Substance Abuse, Public Health, and the Harm Reduction Model

Written By: Calvin Pegus

Harm Reduction Model and the relationship to public health is a set of strategies and/or ideas that are used to reduce the damaging consequences associated with substance abuse.   Harm Reduction Model utilizes interdisciplinary approaches like needle exchange programs, educating people on practicing safer usage, and abstinence.  It is a social movement that is built on the premise of social justice and equity which includes a level of respect for the rights of people who are substance abusers.

It is essential to understand that foremost, to combat substance abuse you have to meet the needs of the most vulnerable populations.  The Harm Reduction Model requires addressing not only the conditions of use but all of the determinants that play a part in contributing to use.  Intervention and policy related approaches can benefit from this model by implementing strategies that are designed to address the individual, as well as, the public needs.

A simple google search can retrieve different strategies in addressing substance abuse while utilizing the Harm Reduction Model approach.  The following 8 strategies suggested by the Harm Reduction Coalition, can assist in improving the well-being of individuals affected by substance abuse or substance abuse related policies:

  • Accepts, for better and/or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them;
  • Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others;
  • Establishes quality of individual and community life and well-being–not necessarily cessation of all drug use–as the criteria for successful interventions and policies;
  • Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live to assist them in reducing attendant harm;
  • Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them;
  • Affirms drug users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use;
  • Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm; and
  • Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.

Though the approach addresses drug use explicitly, embracing these steps can help reduce stigma for substance use disorders. Reducing stigma can create an encouraging environment (or welcoming space) for the user to seek treatment. The need for reducing stigma can provide people who are substance abusers with the options that can assist in minimizing the risks of continued substance abuse.  Harm Reduction Model targets the risk and harms of substance abuse while including interventions that can help keep people healthy and safe.  The ability to tailor these interventions and address specific risks and harms can account for the social determinants that contribute to substances abuse.

Understanding that substance abuse will always exist and impact communities’ health, social and economic well-being, the Harm Reduction Model approach has the prospect to be anticipatory in reducing the adverse consequences associated with substance abuse.  The model does not replace primary or secondary prevention strategies but should encourage an open dialogue about the benefits of utilizing this model as a critical component for health practitioners, families and communities members in taking significant responsibility for each other.

The Harm Reduction Model is easy to enact and can have a positive chain reaction effect on individual and community health.  This model proves accessible, achievable, and cost-effective. The model recognizes that interventions like need needle exchange programs; drug-related therapies; access to naloxone; available nicotine replacements strategies; and plans that can provide tactics that will deter minors from binge drinking are needed components.  The ability to reduce these harms can improve the health of communities.  In utilizing this approach, it is important to remember that as prevention advocates and public health practitioners we are accountable for the success of these interventions. The Harm Reduction Model strategies should encourage the inclusion of a wide-range of stakeholders, policy developers, community liaisons, substance abusers and the affected communities.  It ensures that we do not forget the humanity of individuals who abuse substances. Let us remember that they are someone’s parent, spouse, sibling or child.