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Harm Reduction as Best Practice (Harm Reduction Toolkit Section 1of 4)

Harm reduction is an umbrella term for policies and practices that are focused on reducing problematic effects of alcohol and other drug use. It can take place on the individual, community, or societal level. Harm reduction is focused on minimizing consequences without needing the activity to stop. It is a well-researched, evidence-based approach shown to be effective in addressing substance related harms (minimizing death, disease, and injury). Harm reduction is the only global drug policy response that has proven to save lives and money at the same time as increasing quality of life (Stone & Sander, 2016).

 

About Harm Reduction as Best Practice

Society actively embraces harm reduction in other areas where there is high risk for death and injury. For example, Seat belts, air bags, helmets for bicyclists and motorcyclists are all examples of measures taken to reduce the severity of injuries in the event of collision or upset. These measures neither prevent crashes nor attempt to reduce the high-risk behaviours that lead to negative events. Once again, the primary goal is simply to reduce the likelihood and severity of injury. Not only have such measures proven effective and garnered widespread support, in many jurisdictions they have become legal requirements (National Treatment Strategy Working Group, 2008).

In this context, harm reduction refers to an umbrella term for policies and practices focused on reducing problematic effects of alcohol and other drug use (Erickson, Butters, & Walko, 2002). Harm reduction can take place on the individual, community, or societal level. Examples of familiar substance use harm reduction strategies include: Smart Serve for bartenders, which decreases the potential for public drunkenness and DUIs; needle exchange programs that reduce HIV transmission; no-smoking zones to limit second-hand exposure to smoke (Erickson, Butters, & Walko, 2002). It is a non-judgmental approach that opens up honest dialogue around drug (including alcohol) use and decreases stigma around those whose substance use has become problematic.

Another way of looking at harm reduction is as secondary prevention. Primary prevention focuses on preventing the high risk behaviour or disease in the first place, secondary prevention focuses “on early detection and preventing progression and threats to the health of the individual” (National Treatment Strategy Working Group, 2008). In the case of post-secondary students, reducing the harms they may experience from the use of alcohol and other drugs, and identifying problematic use before it progresses into an addiction would be examples of secondary prevention.

Key principles include:

  • Acceptance that there are benefits and consequences of alcohol and other drug use, and that use has been around for thousands of years.
  • Focus on decreasing more immediate harms vs. striving for a drug free society.
  • Focus is on harms not the substance.
  • Giving people choice and access to a broad range of options that help to keep people safe and alive and healthy.
  • Making an individual’s goals a priority and focusing on what they see is their most immediate need.
  • Small gains add up over time.
  • Recognizing that people know what is best for them and are doing the best they can with what they have.

Harm Reduction for Students

When the greater Canadian social context is examined, it is easy to see that the use of alcohol and other substances, like marijuana, is increasingly normalized as part of social interactions. Alcohol in particular is used to celebrate, commiserate, and socialize (National College Health Improvement Project, 2013). Alcohol has even begun to be present in traditionally non-alcohol related activities, such as paint classes and yoga. To expect post-secondary students to abstain from an activity that is ingrained in the culture and used by the general population is unrealistic. In addition, post-secondary education comes with its unique challenges:

“On campus, where the transition to adulthood and academic life can carry with it enormous social, academic, emotional and financial pressures, students often take drinking to the next level and drunkenness is increasingly becoming the norm”
(Nova Scotia Department of Health and Wellness, 2012).
In the National College Health Assessment, over half of post-secondary students who reported drinking alcohol in the past 12 months reported experiencing one of the following: did something they later regretted, forgot where they were or what they did, got in trouble with the police, had sex with someone without their consent, someone had sex with them without their consent, had unprotected sex, physically injured themselves or another, seriously considered suicide
(American College Health Association, 2016).
In the American survey which interviews approximately 70,000 randomly selected participants who are 12 and older; the National Survey on Drug Use and Health, found that many substance use problems reach their peak in transitional aged youth (typically defined from 18 to 24) where youth experience “rapid transitions into new social contexts that involve greater freedom and less social control than experienced during high school and earlier adolescence”
(Administration, 2017)
Clearly, harm reduction is warranted as a strategy for targeting college students and out-of-the-mainstream youth. One of the major goals of research on harm reduction pertaining to these groups of youth should be how to best tailor and deliver programs to effectively meet their needs
(Poulin, 2006).
There is evidence that programs that reduce the short- and long-term harm to substance users benefit the entire community through reduced crime and public disorder, in addition to the benefits that accrue from the inclusion into mainstream life of previously marginalized members of society. The improved health and functioning of individuals and the net impact on harm in the community are notable indicators of the early success of harm reduction
(Erickson, Butters, & Walko, 2002).

Harm Reduction Resources

  • Johnson, L. (2014) Learning Collaborative on High-Risk Drinking. Using a Public Health and Quality Improvement Approach to Address High-Risk Drinking with 32 Colleges and Universities. White Paper National College Health Improvement Program.
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HARM REDUCTION 101

Harm reduction decreases the health risks of any activity without requiring you to stop the activity itself. Some common examples include bike helmets, seat belts, oven mitts, and “Don’t drink and drive” messages. Here is what you need to know about harm reduction and substance use:

  1. IT WORKS!Harm reduction is a well-researched, evidence-based approach shown to be effective in decreasing substance use related harms.
  2. TO USE OR NOT TO USEHarm reduction does not encourage substance use or force people to stop using; it is a non-judgmental approach that helps create opportunities for people to live healthier lives.
  3. TWO SIDES TO EVERY COINHarm reduction accepts that people experience benefits as well as consequences when they use alcohol and other substances.
  4. RIGHT HERE, RIGHT NOWHarm reduction goals are about decreasing the more immediate harms and increasing the quality of life in the present. It is not concerned about striving unrealistically for a drug-free society.
  5. THERE’S AN “I” IN WINHarm reduction respects each individual’s goals and offers lots of choices. This allows people to focus on their most immediate need and have access to a broad range of options to help them stay safer and healthier. Small gains can lead to BIG succcesses!