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PubMed1996

Substance use reduction in the context of outpatient psychiatric treatment: a collaborative, motivational, harm reduction approach.

A conceptual model for reducing substance use within the context of outpatient psychiatric treatment is described. The proposed model incorporates four themes from the psychological treatment literature: treatment intensity, stages of change, motivational interventions, and harm reduction. The five steps of the model include (1) establishing a working alliance, (2) evaluating the cost-benefit ratio of continued substance use, (3) individualizing goals for change, (4) building an environment and lifestyle supportive of abstinence, and (5) anticipating and coping with crises. This model attempts to integrate clinical realities of mental health treatment with empirically-grounded strategies applicable to substance abuse problems.

Adaptation, Psychological↗

PubMed2006

Tobacco harm reduction: an alternative cessation strategy for inveterate smokers.

According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases. Many smokers are unable--or at least unwilling--to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die. A third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products. This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations. The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in public policy, and to assist consumers in distinguishing real health threats from spurious health claims. As this report documents, there is a strong scientific and medical foundation for tobacco harm reduction, and it shows great potential as a public health strategy to help millions of smokers.

Journal Article↗

PubMed2002

The California Tobacco Control Program and potential harm reduction through reduced cigarette consumption in continuing smokers.

Harm reduction for continuing smokers has been suggested as a public health priority. We evaluated whether tobacco control programs might reduce cigarette consumption among current smokers through strategies aimed primarily at protecting nonsmokers from secondhand smoke (SHS). Data were from adult (18+ years) respondents to multiple (1990, 1992, 1996, 1999), large, cross-sectional, population-based surveys of smoking behavior, conducted to evaluate the California Tobacco Control Program. Adult daily smoking prevalence decreased from 15.9 +/-0.4%(+/-95% confidence interval) of the California adult population in 1990 to 13.0 +/-0.3% in 1999. Concurrently, moderate-to-heavy daily smoking (>or= 15 cigarettes/day) decreased from 10.3 +/-0.4% in 1990 to 7.4 +/-0.3% in 1999, and heavy daily smoking (>or= 25 cigarettes/day) from 3.4 +/- 0.2% in 1990 to 1.9 +/- 0.1% in 1999. Decreased daily smoking was observed in all demographic subgroups except young adults. Among college graduates, the daily smoking prevalence in 1999 was 6.4 +/- 0.4%, a level previously observed only among U.S. physicians. In 1999, nearly 30% of current smokers did not smoke daily, and more than 60% said they now smoked less than previously. In 1999, self-reported cigarette consumption was inversely related to believing SHS is harmful to nonsmokers, having a smoke-free workplace, and living in a smoke-free home. In California, tobacco control strategies that educated the population about SHS and resulted in smoking restrictions may have led continuing smokers to smoke less, which should reduce the harm from smoking to the public health in the long term.

Adolescent↗

PubMed1994

Researching self help drug treatment: collaboration and conflict in the age of harm reduction.

While there is evidence supporting the effectiveness of drug treatment in self help groups there are many points of divergence between the philosophies traditionally espoused by these groups and those advocated within harm reduction policies. In this paper we examine some of the differences between self help and harm reduction approaches. We argue that (in common with other treatment modalities) self help groups have altered and developed in response to changing community expectations and that this process should be expected to continue. We report on our ongoing exploration of research partnerships with self help group members focusing particularly upon research conducted in collaboration with self help groups in Victoria. We argue that research partnerships have advantages for both parties. These partnerships have the potential to better inform researchers of developments in the self help community (including the practices of active drug users). Research partnerships also encourage better understanding among self help group members of some of the potential problems that, as research has indicated, may be associated with certain self help group practices. We advocate such understanding as a potentially effective means of encouraging the appropriate development and refinement of self help group practices in line with harm reduction principals.

Alcoholics Anonymous↗

PubMed1999

Compulsory substance-user treatment and harm reduction: a critical analysis.

Compulsory treatment potentially offers a cost-effective and rehabilitative alternative to incarceration for substance-user offenders. However, the compatibility of harm-reduction principles and compulsory substance-user treatment initiatives is unclear. First, the historical record suggests that policy and legislative changes promoting diversion to treatment are typically not followed up by administrative, fiscal, and evaluative support. Moreover, cost-saving arguments underlying past programs may be inadequate to cope with concerns about civil liberties raised by compulsory treatment practices. Second, empirical evidence suggests that there may be a fundamental incompatibility between attitudes endorsing compulsory treatment and attitudes endorsing harm reduction. Finally, empirical claims about the relative efficacy of mandated versus nonmandated substance-user treatment are plagued by conceptual and methodological problems. These arguments suggest that compulsory substance-user treatment and harm reduction may not be as compatible as is commonly believed. Consequently, caution is warranted in moving toward a widespread adoption of compulsory treatment policies. [Translations are provided in the International Abstracts Section of this issue.]

Canada↗

PubMedDate not supplied

[The introduction of the concept of Harm Reduction in the city of Cherkassy].

The introduction of the concept of Harm Reduction into the practical work of the narcological survive confidence relations with injecting drug users were established, which resulted in the possibility to carry out information and educational, as well as preventive work. In addition, there occurred changes in public opinion with respect to the problems of drug addiction (a drug addict was now regarded as a sick person) and AIDS (HIV infection was considered to be a problem, topical for wide strata of the population). The creation of a dedicated team comprising medical personnel, psychologists, representatives of the clergy, volunteers from drug addicts contributed to successes in this work. The work on the correction of negative manifestations, carried out by the organs of law protection, also contributed to the creation of balance between the strategy of Harm Reduction and the strategy of the reduction of need in narcotic drugs.

Female↗

PubMedDate not supplied

From alcoholism treatment to the alcohol harm reduction strategy for England: an overview of alcohol policy since 1950.

With the publication of the Alcohol Harm Reduction Strategy for England in 2004,(1) it is timely to reflect on the social and political contexts that have influenced alcohol policy. This paper provides an overview of trends in the development of alcohol policy in England since 1950 with a focus on treatment policy. In particular, it traces factors that have prompted change and resulted in the "treatment" response of the 1960s becoming a small part of a larger, complex approach to the "management" of alcohol-related harm. The publication of the Alcohol Harm Reduction Strategy for England(1) and the Interim Analytical Report,(2) which provided the evidence and framework for the strategy, has resulted in fierce debate on the political processes underlying the emergence of the strategy, the extent to which the strategy is "evidence-based," its strategic aims, and the mechanisms for implementation. This paper argues that responses to policy statements-like the policies themselves-have to be examined within the political, economic, and cultural contexts of their time.

Alcohol Drinking↗

PubMed2005

Lessons from the history of tobacco harm reduction: The National Cancer Institute's Smoking and Health Program and the "less hazardous cigarette".

Scientists and public health practitioners are sharply divided today over the risks and benefits of tobacco harm-reduction strategies. At the same time, a range of novel tobacco products is being marketed with claims of reduced exposure or risk. Current scientific efforts to study tobacco products and harm reduction should be informed by past experience. During the 1960s and 1970s, there was substantial support within government and academia, as well as among voluntary health organizations, for efforts to modify tobacco products to reduce harm. This paper analyzes the former National Cancer Institute (NCI) Smoking and Health Program, which, between 1968 and 1980, pursued the development of "less hazardous" cigarettes as its primary goal. During this period, the program spent over dollar 50 million on contract research, of which 74% went toward biological and chemical analysis of modified cigarettes, 9.6% to epidemiological studies of risk factors, and only 1.4% to studies evaluating smoking cessation or prevention programs. NCI officials predicted during the mid-1970s that new "low-tar" cigarette brands would substantially reduce smoking-related mortality, but by 1978 the research agenda began to change in response to a reorganization of NCI research activities, modification of government antismoking efforts, and an emerging understanding of nicotine addiction that challenged key scientific assumptions. In retrospect, the program suffered from significant weaknesses that severely limited the likelihood that it would generate knowledge beneficial to public health, including a research agenda that failed to include surveillance and behavioral research, tobacco industry influence of the research agenda, and a lack of access to information about the characteristics of products on the market. There exists today a need for a public health-oriented research agenda on tobacco products and harm reduction, but current efforts should include input from a diverse range of disciplines, collect data on users' behavior, and limit the involvement of industry scientists.

Biomedical Research↗

PubMed1999

The use of significant reduction rates to evaluate health education methods for pregnant smokers: a new harm reduction behavioral indicator?

This article evaluates the evidence to support the use of biochemical measurement of significant reduction (SR) rates among pregnant smokers as a new behavioral indicator of "harm reduction" (HR). The results of four studies--three randomized patient education clinical trials of pregnant smokers (Trials I, II, and III) and an epidemiological study (Study IV)--are presented. Among Trial I, II, and III cohorts of pregnant smokers, control group SR rates of 7% (I), 9% (II), and 20% (III) were increased among experimental groups to 17% (I), 18% (II), and 32% (III) by the same patient education methods. Analyses of infant birthweight data in Study IV found that a patient SR rate representing a 50% or more decrease between a baseline and follow-up test was associated with an increase in adjusted birthweight of 92 grams.

Adult↗

PubMed2005

Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation.

OBJECTIVE: This study assessed unprotected anal and oral sex behaviors of HIV-positive gay and bisexual men in New York City and San Francisco with their main and non-main sexual partners. Here we focus on the use of three harm reduction strategies (serosorting, strategic positioning, and withdrawal before ejaculation) in order to decrease transmission risk. METHOD: The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising and other techniques. RESULTS: City differences were identified, with more men in San Francisco reporting sexual risk behaviors across all partner types compared with men in New York City. Serosorting was identified, with men reporting significantly more oral and anal sex acts with other HIV-positive partners than with HIV-negative partners. However, men also reported more unprotected sex with partners of unknown status compared with their other partners. Some evidence of strategic positioning was identified, although differences were noted across cities and across different types of partners. Men in both cities reported more acts of oral sex without ejaculation than with ejaculation, but the use of withdrawal as a harm reduction strategy for anal sex was more common among men from San Francisco. CONCLUSION: Overall, evidence for harm reduction was identified; however, significant differences across the two cities were found. The complicated nature of the sexual practices of gay and bisexual men are discussed, and the findings have important implications for prevention efforts and future research studies.

Adult↗

PubMed2006

Advocacy and coverage of needle exchange programs: results of a comparative study of harm reduction programs in Brazil, Bangladesh, Belarus, Ukraine, Russian Federation, and China.

To prevent or mitigate an AIDS epidemic among injecting drug users (IDUs), effective activities need to be implemented on a large enough scale to reach and assist sufficient numbers of drug users and thereby change their risk behaviors related to drug use and sex. Recent work by UNAIDS on "high coverage sites", adopting the above strategies, has shown that one of the key elements in achieving high coverage is ongoing and sophisticated advocacy. High coverage harm reduction sites were studied through literature search and site visits, including key informant interviews, review of service statistics, and data analysis, in order to document the steps that led to scaling up, the way coverage was defined in these sites, and the lessons learned from their efforts. Syringe-exchange programs can achieve high coverage of IDUs. Monitoring to determine regular reach (those who are in regular contact with harm reduction services) should be added to uniform data collection carried out by harm reduction programs. Advocacy is crucial to achieving high coverage.

Bangladesh↗

PubMed2002

Tobacco harm reduction: conceptual structure and nomenclature for analysis and research.

The goal of tobacco control has always been to reduce death and disease due to tobacco use. Recent discussions have broadened the concept of tobacco control beyond cessation and prevention to include concepts such as the use of medications to achieve reduction in tobacco use, chemoprevention to reduce disease, modifications of tobacco products to reduce toxicity, and behavioral approaches to change smoking and tobacco use behavior. Within each of these broad domains, diverse approaches have been suggested. To facilitate clear discussion and analysis, and to avoid confusion among approaches, we catalog 19 approaches to harm reduction, distinguishing and discussing them on 11 dimensions, including their objectives, mechanisms, toxicology, expected population risks, and consumer appeal. Because there have also been so many suggested applications of medicinal nicotine to smoking intervention, we separately catalog and analyze nine applications, some of which constitute new approaches to harm reduction. The suggested framework is intended to clarify the debate, provide for common nomenclature, and facilitate analysis of diverse approaches to tobacco harm reduction.

Harm Reduction↗

PubMed2005

Experiences of harm reduction among women with alcohol use problems.

This paper explores women's choice of controlled drinking or abstinence goals in harm reduction treatment programs for alcohol use problems. Situated within debates about controlled or abstinence goals for alcohol use, this research project provides a specific focus on women's treatment needs. We explore evidence which reveals that women in treatment for alcohol problems often hold deeply internalized dominant social ideologies on addiction. Results demonstrate that while offered the choice of abstinence or controlled use goals, most women defined themselves as "addicts," adopted a disease metaphor of "addiction," and chose abstinence. The findings here raise questions about whether or not clients receive sufficient education about harm reduction and controlled drinking and make adequately informed choices.

Adolescent↗

PubMed2003

Harm reduction actions as a health care construction process at a public health center in Rosario, Argentina.

Even faced with serious numbers of human immunodeficiency virus (HIV) and other infections among injection drug users (IDUs), Argentina lacks large-scale harm reduction programs at national, state, and local levels. We describe the strong relationship of IDUs with the HIV/acquired immunodeficiency syndrome epidemic in Rosario. We discuss a 2-year-long ongoing experience of drug-related harm reduction actions developed at a public health center, which began as a response to a spontaneous demand for needles and syringes and became a permanent and sustainable set of health actions for a group of nearly 50 IDUs, a larger number of drug users who do not inject, and their contacts. These actions comprise voluntary testing and counseling for HIV and other infections, reproductive counseling, condom promotion and distribution, and needle and syringe distribution without needle exchange. This experience, amenable to replication, shows that public health teams can engage successfully in harm reduction actions.

Delivery of Health Care↗

PubMed2004

Harm reduction approaches to reducing tobacco-related mortality.

Tobacco harm reduction approaches are gaining increased attention. Much of this attention is due to a growing concern that significant populations of smokers either do not want to quit or believe they are unable to quit smoking, and to a concern over tobacco-industry attempts to produce tobacco products that claim to result in less toxin exposure. Decreasing tobacco toxin exposure as a method for reducing mortality and morbidity may be a reasonable tobacco control strategy. However, the impact of this strategy must be explored both on individual and population levels. A significant amount of independent research is needed to inform policy decisions. Regulatory authority over potential reduced exposure products is also essential.

Harm Reduction↗

PubMed2002

Harm reduction psychotherapy: an innovative alternative to classical addictions theory.

Harm Reduction Psychotherapy is an innovative treatment for people with alcohol and other drug problems. Unlike the traditional disease model of addiction, HRP uses a biopsychosocial approach to understand the complexities of drug use, abuse, and addiction. In other words, in the context of HRP, addiction is not the primary issue. Rather, it is an interactive phenomenon in which the relative weight of biology, psychology, and social factors varies for each person and for each drug he or she uses. HRP allows us to assess each person individually and to plan treatment that is tailored to the individual's relationship with alcohol and other drugs. It also incorporates other important problems: emotional disorders, family problems, social alienation, and medical complications. These issues are discussed at the beginning of consultation, without patients having to focus solely on their alcohol or drug problem. The unique aspect to HRP is that patients do not have to commit to abstinence as a condition of, or even necessarily as a goal of, treatment. HRP seeks to identify and work with the barriers to treatment adherence in any patient. It is clear that most medical patients have some difficulty understanding and adhering to medical recommendations and treatment protocols. However, drug users have particular problems that must be identified. HRP helps people create individual strategies to decrease harmful alcohol and drug use. It uses a nonjudgmental and collaborative approach to actively encourage individuals to explore their own barriers to change and to choose among a range of options such as abstinence, moderation, or other short-term goals. Motivational interviewing can be used to motivate behavioral change with the goal of reducing the effects of adverse consequences.

Harm Reduction↗

PubMed2006

Smoke from traditional commercial, harm reduction and research brand cigarettes impairs oviductal functioning in hamsters (Mesocricetus auratus) in vitro.

BACKGROUND: Cigarette smoke from 2R1 research brand cigarettes and specific toxicants in smoke inhibit oviductal functioning. Our purpose was to test the hypothesis that smoke from commercial cigarettes, including harm reduction cigarettes, inhibits oviductal functioning and to measure the concentration of previously identified toxicants in smoke from research and commercial cigarettes. METHODS: Mainstream (MS) and sidestream (SS) smoke solutions from two research, six traditional commercial and three harm reduction brands were tested in vitro using an oviductal assay that measures ciliary beat frequency, oocyte retrieval rate and smooth muscle contraction. RESULTS: Generally, smoke from each brand of cigarette was inhibitory in the three oviductal bioassays. SS, the major component of environmental tobacco smoke, was usually more inhibitory than MS, the smoke inhaled by active smokers. Nine cigarette toxicants, previously shown to be highly inhibitory in the oviductal bioassays, were quantified in MS and SS. 4-Methylpyridine, which was inhibitory by itself in picomolar doses, was present in the highest concentration in MS and SS solutions from all brands tested. In general, toxicant concentrations were higher in SS than in MS solutions. CONCLUSIONS: These data show that commercial brands of cigarettes, including harm reduction cigarettes, contain toxicants that inhibit biological processes in the oviduct and could affect reproductive outcomes.

Animals↗

PubMed1996

[Harm reduction--on the paradigm changes in drug dependence treatment].

Until the mid 80's drug aid in Germany was characterized by the orientation towards abstinence as the decisive goal in treatment and advising of drug addicts which had to be reached directly. The process of change in psychiatry, the work of the Aids-centres and the international discussion about harm reduction have been taken into account in Germany more and more in the face of growing problems in the field of drug aid and increasing poverty among drug addicts. Harm reduction is orientated on the real problems and resources of drug addicts. The historical background and the future demands of harm reduction are discussed.

Alcoholism↗