In This Article Expand or collapse the "in this article" section Harm Reduction

  • Introduction
  • Seminal Works
  • Definition
  • Criticisms
  • Professional Perspectives
  • Organizations

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Social Work Harm Reduction
Mark O. Bigler
  • LAST REVIEWED: 30 January 2014
  • LAST MODIFIED: 30 January 2014
  • DOI: 10.1093/obo/9780195389678-0148


Harm reduction is an evolving prevention and practice model for helping professionals that views any positive change in undesired, problematic, or risky target behaviors as a successful outcome. Harm reduction represents a significant shift away from the absolute, all-or-nothing expectations of traditional, medical-model-based approaches commonly employed in health and human service programs and interventions. In contrast to programs, practices, and policies based on behavioral models that seek to eliminate risk altogether, harm reduction strategies focus on minimizing the potential harm that results from risky behaviors in a person’s life. In recent decades, in response to growing concerns about harmful outcomes of drug use, substance abuse, and chemical dependency, harm reduction strategies have been used to address rising rates of human immunodeficiency virus (HIV) and hepatitis infection, overdose deaths, and other health concerns among drug users, particularly those who inject. Syringe exchange programs, safe injection/supervised consumption rooms, narcotic substitution, and other innovative applications of harm reduction principles have emerged, and evidence of the success of such efforts is mounting. While many of these activities and interventions exist in the United States, US officials have been reluctant to fully embrace harm reduction. Resistance by politicians, policymakers, and funders has been common. In contrast, harm reduction has been adopted as a central theme of national drug policies in many countries and international entities around the world. Furthermore, although originating in the field of chemical dependency, the philosophy and strategies of harm reduction are pertinent to a wide variety of complex social welfare and public health issues, including alcohol and tobacco use, homelessness, sexual behavior, sex work/prostitution, sex offender treatment, domestic violence, divorce law, and compulsive behaviors such as gambling and computer use. Nonprofit and nongovernment organizations now exist in the United States and elsewhere and provide services, information, and advocacy based on harm reduction.

Seminal Works

Though discussed in greater depth and with increased intensity over the last two decades, harm reduction has a long, albeit fragmented, history, beginning with recommendations of the Rolleston Committee in England in the 1920s, through the adoption of methadone maintenance in Canada and the United States in the 1950s and 1960s, to the early 1980s and the beginnings of responses to HIV and hepatitis epidemics around the world. These responses, such as syringe exchange programs, safe injection/supervised consumption rooms, and prescription narcotics, continue to the present day. Seminal works on harm reduction listed in this section include des Jarlais, et al. 1993, a public health perspective; Marlatt and Witkiewitz 2002, a review of studies regarding the application of harm reduction to problematic alcohol use; Inciardi 2000 and Marlatt, et al. 2012, compilations of works on harm reduction strategies; and O’Hare, et al. 1992, one of the earliest texts to discuss explicitly harm reduction and its application.

  • des Jarlais, Don C., Samuel R. Friedman, and Thomas P. Ward. 1993. Harm reduction: A public health response to the AIDS epidemic among injection drug users. Annual Review of Public Health 14:413–450.

    DOI: 10.1146/annurev.pu.14.050193.002213

    Des Jarlais and his colleagues frame a definition of harm reduction as a public health response to the growing worldwide HIV/ acquired immune deficiency syndrome (AIDS) epidemic. The authors discuss the evolution of HIV/AIDS, the role of injection drug use in HIV epidemiology, and harms associated with drug use beyond the spread of HIV.

  • Inciardi, James A., ed. 2000. Harm reduction: National and international perspectives. Thousand Oaks, CA: SAGE.

    This volume is one of the earlier texts on harm reduction. Contributing authors discuss the conceptualization and definition of harm reduction and its history, different types of harm reduction strategies, and the application of harm reduction in Brazil, Canada, Australia, and the United States.

  • Marlatt, G. Alan, and Katie Witkiewitz. 2002. Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment. Addictive Behaviors 27:867–886.

    DOI: 10.1016/S0306-4603(02)00294-0

    Marlatt and Witkiewitz provide a seminal summary of research on the application of harm reduction to problematic alcohol consumption. Empirical evidence supports the use of such strategies. The authors highlight the need to individualize alcohol prevention and intervention efforts.

  • Marlatt, G. Alan, M. E. Larimer, and K. Witkiewitz, eds. 2012. Harm reduction: Pragmatic strategies for managing high-risk behaviors. 2d ed. New York: Guilford.

    Originally published in 1998, this volume offers an overview of harm reduction and discusses the application of harm reduction strategies to various substances and specific populations. The text also considers the role of harm reduction in US drug control policy.

  • O’Hare, Patrick A., Russell Newcombe, Alan Matthews, Ernst C. Buning, and Ernest Drucker, eds. 1992. The reduction of drug-related harm. New York: Routledge.

    Arguably the first comprehensive publication on harm reduction, this text addresses a broad range of harm reduction strategies and programs for drug users that are operating and developing in Australia, Europe, and North America.

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