with those behaviours. Harm Reduction in Substance Use and High-Risk Behaviour offers a comprehensive exploration of the policy, practice and evidence base of harm reduction. Starting with a history of harm reduction, the book addresses key ethical and legal issues central to the debates and developments in the field. It discusses the full range of psychoactive substances, behaviours and communities with chapters on injecting, dance drugs, stimulant use, tobacco harm reduction, alcohol use and sex work. Written by an international team of contributors, this text provides an essential panorama of harm reduction in the 21st century for educators and researchers in addiction and public health, postgraduate students and policy makers.

This ground-breaking volume provides readers with both an overview of harm reduction therapy and a series of ten case studies, treated by different therapists, that vividly illustrate this treatment approach with a wide variety of clients. Harm reduction is a framework for helping drug and alcohol users who cannot or will not stop completely—the majority of users—reduce the harmful consequences of use. Harm reduction accepts that abstinence may be the best outcome for many but relaxes the emphasis on abstinence as the only acceptable goal and criterion of success. Instead, smaller incremental changes in the direction of reduced harmfulness of drug use are accepted. This book will show how these simple changes in emphasis and expectation have dramatic implications for improving the effectiveness of psychotherapy in many ways. From the Foreword by Alan Marlatt, Ph.D.: “This ground-breaking volume provides readers with both an overview of harm reduction therapy and a series of ten case studies, treated by different therapists, that vividly illustrate this treatment approach with a wide variety of clients. In his introduction, Andrew Tatarsky describes harm reduction as a new paradigm for treating drug and alcohol problems. Some would say that harm reduction embraces a paradigm shift in addiction treatment, as it has moved the field beyond the traditional abstinence-only focus typically associated with the disease model and the ideology of the twelve-step approach. Others may conclude that the move toward harm reduction represents an integration of what Dr. Tatarsky describes as the “basic principles of good clinical practice” into the treatment of addictive behaviors. “Changing addiction behavior is often a complex and complicated process for both client and therapist. What seems to work best is the development of a strong therapeutic alliance, the right fit between the client and treatment provider. The role of the harm reduction therapist is closer to that of a guide, someone who can provide support an