Academic journal article Social Work

Harm Reduction: A New Perspective on Substance Abuse Services

Academic journal article Social Work

Harm Reduction: A New Perspective on Substance Abuse Services

Article excerpt

Complete abstinence from nonmedical drugs has been the goal of most substance abuse treatment in the United States. Although nonabstinence-based interventions have existed since the inception of substance abuse treatment, the harm reduction model provides a new perspective on these services. Harm reduction is increasingly used in substance abuse practice. Viewed from the perspective of the stages of change (Prochaska & DiClemente, 1982) model, strict adherence to an abstinence-only perspective is questionable. This issue is critical to all social workers, because individuals with substance abuse issues are encountered in every practice setting. This article outlines the abstinence and harm-reduction perspectives and the stages of change model and discusses how these perspectives can be integrated in social work practice in substance abuse. Examples of how these perspectives inform services provision and a discussion of the fit of harm reduction with social work ethics are also provided.

Abstinence-Only Orientation

Drug policy in the United States is one of general prohibition in a criminal justice framework. Although the federal government did not regulate drug use until passage of the Harrison Act in 1914, abstinence and prohibition of most substance use (with the obvious exception of substances such as alcohol, nicotine, and caffeine), has characterized drug policy for most of this century (Zimring & Hawkins, 1992). Although alcohol remains legal for those over age 21, there are similar "zero-tolerance" mandates for under-age drinking (Office of National Drug Control Policy [ONDCP], 1999). The Drug-Free Schools and Communities Act Amendment of 1989 (P.L. 101-226) requires all elementary and secondary schools and colleges to implement and enforce abstinence-based policies related to substance use by students (U.S. Department of Education, 1999). The Anti-Drug Abuse Act of 1988 (P.L. 100-690) mandates abstinence-based drug policy. Current drug policy is based on section 6201 of this act, which established the goal of a drug-free America and provided congressional requirements to reduce drug abuse and its consequences (ONDCP). This policy states that all nonmedical drug use is illegal, there are fines and imprisonment for substance abuse, and help is only extended to those who have a desire to abstain from all use (Brown, 1995). Although prohibition has been the dominant drug policy for most of this century, the significant rise in the number of people serving time for drug-related offenses, (more than 1,000 percent between 1980 and 1997), did not begin until 1980 (Bureau of Justice Statistics, 1998).

The Anti-Drug Abuse Act of 1988, which instituted mandatory minimum sentencing, requires that proposals to combat sale and use of illicit drugs by legalization be rejected; and that consideration be given only to proposals to attack directly the supply of and demand for illicit drugs (Zimring & Hawkins, 1992). The second clause often underlies arguments of proponents of abstinence-only programs. Barry McCafferty, director of the Office of the National Drug Control Policy, reported that "at best, harm reduction is a halfway measure, a half-hearted approach that would accept defeat. Increasing help is better than decreasing harm. Pretending that harmful activity will be reduced if we condone it under the law is foolhardy and irresponsible" (McCafferty, 2000).

Implicitly or explicitly, the goal of most substance abuse services is the elimination of nonmedical substance use. A national study of substance abuse treatment centers found that 99 percent reported an abstinence orientation to treatment. In addition, 93 percent of all drug and alcohol treatment centers in the United States base their programs on the 12-step model of treatment (Roman & Blum, 1997). The 12-step model is consistent with current drug policy because it requires a commitment to abstinence on behalf of service users and often relies heavily on confrontation of service users (Miller et al. …

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