Harm Reduct1
Running head: HARM REDUCT
Harm Reduction
Michael S. Bermes
University of CentralFlorida
Harm Reduct1
HARM REDUCTION
Our text begins with the comment that harm reduction continues to be one of the more controversial issues in substance misuse treatment venues (Van Wormer & Davis, 2008). During the research for this paper it appears that harm reduction has been around for about three decades and has been successfully integrated into various interventions to include substance misuse, youth gambling, sexual transmitted disease prevention, child custody cases, and even cancer treatments. However, for purposes of this paper we shall focus on substance misuse issues. These methods have never seemed to be accepted or fully developed into the fiber of our practices. Harm reduction provides a pragmatic, incremental, comprehensive, scientific, proactive and accessible approach to meeting our clients where they are (Tsui, 2000). Yet our culture lags behind the rest of the world in implementing policy that embraces prevention and intervention of harm reduction. Why are America’s policies so mired in traditionalism? Why is Federal spending for drug enforcement increasing exponentially? In 1985 $1.6 billion spent, 1991 $10.5 billion spent, and more than $19 billion in 2000 while 23.2 million Americans needed drug or alcohol treatment. The justice system alone spends $433 million on drug and alcohol treatments (Common Sense for, 2007). From reading these statistics it appears we need policy changes and a paradigm shift in how we help clients at risk.
It seems rational to believe that traditional treatments are not as effective as one would suspect. Treatments in the substance abuse treatment community are dominated by the ideology of the disease concept of addiction and therefore traditional treatments are continued to be funded as the mainstream approach. Oddly, fewer than 20 percent of those needing care seek traditional programs because of the dogmatic, generalized treatment approaches that also insert moral overtones to the participants (Brocato & Wagner, 2003).
On another theme, it is sadly interesting to note that 20 to 34 percent of people with HIV and hepatitis C infections have acquired it through sharing contaminated needles. However, even with the Center for Disease Control (CDC) and the National Institutes of Health (NIH) testifying to Congress that a clean syringe program will reduce risk by 80 percent our text goes on to explain that 47 states still have laws that make this a criminal offense(Van Wormer & Davis, 2008). So again social policy does not support good prevention and intervention practices and actually increases some forms of harm.
As a culture our policies are still resistant to harm reduction approaches because of the fear that this modality would lead to new users and undermine efforts to engage current users in trying to achieve abstinence(Brocato & Wagner, 2003). In contrast to this medical model mentality research indicates that almost 64 percent of all individuals who receive traditional treatments relapse after one year (Ray & Ksir, 2004). In fairness we must understand that one size does not fit all, but as social workers must work at infusing our profession’s traditional values into our practice. We must ensure that we are providing our clients self-determination and social justice, and a broader ecological approach to help understanding and overcome challenges. Practice success through so called alternative interventions such as harm reduction should compliment traditional approaches strengths and weakness. Through this micro approach we will help shape macro policy and social workers must be in the front row to make that change for our client.
This writer has successfully used harm reduction practices with clients with co-occurring diagnosis with great success. However, the problem is the thought processes of local law enforcement and judiciary who view harm reduction as a way to continue to take drugs or drink alcohol. However, the surprising changes that occur with a client that actually has control of their intervention is a wonderful thing to observe as they develop and heal themselves on their journey of recovery through harm reduction.
Harm Reduct1
References
Brocato, J., & Wagner, E. (2003). Harm Reduction: A Social Work Practice and Social Justice Agenda. Health and Social Work, 28(2), 117-125.
Common Sense for Drug Policy. (2007). In D. McVay (Ed.), Drug War Facts (Treatments). Lancaster, PA: Common Sense for Drug Policy. Retrieved April 12, 2008, from Drug War Facts Web site: http://drugwarfacts.org/index2.htm
Tsui, Ray, O., & Ksir, C. (2004). Drugs, Society, and Human Behavior (10th ed.). New York: McGraw-HillM. (2000). The Harm Reduction Approach revisited: An international perspective. International Social Work, 43(2), 243-251.
Van Wormer, K., & Davis, D. (2008). Addiction Treatment. A Strengths Perspective (2nd ed.). Belmont, CA: Thomson, Brooks/Cole.