No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
Harm reduction: Pragmatic strategies for managing high-risk behaviors.
Abstract
Harm reduction is an increasingly recognized approach to the management of substance abuse and other behaviors that may pose serious health risks. Rather than defining drug use as a disease or a moral failing, harm reduction proponents stake out a humane and practical alternative—meeting clients "where they are at" to help them understand the risks involved in their behaviors and make appropriate decisions about their own treatment goals.
This volume explains the model's rationale and examines a range of applications in diverse communities. Following an overview of harm reduction principles and strategies, chapters show how education, behavioral training, and environmental modifications can help clients reduce the severity of consequences to themselves and their communities as they work toward decreased use or abstinence. Clinical applications are then surveyed for problems including heavy drinking, smoking, illicit drug use, and high-risk sexual behaviors. The book offers specific recommendations for policy and practice for front-line drug and alcohol treatment providers, AIDS educators, and community health activists. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... However, trying to rigidly abstain from all high-risk foods may evoke feelings of deprivation and trigger out-of-control eating. In the field of addiction, a personalized plan of moderated substance use is an empirically supported approach that does not require abstinence, but aims to help people consume addictive substances safely (i.e., harm reduction) [17]. Harm reduction approaches offer an alternative to abstinence-based approaches and seek to minimize the negative consequences that are commonly associated with addictive substance intake. ...
... During this phase, group members are exposed to higher-risk foods and situations to increase their confidence and ability to manage real-life situations. Phase 4 also involves personalized planning for the future and continued development of relapse prevention skills consistent with harm-reduction treatment approaches [17,24]. Finally, the treatment concludes with a "graduation" for group members as well as individualized referrals for those in need of continued mental health resources. ...
... First, both participants reported that they found the harm reduction approach to be helpful and aided in learning new skills to manage high-risk foods. This is consistent with treatments for other addictive substances where an empirically supported treatment that does not require abstinence provides a wider range of treatment approaches that can be personalized to an individual's goals [17][18][19]34]. This preference is supported by recent weight management technological applications (e.g., Noom) that also take a harm reduction approach. ...
While the construct of food addiction has been controversial, there is growing evidence that certain foods can activate biobehavioral and neurological mechanisms consistent with addiction to other substances. Despite increased evidence and acceptance of certain foods as addictive substances amongst the scientific community, there is a paucity of interventions available that are uniquely suited for the treatment of this condition. Further, many of the addiction and disordered eating treatment models currently utilized for food addiction are seemingly at odds, with the former often recommending complete abstinence from trigger foods and the latter promoting intake of all foods in moderation. The Food Addiction Clinical Treatment (FACT) manual was created as an alternative using an empirically supported harm-reduction model specifically targeted to treat the addiction and disordered eating features of food addiction. The purpose of the current article is to expose readers to the key tenets of the FACT manual, demonstrate the feasibility of this intervention with a sample of participants with severe food addiction, and discuss future directions for the treatment of food addiction. Positive outcomes from this intervention provide preliminary evidence for the efficacy of FACT for the treatment of food addiction with minimal negative adverse effects. Future research using randomized control trials and longer follow-up is needed to validate the FACT manual as an empirically supported treatment for food addiction.
... Research has shown that common reasons drug education programs for youth have failed were lack of student interest because they were not developmentally appropriate, or because activities did not relate to their actual lives [1,2]. A review of school-based drug education studies [1] showed that for substance use education programs to be effective they should be based on the real experiences of young people, a harm reduction principle [1][2][3]. The study of Drug Policy Alliance's (DPA) Safety First: Real Drug Education for Teens (hyperlinked) drug education curriculum for health education classes is grounded in harm reduction theory. ...
... Harm reduction is an ecological systems approach, addressing drug use from the micro level, individuals, families and communities to the macro level, local, state, and federal policies and norms [3,[7][8][9]. The theory promotes social justice with an emphasis on users' rights, health, social and economic development, as opposed to the demonization of drug consumption [10]. ...
... A code was assigned to prevalent themes and counted and compared to determine outcomes (Additional file 1: Appendix B). Young people demonstrated an understanding of key harm reduction thought processes and strategies solidifying successful aspects of the Safety First curriculum [3]. Students made change in their ability to describe specific harm reduction strategies possibly due to Safety First (p < .001). ...
A pilot study of Safety First: Real Drug Education for Teens showed significant results pre to post curriculum with high school freshmen. Negative outcomes of drug education are linked to a failure to engage students because of developmentally inappropriate materials that include activities that have no relevance to real experiences of young people. The few harm reduction studies showed increased student drug related knowledge. Students were less likely to consume substances, and less likely to consume to harmful levels. More studies are necessary to evidence harm reduction efficacy in the classroom. The goal of this study was to measure harm reduction knowledge and behaviors, including drug policy advocacy, before and after Safety First. Data were analyzed using McNemar’s test, ANOVA, linear regression, t-tests and thematic coding. Survey results, corroborated by the qualitative findings, showed a significant increase (p < .05) in high school freshmen harm reduction knowledge and behaviors in relationship to substance use pre to post Safety First. This increase related to a decrease in overall substance use. Harm reduction is often perceived as a controversial approach to substance use. These findings have implications for further study of what could be a promising harm reduction-based substance use intervention with teens.
... A RD pode abarcar um conjunto amplo de práticas, projetos e ações de atendimento no campo de atenção a pessoas que usam drogas, posto que a diversidade de ações é uma de suas características (Marlatt;Larimer;Witkiewitz, 2012). O termo designa: "um conjunto de políticas e práticas cujo objetivo é reduzir os danos associados ao uso de substâncias psicoativas em pessoas que não podem ou não querem parar de usar drogas" (International Harm Reduction Association, 2010, p.1). ...
... A RD pode abarcar um conjunto amplo de práticas, projetos e ações de atendimento no campo de atenção a pessoas que usam drogas, posto que a diversidade de ações é uma de suas características (Marlatt;Larimer;Witkiewitz, 2012). O termo designa: "um conjunto de políticas e práticas cujo objetivo é reduzir os danos associados ao uso de substâncias psicoativas em pessoas que não podem ou não querem parar de usar drogas" (International Harm Reduction Association, 2010, p.1). ...
... A RD pode abarcar um conjunto amplo de práticas, projetos e ações de atendimento no campo de atenção a pessoas que usam drogas, posto que a diversidade de ações é uma de suas características (Marlatt;Larimer;Witkiewitz, 2012). O termo designa: "um conjunto de políticas e práticas cujo objetivo é reduzir os danos associados ao uso de substâncias psicoativas em pessoas que não podem ou não querem parar de usar drogas" (International Harm Reduction Association, 2010, p.1). ...
Resumo O uso de conceitos e práticas de Redução de Danos (RD) na atenção às pessoas que usam drogas foi iniciado no Brasil nos anos 1990, como resposta preventiva à propagação do HIV/aids. Ao longo dos anos, ganhou espaço em outros campos de ação, como a saúde mental e a proteção social. Em 2019, com as mudanças no governo federal, esta prática foi retirada da definição da política sobre drogas. Com foco nos reflexos dessas mudanças, este estudo visou caracterizar quem atua e quais ações são desenvolvidas junto às pessoas que usam drogas, sob a perspectiva da RD, em municípios da região Sul do Brasil (RS, SC e PR). Trata-se de um estudo exploratório descritivo e transversal, que usou um questionário virtual composto por questões abertas, fechadas e métodos mistos de análise de dados. Os participantes foram recrutados por meio do método Snowball Sampling, de forma virtual, alcançando 72 questionários validados. Foi desenvolvida uma análise exploratória dos dados quantitativos. Para as respostas qualitativas foi usada a Análise Textual Discursiva e o software NVivo (versão 12). Os resultados demonstraram o perfil dos profissionais; mudanças ao longo dos anos e a necessidade de ampliar investimentos em pesquisas sobre RD. Palavras-chave: Substâncias psicoativas; Redução de Danos; Políticas públicas.
... A RD pode abarcar um conjunto amplo de práticas, projetos e ações de atendimento no campo de atenção a pessoas que usam drogas, posto que a diversidade de ações é uma de suas características (Marlatt;Larimer;Witkiewitz, 2012). O termo designa: "um conjunto de políticas e práticas cujo objetivo é reduzir os danos associados ao uso de substâncias psicoativas em pessoas que não podem ou não querem parar de usar drogas" (International Harm Reduction Association, 2010, p.1). ...
... A RD pode abarcar um conjunto amplo de práticas, projetos e ações de atendimento no campo de atenção a pessoas que usam drogas, posto que a diversidade de ações é uma de suas características (Marlatt;Larimer;Witkiewitz, 2012). O termo designa: "um conjunto de políticas e práticas cujo objetivo é reduzir os danos associados ao uso de substâncias psicoativas em pessoas que não podem ou não querem parar de usar drogas" (International Harm Reduction Association, 2010, p.1). ...
... A RD pode abarcar um conjunto amplo de práticas, projetos e ações de atendimento no campo de atenção a pessoas que usam drogas, posto que a diversidade de ações é uma de suas características (Marlatt;Larimer;Witkiewitz, 2012). O termo designa: "um conjunto de políticas e práticas cujo objetivo é reduzir os danos associados ao uso de substâncias psicoativas em pessoas que não podem ou não querem parar de usar drogas" (International Harm Reduction Association, 2010, p.1). ...
Resumo O uso de conceitos e práticas de Redução de Danos (RD) na atenção às pessoas que usam drogas foi iniciado no Brasil nos anos 1990, como resposta preventiva à propagação do HIV/aids. Ao longo dos anos, ganhou espaço em outros campos de ação, como a saúde mental e a proteção social. Em 2019, com as mudanças no governo federal, esta prática foi retirada da definição da política sobre drogas. Com foco nos reflexos dessas mudanças, este estudo visou caracterizar quem atua e quais ações são desenvolvidas junto às pessoas que usam drogas, sob a perspectiva da RD, em municípios da região Sul do Brasil (RS, SC e PR). Trata-se de um estudo exploratório descritivo e transversal, que usou um questionário virtual composto por questões abertas, fechadas e métodos mistos de análise de dados. Os participantes foram recrutados por meio do método Snowball Sampling, de forma virtual, alcançando 72 questionários validados. Foi desenvolvida uma análise exploratória dos dados quantitativos. Para as respostas qualitativas foi usada a Análise Textual Discursiva e o software NVivo (versão 12). Os resultados demonstraram o perfil dos profissionais; mudanças ao longo dos anos e a necessidade de ampliar investimentos em pesquisas sobre RD.
... Many college students do not consider their drinking to be problematic or something that needs to be changed [9]; many are in a stage of change where they are not yet considering making any changes to their drinking (called the precontemplation stage in the transtheoretical model) or are considering making some changes but have no plan of action to make such changes (called contemplation) [11]. Most of the interventions use components first documented together in the Brief Alcohol Screening and Intervention for College Students (BASICS) approach [12], typically combine strategies from Motivational Interviewing (MI), [13] (e.g., strategies to increase motivation to change/reduce risky behavior), cognitive behavioral skills training [14] (e.g., drink refusal skills), harm reduction strategies [15,16] (e.g., protective strategies for limiting consumption), and personalized feedback (e.g., review of personalized consequences such as alcohol calories consumed each week). Yet, studies on in-person BASICS and adaptations of the program's components into group, computer, web-based, and mobile formats have demonstrated modest effects at best [3,[17][18][19], which has sparked debate about whether such brief interventions are clinically meaningful or impactful on a broader public health scale [20][21][22][23]. ...
... Although brief interventions with students often include aspects based on a relapse prevention approach, wherein they identify high-risk situations and apply specific skills to manage these situations with minimal or no use of alcohol [12,14,16], global interventions can be vague with regard to when to use certain skills. The college context is diverse, with individual student's drinking levels varying between specific contexts (e.g., drinking more at a bar versus at a party, drinking less on a Wednesday than on a Thursday) [24,25]. ...
... It is tailored toward an individual's personal goals, beliefs (perceptions, expectancies, self-efficacy), and behavior (protective strategies), focusing on the core components of brief interventions that mediate the effects of multiple component intervention programs (e.g., correcting perceived norms, use of protective behavioral strategies, increased self-efficacy, challenging expectancies, BAL feedback) [17,18]. Content was informed by the BASICS approach [61], which is based on aspects of both Motivational Interviewing [62] and relapse prevention [63] and rooted in a harm reduction framework [15,16]. BASICS for general drinking has been efficacious when delivered in individual and group formats [64,65] and recently has been adapted for use on mobile phones [66]. ...
Background
Pregaming is a high-drink context popular among college students that often leads to elevated blood alcohol levels and negative consequences. Over 15 years of research studies have demonstrated that pregaming represents one of the riskiest known behaviors among college students, yet no pregaming-specific interventions have been developed to help prevent this behavior. General brief interventions for students do not reduce pregaming behavior and may not be appropriate, as they do not help students develop skills unique to the pregaming context that could help them drink less. We developed a brief, mobile-based intervention that is proposed to prevent heavy drinking during pregaming for college students, with the ultimate goal that behavioral reductions in this risky practice will ultimately affect global drinking and prevent consequences.
Methods/Design
The intervention, Pregaming Awareness in College Environments (PACE), was developed by combining two innovations to facilitate behavior change: (1) a mobile-based application that increases accessibility, is easy and engaging to use, and broadens the reach of the intervention content and (2) personalized pregaming-specific intervention content with harm reduction and cognitive behavioral skills proven to be mechanisms preventing and reducing heavy drinking among college students. After a develop and beta-test phase, we propose to test the efficacy of PACE in a preliminary randomized controlled trial with 500 college students who pregame at least once per week. Pregaming, general drinking, and alcohol-related consequences outcomes will be examined in the immediate (2 weeks post-intervention) and short-terms (six and 14-week post-intervention). We will also evaluate moderator effects for age, sex, and heaviness of drinking to allow for more refined information for a planned larger test of the intervention to follow this initial trial of PACE.
Discussion
This pregaming intervention clinical trial, if found to be efficacious, will culminate with an easily-disseminated mobile-based intervention for college student drinkers. It has the potential to reach millions of college students, perhaps as a clinical tool used by college counseling centers as an adjunct to formal care or as a preventive tool for first-year students or other high-risk groups on campus.
Trial registration : ClinicalTrials.gov Identifier NCT04016766.
... There is a clear alignment between the core principles of occupational therapy and the main tenants of harm reduction. Harm reduction's core values are centered on understanding behaviors in the context of sociocultural norms, meeting individuals where they are, and accounting for both positive and negative effects associated with "high-risk" behaviors (Marlatt et al., 2011). Importantly, harm reduction does not seek to pathologize "high-risk" behaviors (Marlatt et al., 2011). ...
... Harm reduction's core values are centered on understanding behaviors in the context of sociocultural norms, meeting individuals where they are, and accounting for both positive and negative effects associated with "high-risk" behaviors (Marlatt et al., 2011). Importantly, harm reduction does not seek to pathologize "high-risk" behaviors (Marlatt et al., 2011). Occupational therapy education promotes a strengths-based approach to view clients as holistic occupational beings rather than reducing clients to their diagnoses labels or behaviors. ...
... Harm reduction, a public health strategy focused on reducing the harms associated with a risky health behavior without requiring the elimination of the behavior itself represents a useful approach to both engage and retain individuals with SUDs in care. 5 In the context of substance use, harm reduction prioritizes the prevention or minimization of drug-related harms such as HIV/AIDS transmission and overdoses, without requiring abstinence or a reduction in drug use, 5 and has historically been conceptualized as a set of activities aimed at reducing harm; this includes syringe access services, supervised injection, drug checking, and naloxone distribution. 6 However, harm reduction can also be understood as a philosophy of care that emphasizes creating patient-centered service environments that meet patients "where they are at" in terms of their drug use. ...
... Harm reduction, a public health strategy focused on reducing the harms associated with a risky health behavior without requiring the elimination of the behavior itself represents a useful approach to both engage and retain individuals with SUDs in care. 5 In the context of substance use, harm reduction prioritizes the prevention or minimization of drug-related harms such as HIV/AIDS transmission and overdoses, without requiring abstinence or a reduction in drug use, 5 and has historically been conceptualized as a set of activities aimed at reducing harm; this includes syringe access services, supervised injection, drug checking, and naloxone distribution. 6 However, harm reduction can also be understood as a philosophy of care that emphasizes creating patient-centered service environments that meet patients "where they are at" in terms of their drug use. ...
Background
Evidence suggests that harm reduction, a public health strategy aimed at reducing the negative consequences of a risky health behavior without requiring elimination of the behavior itself, may be a promising approach for minimizing drug-related harms while engaging individuals with substance use disorders (SUDs) in care. However, philosophical clashes between the medical and harm reduction models may pose barriers to adopting harm reduction approaches within medical settings.Objective
To identify barriers and facilitators to implementing a harm reduction approach toward care within healthcare settings. We conducted semi-structured interviews with providers and staff at three integrated harm reduction and medical care sites in New York.DesignQualitative study using in-depth and semi-structured interviews.ParticipantsTwenty staff and providers across three integrated harm reduction and medical care sites across New York state.ApproachInterview questions focused on how harm reduction approaches were implemented and demonstrated in practice and barriers and facilitators to implementation, as well as questions based on the five domains of the Consolidated Framework for Implementation Research (CFIR).Key ResultsWe identified three key barriers to the adoption of the harm reduction approach that surrounded resource constraints, provider burnout, and interacting with external providers that do not have a harm reduction orientation. We also identified three facilitators to implementation, which included ongoing training both within and external to the clinic, team-based and interdisciplinary care, and affiliations with a larger healthcare system.Conclusions
This study demonstrated that while multiple barriers to implementing harm reduction informed medical care existed, health system leaders can adopt practices to mitigate barriers to adoption, such as value-based reimbursement models and holistic models of care that address the full spectrum of patient needs.
... Indeed, hope has been associated with adaptive coping and greater adaptability when faced with stress [62,63]. In addition, hope may be an important component of recovery from substance abuse and may provide willpower in quitting substance use [64]. Research has shown that hope activity and hope pathway scores contribute to drug abstinence [65]. ...
Background: Experiences of ostracism may be related to attitudes toward substance abuse. However, the protective factors underlying this relationship are still unclear. Therefore, based on the Need-threat and Self-control theory, we aimed to test a model in which self-control and hope mediate the relationship between ostracism and attitudes toward addictive substances. Methods: In this model, we highlighted risk factors (ostracism) and protective factors (self-control and hope). This study was a cross-sectional data analysis of 787 students (52.50% boys, 47.50% girls; Mage = 15.69, SD = 1.12). Results: The results revealed that ostracism was positively associated with attitudes toward addictive substances, and evidence was provided that this relationship was mediated by hope and self-control. Ultimately, the research highlights the link between ostracism and attitudes toward addictive substances, identifying hope and self-control as mediators. Conclusions: This study highlights individual risk and protective factors related to attitudes toward addictive substances and offers new perspectives on ways to prevent and reduce adolescents’ positive attitudes toward substance use. School counselors and educators should help students strengthen skills such as hope and self-control to prevent them from developing positive attitudes toward substance use in the future.
... 3,4 This approach was politically controversial and illegal in many states at the time and would not be federally supported for decades. 4,5 Currently, some harm reduction approaches, such as naloxone distribution (now available in all 50 states) 6 and syringe service programs, are becoming more accepted in the United States as a result of HIV outbreaks in rural settings such as Scott County, Indiana 7 ; the national hepatitis C virus epidemic 8 ; and the ongoing opioid overdose crisis. 9,10 However, harm reduction efforts still face major barriers due to a combination of stigma, preferences for punitive approaches to substance use, and policy and legal-moral objections. ...
Practices and interventions that aim to slow progression or reduce negative consequences of substance use are harm reduction strategies. Often described as a form of tertiary prevention, harm reduction is key to caring well for people who use drugs. Evidence-based harm reduction interventions include naloxone and syringe service programs. Improving equitable outcomes for those with opioid use disorder (OUD) requires access to the continuum of evidence-based OUD care, including harm reduction interventions, as well as dismantling policies that undermine mental health and substance use disorder treatment continuity, housing stability, and education and employment opportunities.
... 171-176). Faith plays an important role in Buddhist traditions-for example, the stories in the Divine Stories frequently begin with people seeing the Buddha, a sight which generates (Groves, 2014;Marlatt, 2002;Marlatt et al., 2011), but to my knowledge, no investigation has been conducted on the Buddhist recovery manuals examined in this article. ...
Buddhist recovery manuals, a genre that has emerged in the last 30 years, aim to use Buddhist ideas and practices to address the challenges of addiction. These books draw on classical Buddhist thought and Twelve-Step programs such as Alcoholics Anonymous. Both of these influences share the framework of a step-wise path of transformation from a state of maladaptive compulsion to a state of freedom. This article analyzes the paths laid out by these Buddhist recovery manuals and compares them to classical Buddhist and Twelve-Step paths. This comparison demonstrates that Buddhist recovery manuals creatively draw on classical Buddhism and Twelve-Step but also differ from them in important ways as they re-imagine a path from addiction to recovery. This article documents the growing genre of Buddhist recovery manuals, thus expanding our understanding of Anglophone Buddhism and providing substance abuse professionals with a knowledge of the Buddhist recovery landscape. The article also argues that Buddhist recovery manuals differ from classical Buddhism by emphasizing meditation at the beginning of the path, rather than placing it after training in giving and ethical discipline.
... The theory aims to provide pragmatic and compassionate interventions that minimize the harm associated with drug use, such as education, testing, treatment, and safe injection sites. The theory emerged from the grassroots movements of drug users and activists in the 1980s and 1990s (Marlatt, 1998). The theory is relevant to the suggested topic because it can help evaluate the effectiveness and acceptability of different prevention and intervention strategies for drug use among male and female athletes in different sports. ...
Purpose: The main objective of this study was to identify the determinants and prevalence of drug abuse by gender in selected competitive sports at the universities in Kenya. Methodology: The study used a mixed methods research design with an intention to capture and utilise both qualitative andquantitative data. The study sample comprised 300 respondents. Out of the 300 students, 173(57.7%) were male and 127 (42.3%) were female players derived from six selected competitive sports at the universities in Kenya.The selected sports were badminton, tennis, basketball, volleyball, soccer and rugby. Stratified sampling followed by simple random sampling was used to select 10 universities proportionately (4 private and 6 public), the method was the most appropriate to capture universities with women rugby in addition to the five other selected sports. The study sought to investigate the prevalence of drug abuse due to factors such as psychosocial, medicinal and competition. SPSS computer version 20 was used to process data. The data was presented inform of Tables. Findings: The study found that more male players than females abused drugs, with majority being rugby players. Findings indicated that there were more males than females abusing drugs at approximately 89% and 11% respectively. It was concluded that more male than female athletes engaging in sports in universities in Kenya, abuse drugs. This could be attributed to the assumption that males tend to experiment more on most things than do their female counterparts. Unique Contribution to Theory, Practice and Policy: The Social Learning Theory, Self Determination Theory and Harm Reduction Theory may be used to anchor future studies. It was recommended that various stakeholders that include the university management, NACADA and the security apparatus work together with an aim to sensitize and curb drug abuse menace among university athletes, general students’ community and the entire community bordering the universities.
... Harm reduction theory and practice should consider micro-social activities and formally organized groups of people who use drugs [2,70]. The most effective harm reduction approaches with lasting effects have integrated both bottom-up grassroots activism and top-down public health approaches to respond to the needs of people who use drugs [71]. ...
Background
Although harm reduction is highlighted as an effective intervention for alcohol and drug use, a funding gap for harm reduction interventions has been identified, mainly in low- and middle-income countries. In these countries, tensions between abstinence and harm reduction models have impaired the shift from punitive practices to evidence-based interventions committed to guaranteeing the human rights of people who use drugs. Since 2015, the Brazilian government has adopted a more punitive and abstinence-focused drug policy that jeopardizes the care of people who use alcohol and other drugs and the comprehension of the harm reduction workers' perspective in relation to their practice. Therefore, this study aimed to comprehend the meanings constructed by Brazilian harm reduction workers regarding their practices with vulnerable populations amidst a context of political tension.
Methods
We conducted 15 in-depth semi-structured qualitative interviews with harm reduction workers employed in public health services for at least 6 months. Data were analyzed using thematic analysis.
Results
The thematic axis "The joy and pain of being a harm reduction worker in Brazil" was constructed and divided into four major themes: (1) Invisibility of harm reduction work; (2) Black, poor, and people who use drugs: identification with the service users; (3) Between advocacy and profession: harm reduction as a political act; (4) Small achievements matter. Despite the perceived invisibility of harm reduction workers in the public health and alcohol and drug fields, valuing small achievements and advocacy were important resources to deal with political tension and punitive strategies in Brazil. The findings also highlight the important role of harm reduction workers due to their personal characteristics and understanding of drug use behavior, which bring the target audience closer to actions within the public health system.
Conclusion
There is an urgent need to acknowledge harm reduction based on peer support as a professional category that deserves adequate financial support and workplace benefits. Additionally, expanding evidence-based harm reduction interventions and community-based voluntary drug use treatment centers should be prioritized by public policies to address the human rights violations experienced by people who use drugs.
... The theory aims to provide pragmatic and compassionate interventions that minimize the harm associated with drug use, such as education, testing, treatment, and safe injection sites. The theory emerged from the grassroots movements of drug users and activists in the 1980s and 1990s (Marlatt, 1998). The theory is relevant to the suggested topic because it can help evaluate the effectiveness and acceptability of different prevention and intervention strategies for drug use among male and female athletes in different sports. ...
Purpose: The main objective of this study was to identify the determinants and prevalence of drug abuse by gender in selected competitive sports at the universities in Kenya. Methodology: The study used a mixed methods research design with an intention to capture and utilise both qualitative and quantitative data. The study sample comprised 300 respondents. Out of the 300 students, 173 (57.7%) were male and 127 (42.3%) were female players derived from six selected competitive sports at the universities in Kenya. The selected sports were badminton, tennis, basketball, volleyball, soccer and rugby. Stratified sampling followed by simple random sampling was used to select 10 universities proportionately (4 private and 6 public), the method was the most appropriate to capture universities with women rugby in addition to the five other selected sports. The study sought to investigate the prevalence of drug abuse due to factors such as psychosocial, medicinal and competition. SPSS computer version 20 was used to process data. The data was presented in form of Tables. Findings: The study found that more male players than females abused drugs, with majority being rugby players. Findings indicated that there were more males than females abusing drugs at approximately 89% and 11% respectively. It was concluded that more male than female athletes engaging in sports in universities in Kenya, abuse drugs. This could be attributed to the assumption that males tend to experiment more on most things than do their female counterparts. Implications to Theory, Practice and Policy: The Social Learning Theory, SelfDetermination Theory and Harm Reduction Theory may be used to anchor future studies. It was recommended that various stakeholders that include the university management, NACADA and the security apparatus work together with an aim to sensitize and curb drug abuse menace among university athletes, general students’ community and the entire community bordering the universities
... Most behavioral SUD treatments worldwide tend to be abstinence-focused, with legal or stigmatizing consequences for people who may not be ready, willing, or able to stop using substances. Over the past few decades, there has been an increasing interest in non-abstinence-based treatment approaches to reach this population (Bischof et al., 2021;Marlatt et al., 2011). One recent development is behavioral health treatments that focus on reducing the harms of substance use, which may involve a focus other than abstinence (e.g., Collins & Clifasefi, 2023;Denning & Little, 2012). ...
“Substitute addiction” refers to the process of achieving abstinence or resolution of one addictive behavior and subsequently engaging in one or more additional addictive behaviors in its place. Substitute addiction, a concept in the abstinence-based recovery field for decades, is viewed as a cause for concern because resolving one addictive behavior might not fully remove harm or ensure recovery. Conversely, “harm-reduction treatment” refers to a counseling orientation that focuses on helping service users reduce substance-related harm and improve their quality of life without necessarily requiring abstinence or use reduction. Harm-reduction treatment assesses a constellation of addictive behaviors in the larger context of a person’s life to holistically reduce harm in that constellation. In this commentary, we define and compare both constructs and point out their implications for addictions treatment.
... The theory aims to provide pragmatic and compassionate interventions that minimize the harm associated with drug use, such as education, testing, treatment, and safe injection sites. The theory emerged from the grassroots movements of drug users and activists in the 1980s and 1990s (Marlatt, 1998). The theory is relevant to the suggested topic because it can help evaluate the effectiveness and acceptability of different prevention and intervention strategies for drug use among male and female athletes in different sports. ...
Purpose: The main objective of this study was to identify the determinants and prevalence of drug abuse by gender in selected competitive sports at the universities in Kenya. Methodology: The study used a mixed methods research design with an intention to capture and utilise both qualitative and quantitative data. The study sample comprised 300 respondents. Out of the 300 students, 173 (57.7%) were male and 127 (42.3%) were female players derived from six selected competitive sports at the universities in Kenya. The selected sports were badminton, tennis, basketball, volleyball, soccer and rugby. Stratified sampling followed by simple random sampling was used to select 10 universities proportionately (4 private and 6 public), the method was the most appropriate to capture universities with women rugby in addition to the five other selected sports. The study sought to investigate the prevalence of drug abuse due to factors such as psychosocial, medicinal and competition. SPSS computer version 20 was used to process data. The data was presented in form of Tables. Findings: The study found that more male players than females abused drugs, with majority being rugby players. Findings indicated that there were more males than females abusing drugs at approximately 89% and 11% respectively. It was concluded that more male than female athletes engaging in sports in universities in Kenya, abuse drugs. This could be attributed to the assumption that males tend to experiment more on most things than do their female counterparts. Unique Contribution to Theory, Practice and Policy: The Social Learning Theory, Self-Determination Theory and Harm Reduction Theory may be used to anchor future studies. It was recommended that various stakeholders that include the university management, NACADA and the security apparatus work together with an aim to sensitize and curb drug abuse menace among university athletes, general students’ community and the entire community bordering the universities.
... Harm reduction interventions do not require abstinence. For alcohol, this includes a set of pragmatic strategies that minimize alcohol-related damage for the affected individual and society at large (Marlatt et al., 1998;Denning and Little, 2000). ...
Introduction
Alcohol-related problems disproportionally affect people experiencing homelessness. As the first wave of the COVID-2019 pandemic spread in 2020, a number of emergency shelters were opened in Lisbon. Increased difficulties in obtaining alcohol could have led to an increased incidence of alcohol withdrawal. Therefore, a low-threshold harm reduction intervention was introduced to these emergency shelters. This consisted of a fixed medication treatment, made available immediately for those with specific conditions, without the need for a medical evaluation or abstinence from alcohol, together with an offer of subsequent access to specialized addiction centers. The Problemas Ligados ao Álcool em Centros de Emergência (PLACE) study (alcohol-related problems in emergency shelters) is a retrospective mixed-methods observational study. It describes the demographic, health, and social characteristics of shelter users participating in the program and aims to evaluate the intervention as well as the experience of the patients, professionals, and decision-makers involved.
Results
A total of 69 people using shelters self-reported alcohol-related problems. Among them, 36.2% of the people accepted a pharmacological intervention, and 23.2% selected an addiction appointment. The take-up of the intervention was associated with better housing outcomes. A description of an individual's trajectory after leaving the shelter is provided.
Discussion
This study suggests that non-abstinence-focused interventions can be useful and well-tolerated in treating addiction in this population.
... 3 In the context of drug use, HR prioritizes the prevention or minimization of drug-related harms such as HIV transmission and overdose without requiring the elimination or reduction of drug use itself. 4 Although HR strategies have been supported by grassroots efforts for decades, they remained controversial in the United States, where the "War on Drugs" model predominated since the 1970s. Although states such as New York have already instituted guidelines that encourage an "HR approach in the care of all individuals who use substances," the Biden administration's new strategy is the first endorsement of HR as a policy at the federal level. ...
Background:
Substance use disorders (SUDs) are at a national high, with significant morbidity and mortality. Harm reduction, a public-health strategy aimed at reducing the negative consequences of a risky behavior without necessarily eliminating the behavior, represents a useful approach to engage patients with SUDs in care. The objective of this article is to describe how 3 medical practices operationalized harm reduction as a framework toward patient care and identify the common practices undertaken across these settings to integrate harm reduction and medical care.
Methods:
We conducted a qualitative study using in-depth, semistructured interviews with 20 staff and providers at 3 integrated harm reduction and medical care sites across New York State from March to June 2021. Interview questions focused on how harm reduction approaches were implemented, how harm reduction philosophies were demonstrated in practice, and barriers to adoption.
Results:
The interviews resulted in 8 main themes of integrated harm reduction medical care: 1) role of provider as both learner and informer; 2) pragmatic measures of success; 3) collaborative and interdisciplinary care teams; 4) developing a stigma-free culture; 5) creating a comfortable and welcoming physical space; 6) low-threshold care with flexible scheduling; and; 7) reaching beyond the clinic to disseminate harm reduction orientation; and 8) creating robust referral networks to enhance transitions of care. These themes existed at the patient-provider level (#1 to 3), the organizational level (#4 to 6), and the level extending beyond the clinic (#7 to 8).
Conclusions:
All 3 sites followed 8 common themes in delivering harm reduction-informed care, most of which are consistent with the broader movement toward patient-centered care. These practices demonstrate how medical providers may overcome some of the barriers imposed by the medical model and successfully integrate harm reduction as an orienting framework toward care delivery.
... This includes cannabis researchers (Solomon, 2020). Harm reduction can be described as a pragmatic and compassionate set of strategies designed to reduce the harms associated with certain behaviors (Marlatt, 1998). This may include policies, programs, or practices that aim to minimize adverse health, social and legal impacts associated with certain behaviors, often associated with illicit drug use. ...
Despite growing evidence to the contrary, researchers continue to posit causal links between cannabis, crime, psychosis, and violence. These spurious connections are rooted in history and fueled decades of structural limitations that shaped how researchers studied cannabis. Until recently, research in this area was explicitly funded to link cannabis use and harm and ignore any potential benefits. Post-prohibition cannabis research has failed to replicate the dire findings of the past. This article outlines how the history of controlling cannabis research has led to various harms, injustices, and ethical complications. We compare commonly cited research from both the prohibition and post-prohibition eras and argue that many popular claims about the dangers of cannabis are the result of ethical lapses by researchers, journals, and funders. We propose researchers in this area adopt a duty of care in cannabis research going forward. This would oblige individual researchers to establish robust research designs, employ careful analytic strategies, and acknowledge limitations in more detail. This duty involves the institutional recognition by funders, journals, and others that cannabis research has been deliberately misconstrued to criminalize, stigmatize, and pathologize.
... For example, studies have found that emergency medical technicians (EMTs) administer naloxone at significantly higher rates in areas with overdose-related needs (46), and that peer-based recovery services, a potential form of risk reduction for people who use drugs, are more often found in neighborhoods with a high burden of SUD (47). The finding that hospitals who perceive substance use to be a top need in their communities implement harm reduction/risk education programs, which are non-traditional in medical settings (48), at significantly higher rates, indicates that burden remains associated with adoption. ...
Background: Hospitals are well-positioned to integrate harm reduction into their workflow. However, the extent to which hospitals across the United States are adopting these strategies remains unknown.
Objectives: To assess what factors are associated with hospital adoption of harm reduction/risk education strategies, and trends of adoption across time.
Methods: We constructed a dataset marking implementation of harm reduction/risk education strategies for a 20% random sample of nonprofit hospitals in the U.S (n = 489) using 2019–2021 community health needs assessments (CHNAs) and implementation strategies obtained from hospital websites. We used two-level mixed effects logistic regression to test the association between adoption of these activities and organizational and community-level variables. We also compared the proportion of hospitals that adopted these strategies in the 2019–2021 CHNAs to an earlier cohort (2015–2018.)
Results: In the 2019–2021 CHNAs, 44.7% (n = 219) of hospitals implemented harm reduction/risk education programs, compared with 34.1% (n = 156) in the 2015–2018 cycle. In our multivariate model, hospitals that implemented harm reduction/risk education programs had higher odds of having adopted three or more additional substance use disorder (SUD) programs (OR: 10.5: 95% CI: 5.35–20.62), writing the CHNA with a community organization (OR: 2.14; 95% CI: 1.15–3.97), and prioritizing SUD as a top three need in the CHNA (OR: 2.63; 95% CI: 1.54–4.47.)
Conclusions: Our results suggest that hospitals with an existing SUD infrastructure and with connections to community are more likely to implement harm reduction/risk education programs. Policymakers should consider these findings when developing strategies to encourage hospital implementation of harm reduction activities.
... Drug checking is a harm reduction response to help prevent PWUD from consuming substances they did not intend to purchase and to provide the opportunity to make informed decisions about drug use [8,29]. This approach has been adopted across European countries and in some cities in North America, which accept illicit drug use will continue despite prohibitions and opt to offer special services to drug users [25,30]. ...
Background:
Community drug checking is an emerging response to the overdose crisis. However, stigma has been identified as a potential barrier to service use that requires investigation.
Methods:
A qualitative study explored how best to implement drug checking services to the wider population including those at risk of overdose. A secondary analysis of 26 interviews with potential service users examine how stigma may be a barrier to service use and strategies to address this. A Substance Use Stigma Framework was developed to guide analysis.
Results:
Drug checking is operating in a context of structural stigma produced by criminalization. People fear criminal repercussions, anticipate stigma when accessing services, and internalize stigma resulting in shame and avoidance of services. A perceived hierarchy of substance use creates stigma results in stigma between service users and avoidance of sites associated with certain drugs. Participants frequently recommended drug checking to be located in more public spaces that still maintain privacy.
Conclusions:
Criminalization and societal views on substance use can deter service use. Strategies to mitigate stigma include employment of people with lived and living experience from diverse backgrounds; public yet private locations that preserve anonymity; and normalization of drug checking while decriminalization could address the root causes of stigma.
... 16 The presence of harm reduction practitioners may help destigmatize PWUDs-a core principle of the philosophy driven by acceptance, nonjudgmentalism, and attempting to restore autonomy and agency. 10 Reducing stigma was one of the more common outcomes perceived by staff members-particularly during visits in which social network members were present. ...
Context:
Post-overdose outreach programs have emerged in response to surging overdose deaths amid fentanyl contamination of the illicit opioid supply. Predominantly centered in police departments in collaboration with public health providers, these programs conduct home-based outreach with survivors and their social networks following an overdose.
Approach:
We describe implementation of the Post Overdose Support Team (POST) initiative, an ongoing public health funded and centered approach. Post Overdose Support Team is a person-centered model led by harm reductionists in health and human services agencies in collaboration with municipal first responders. The goal of POST is to engage overdose survivors and their social network to improve general health, connect people to services (including access to treatment, if desired), and reduce risk of subsequent overdose.
Implementation:
Nine agencies in Massachusetts that are part of the state's overdose education and naloxone distribution network implemented POST programs, covering 28 municipalities. The POST teams conduct home-based outreach with individuals who experienced an opioid-related overdose to provide a menu of services, including naloxone rescue kits, overdose response and risk reduction planning, referral to treatment for substance use disorders, including medication for opioid use disorder, and referral to recovery and family supports.
Evaluation:
From October 2017 to October 2021, the POST teams attempted to reach 5634 overdose survivors via 10 536 outreach visits. Teams successfully engaged 3014 survivors, either directly or through contact with their social network (53.5% success rate). Using data from a real-time encounter-level database, monthly peer-sharing calls with program sites, and annual site visits, we describe the implementation of the POST initiative and provide practice-based recommendations and lessons learned.
Discussion:
Early evidence suggests that the POST initiative is meeting its goal to engage overdose survivors, improve general health, and reduce subsequent overdose risk. Future evaluations should examine long-term outcomes among participants, including service linkages and incremental behavior change.
... Globally, UNICEF estimates that there are as many as 100 million street-involved youth (SIY) [3]. Defined as children and adolescents who spend a substantial amount of time on the street, are heavily engaged in the street economy, and may be absolutely or periodically at risk of becoming homeless, SIY are often victims of abuse and exploitation internationally [4,5]. In Kenya there are as many as 300,000 SIY who are marginalized by human rights violations and often experience poor health outcomes [6,7]. ...
Introduction
UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of peer navigators to increase access to HIV services.
Methods
Semi-structured interviews, focus group discussions (FGD), and theatre testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM).
Results
Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services.
Conclusion
Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites.
... Finally, in other addiction-related disorders, the notion of harm reduction is part of evidence-based treatment (Marlatt et al., 2011). For example, rather than an abstinence-only approach to reduce problematic alcohol use on campuses, harm reduction might include offering safe rides home to reduce drunk driving accidents, or educating students about how to track and limit their alcohol consumption. ...
Objective: ADHD is associated with impairment in several important areas of life for college students, including lower grades and lower degree completion rates. Further, college students with ADHD may be involved in higher levels of problematic gaming than their peers, conveying incremental impairment. Therefore, the aim of the current study was to examine whether problematic gaming is associated with impairment in the context of elevated ADHD symptoms in college students, with a focus on possible sex differences. Method: College students (N = 1,489; Mage=19.13, 69.4% female, 86.7% white) from three universities completed an online survey assessing ADHD symptoms, problematic gaming, and functional impairment. Results: There was a significant 3-way interaction among inattention symptoms, problematic gaming, and sex on impairment, such that impairment was greatest among female college students high in inattention (IA) and problematic gaming. There was not a significant 3-way interaction that included hyperactivity/impulsivity (HI) symptoms, but significant 2-way interactions indicated that women who game experience more impairment than men who game, and that when gaming is added to elevated HI, impairment increases significantly. Conclusions: Our data suggest that problematic gaming by college students with elevated ADHD symptoms might lead to additional impairment, especially in women. We discuss clinical implications such as a potential problematic gaming module for college ADHD treatments, and a harm-reduction approach to gaming in this population.
... Drawing upon behavior change models, harm reduction is an evidence-based public health strategy developed for adults engaging with problematic substance use for whom abstinence is not feasible (Marlatt et al., 2011). This approach accepts that a continuing level of risk behavior (e.g., drug use, COVID-19 contagion) in society is inevitable, and instead of abstinence, focuses on sustainably reducing the negative consequences of these behaviors (e.g., implementing needle exchange programs, encouraging the public to wear masks indoors but lifting requirements for wearing masks outdoors). ...
Psychological science is committed to the research and use of evidence-based practice. To address the burden of mental illness, there is also a need to use psychological science for mental health advocacy and promotion. However, psychology training programs often focus on individual-level intervention instead of public health prevention in teaching, care delivery, and scholarship. Preparing psychologists to address population mental health and adequately serve all communities, especially those on the margins which our current system fails, will require moving beyond individual treatment and integrating public health values in training programs. We reflect on ways the Public Health Code of Ethics can be used to revise the current American Psychological Association psychology training competencies and discuss strategies psychology training programs can implement to train public-health oriented psychologists to move toward more ethical and effective practice.
... Thus, there should be pervasive public information about the symptoms of problem gambling and where to get help (both self-help and external help). While all treatment approaches should eventually strive for abstinence to obtain the best long-term outcomes, having a low threshold for treatment access will encourage participation (i.e., promoting "reduced gambling" or "harm reduction" as an initial step; Marlatt, 1996;Marlatt et al., 2011). An important focus of treatment needs to be a countering of gambling fallacies (Fortune & Goodie, 2012) and teaching more adaptive ways to escape negative emotions and loneliness. ...
Objective: To conduct a large-scale national cohort study to identify the current etiological risk factors for problem gambling in Canada. Method: A cohort of 10,119 Canadian gamblers completed a comprehensive self-administered online questionnaire in 2018 and were reassessed in 2019. At baseline, the sample contained 1,388 at-risk gamblers, 1,346 problem gamblers, and 2,710with a major DSM-5mental health disorder. A total of 108 independent variables (IVs) were available for analysis, as well as the self-report of perceived causes of gambling-related problems for 1,261 individuals. Results: The strongest multivariate predictors of current and future problemgambling were “gambling-related” variables (i.e., current and past problem gambling, intensive gambling involvement, playing electronic gambling machines (EGMs), gambling fallacies, socializing with other people having gambling-related problems, and family history of having gambling-related problems). Beyond gambling-related variables, greater impulsivity and lower household income were robustly predictive. Thirteen additional variables were either concurrently or prospectively predictive, but not both. In contrast to the many different quantitative predictors, self-reported causes tended to be singular and psychologically oriented (i.e., desire to win money, boredom, stress, poor self-control). Conclusions: The predictors of problematic gambling in the present study are very similar to the predictors identified in prior international longitudinal and cross-sectional research. This implies core cross-cultural risk factors, with gambling-related variables and impulsivity being most important, and comorbidities and demographic variables having more modest contributions. The additional value of the present results is that they comprehensively identify the relative importance of all known etiologically relevant variables within a current Canadian context.
... It's focus on collaborative approaches to interacting determinants of health makes it well-suited to developing a converged understanding and collaborative management of complex One Health problems . Its conceptual foundation is in public health, where it is mostly focuses on harms resulting from highrisk behaviors including drug, alcohol and tobacco addictions, sex work and homelessness in marginalized or underserved populations (Marlatt et al., 2011;Hawk et al., 2015;Jalloh et al., 2017). Prominently recognized since the 1970s and 1980s, its concepts and programs have a global reach and are endorsed and practiced by the World Health Organization, United Nations General Assembly and many other nations (World Health Organization [WHO], n.d.). ...
Wicked problems in One Health are associated with dynamicity and uncertainty that require experts, authorities and community members to reach for innovative means of collective inquiry, and collaborative interventions to address the deep social issues at the root of interspecies problems. In this study we explore the value of harm reduction concepts to understand a hundreds of year old issue, the St. Kitts’ “monkey problem,” which involves the invasive African green monkey (Chlorocebus sabaeus) as the cause of deleterious effects on agriculture, but concurrent positive effects on tourism and biomedical research. The harm reduction approach, a systems and settings-based approach with decades of success in public health, can serve as a framework to produce action on persistent societal problems. Harm reduction concepts and methods and participatory epidemiology were used to uncover local perceptions about human-monkey interactions and “meet people where they are” by asking the research question: Are there commonalities in perceptions and values linked to the St. Kitts’ “monkey problem” that are shared across diverse representatives of society that can act as a common starting place to launch collaborative responses to this invasive species? Through a series of focus group activities and interviews we found that the Kittitian “monkey problem” is a contentious and dichotomous problem pervasive in most of society that has no single stakeholders nor one solution. Harm reduction helped to map the island’s human-monkey system and elucidated an entry point toward tackling this problem through the identification of shared values, and also provided a model for incremental gains that may be achieved. Likening the St. Kitts “monkey problem” to a wicked problem enabled stakeholders to seek more options to manage the problem rather than to conclusively solve it. Frequently mentioned shared values including the protection of farmer crops and backyard harvests likely represent strong entry points to this problem and a jumping-off point to begin collective action toward future improvements.
... There are health risks associated with this, as taking unregulated dosages of hormones without medical supervision may result in dissatisfactory physical development or life-threatening conditions (Giordano, 2008;Mepham et al., 2014). A harm reduction approach would suggest that campus counselors first work with the client to attain proper oversight and medical care from qualified health professionals (Marlatt et al., 2011). If the student continues to self-medicate, the counselor should make a referral to campus or local health services that offer free instruction on how to properly inject medications. ...
The evidence-based literature included in this chapter provides an in-depth understanding of various aspects related to clinical social work practice and education. The content in the chapter includes but is not limited to topics such as a historical overview of the development of clinical social work, the skills required for clinical social work in the twenty-first century, harm reduction guidelines for clinical social work practitioners, the state of clinical social work in South Africa, COVID-19 and clinical social work and social work education and clinical learning.
NAPZA (Narkotika, Psikotropika, dan Zat Adiktif lainnya) menjadi masalah serius di kalangan remaja di Indonesia. Penyuluhan ini bertujuan untuk meningkatkan pengetahuan dan kesadaran tentang bahaya NAPZA di kalangan anak usia sekolah melalui kegiatan yang dilaksanakan di Masjid Rahmatan Lilalamin, Padang. Melalui ceramah, diskusi interaktif, dan kuiz edukatif, kegiatan ini berhasil meningkatkan pemahaman remaja tentang bahaya NAPZA. Evaluasi menunjukkan bahwa 95% peserta memahami jenis-jenis NAPZA dan efek negatifnya terhadap kesehatan fisik dan mental. Penyuluhan ini diharapkan memberikan dampak jangka panjang dalam pencegahan penyalahgunaan NAPZA
Introduction:
Electronic cigarettes and "vaping" have become popular since their appearance in Europe and the USA in approximately 2006. They are often perceived as having fewer health risks than conventional cigarettes, which makes them of interest as a support tool in smoking cessation. However, its efficacy regarding cessation or reduction of smoking under real-life conditions remains controversial. Our objective was to clarify this question in an observational study of smoking habits after initiating vaping without targeted intervention, as compared to a validated cessation programme.
Methods:
From October 2015 to April 2018, 80 subjects (60 in the e-cigarette group and 20 in the supervised smoking cessation group) were included in two trial visits, one at the start of the trial and the second after 3 months, plus 4 questionnaire surveys: at the start of the trial and after a 1, 2, and 3 month period. The questionnaire included a nicotine use inventory, a modified Fagerström test for nicotine dependence, and the WHO-QOL-BREF survey.
Results:
E-cigarettes were effective, leading to a significant (p < 0.03) reduction (p < 0.03) in tobacco consumption and nicotine dependence, with an abstinence rate of 43% after 3 months. Compared to participants in the smoking cessation programme, their use was not associated with an improvement in quality of life during the quitting attempt, and there were no significant differences in clinical symptoms between groups. The reduction in nicotine dependence was more pronounced (p < 0.012) for the smoking cessation programme, with higher abstinence rates (p = 0.011 after 12 weeks) and lower (p < 0.003) remaining tobacco consumption compared to electronic cigarettes.
Discussion/conclusions:
The use of electronic cigarettes reduced nicotine dependence and tobacco consumption, but a supervised smoking cessation programme was superior in terms of achieved cessation in both regards. Electronic cigarettes did not improve the quality of life. Since e-cigarettes could be associated with long-term health risks, their usefulness in smoking cessation remains questionable, and a professionally guided and validated smoking cessation programme still appears to be superior and preferable, in terms of achieved cessation. Although this trial is limited regarding the number of participants and follow-up time, it highlights the need for additional, large clinical trials evaluating the efficacy of e-cigarettes for smoking cessation in comparison to a professionally guided smoking cessation programme.
Although advocacy is a valuable concept, it has received little attention in social work practice with people who have substance use problems. The tendencies of medicalisation and responsibilisation, as well as criminalisation and the War on Drugs ideology, create an unfavourable environment for the emergence of an advocacy discourse. Within the neoliberal context, advocacy in social work practice in the field of addiction is not only an overlooked but also an under-theorised issue. Using Tronto’s political ethics of care theory, the article argues that a perspective on advocacy that places care at the centre of its analysis might provide an illuminating framework for working with people who have substance use problems. Each of Tronto’s ethical elements of care, which are attentiveness, responsibility, competence, responsiveness and trust, can offer useful directions for advocacy practice in the field of substance use and addiction.
Zusammenfassung
Ziel Marginalisierte Konsumierende im urbanen Raum waren insbesondere zu Beginn der Covid-19-Pandemie stark von Effekten der Infektionsschutzmaßnahmen betroffen, u. a. durch die Einschränkungen des öffentlichen Lebens und Angeboten zur Schadensminderung. Neben anderen Erfahrungen und Wahrnehmungen von Betroffenen erörtert dieser Artikel, wie durch die Pandemie die Nutzung von Harm Reduction und des öffentlichen Raums beeinflusst wurde.
Methodik In vier deutschen Städten (Frankfurt, Darmstadt, Nürnberg und Mannheim) wurden von März bis Juni 2021 28 Personen, die intensiv Drogen konsumieren, mittels halboffenen leitfadengestützten qualitativen Interviews befragt. Die Daten wurden einer thematisch-strukturierten Inhaltsanalyse unterzogen.
Ergebnisse Die meisten Befragten bestätigten die Einschätzung, dass es durch die pandemiebedingten Kontaktbeschränkungen besonders schwierig war, Geld für Drogen zu beschaffen. Für Mitglieder der Szene war es oft schwierig, Infektionsschutzmaßnahmen einzuhalten. Insbesondere die Wohnsituation verschlechterte sich im Laufe der Pandemie. Viele Befragte hatten den Eindruck, dass repressive Maßnahmen der Strafverfolgungsbehörden zunahmen. Was die Beeinträchtigung von Harm-Reduction-Maßnahmen betrifft, so fielen diese je nach Stadt und Einrichtung unterschiedlich stark aus, was sich massiv auf Wahrnehmung und Stimmungslage der Betroffenen auswirkte.
Schlussfolgerung Nicht nur aufgrund der ohnehin prekären Verhältnisse und der Tatsache, dass sich ein Großteil des Szenealltags im (halb-)öffentlichen Raum abspielt, sondern auch im Zusammenhang mit der Drogenprohibition erfuhren marginalisierte Menschen, die Drogen konsumieren, eine strukturelle Viktimisierung durch sekundäre Auswirkungen der Covid-19-Pandemie.
The growing number of systems science simulation models for alcohol use (AU) are often disconnected from AU models within empirical and theoretical alcohol research. As AU prevention/intervention efforts are typically grounded in alcohol research, this disconnect may reduce policy testing results, impact, and implementation. We developed a simulation model guided by AU research (accounting for the multiple AU stages defined by AU behavior and risk for harm and diverse transitions between stages). Simulated projections were compared to historical data to evaluate model accuracy and potential policy leverage points for prevention and intervention at risky drinking (RD) and alcohol use disorder (AUD) stages. Results indicated prevention provided the greatest RD and AUD reduction; however, focusing exclusively on AUD prevention may not be effective for long‐term change, given the continued increase in RD. This study makes a case for the strength and importance of aligning subject‐based research with systems science simulation models. © 2023 System Dynamics Society.
Substance use disorders (SUD) are prevalent, complex medical conditions. Individuals with SUD vary considerably in clinical severity, accompanying medical sequelae, degree of functional impairment, often struggle with comorbid psychiatric conditions. Cognitive-behavioral therapies for individuals with SUD and co-occurring mental health conditions have shown to be effective in reducing psychopathology and substance use and increasing the chances of remission. This chapter highlights three CBT-based interventions for this patient population: Dialectical Behavior Therapy; Acceptance and Commitment Therapy; and Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) and provides an illustrative case example for each treatment approach to demonstrate how to implement each intervention.KeywordsSubstance use disorderAddictionCognitive-behavioral therapyDialectical behavior therapyAcceptance and commitment therapyProlonged exposure
Purpose:
Social determinants of health (SDH) are a substantial contributor to health outcomes and health inequities across populations. The Accreditation Council for Graduate Medical Education has called for the incorporation of SDH into graduate medical education (GME), yet there is no consensus on what SDH knowledge or skills residents in primary care specialties should have on completion of training. The aim of this study was to develop expert consensus on the most important SDH knowledge topics and behavior learning goals for residents in 4 primary care fields.
Method:
The authors used a modified Delphi technique to develop consensus among experts in internal medicine, pediatrics, family medicine, and obstetrics and gynecology across the United States via a survey administered between February and October 2021. They conducted a literature review on SDH in GME to develop an initial set of topics and learning goals and recruited experts who published about SDH and GME or led a SDH curriculum in GME. Consensus was determined a priori as 80% agreement that a topic or learning goal was very or extremely important.Results: Forty-one experts participated in the first round of the survey and 33 participated in the second round (80% retention). Experts reached consensus on the importance of 22/51 (43%) topics and 18/47 (38%) learning goals. Topics reaching consensus emphasized structural forces, broad domains of SDH, resources for addressing SDH, and advocacy strategies and resources. Learning goals reaching consensus focused on individual- and interpersonal-level behaviors.
Conclusions:
To the authors' knowledge, this study represents the first rigorous evaluation of expert consensus on SDH in GME across 4 primary care specialties. The results could inform curriculum development and implementation and program evaluation, residency program goals, and shared GME milestones. Among other things, future studies can assess expert consensus on SDH in GME across nonprimary care specialties.
Background:
Vending machines for harm reduction (VMHR) are an innovative approach to deliver life-saving materials, information, and treatment for hard-to-reach populations, particularly for persons who inject drugs. The current study explores stakeholders’ perspectives on the feasibility and acceptability of VMHR in Philadelphia.
Methods:
From October 2021 to February 2022, we conducted 31 semi-structured interviews with potential end-users, staff, and leadership at a local federally qualified health center, and community members. Trained coders extracted themes from interview transcripts across four key domains: materials and logistics, location, access, and community introduction.
Results:
All stakeholder groups endorsed using VMHR to provide supplies for wound care, fentanyl test strips, naloxone, and materials to connect individuals to treatment and other services. Providing syringes and medications for opioid use disorder elicited a broader range of acceptability. Stakeholders held varying views on the location and placement of the machines, but almost all agreed that a machine should be placed in the highest drug use areas. Stakeholders suggested several strategies to introduce and gain community acceptance of VMHR, including community education, one-on-one conversations with community members, and coupling the machine with safe disposal of syringes and information to link individuals to treatment.
Conclusions:
Stakeholders were generally receptive to VMHR. The current study findings are consistent with qualitative analyses from outside of the United States and contribute new ideas regarding the anticipated community response and best methods for introducing these machines to a community. With thoughtful planning and design, VMHR could be a feasible and acceptable modality to reduce death and disease transmission associated with the opioid and HIV epidemics in cities like Philadelphia.
In the treatment of substance use disorders (SUDs), second wave approaches, such as cognitive behavior therapy (CBT), have led to several important developments that have shaped the scientific and treatment landscape. These developments include the integration of behavioral, social, and motivational approaches and a boom in empirical research, including large-scale RCTs on these treatment approaches. Overall, CBT has been found to be an efficacious approach for treating SUD. However, more scientific work, especially studies using dismantling and implementation science methods, is needed to better understand how, for whom, and in what context CBT for SUDs works best. Despite these gaps, CBT for SUD remains an important approach for reducing suffering related to SUDs.
Support for acceptance and commitment therapy (ACT), mindfulness-based, and other third wave therapies to treat addiction is growing, with recent support for treating alcohol use disorders AUDs and additional data demonstrating efficacy for smoking cessation. Several third-wave interventions with AUDs or substance use disorders (SUDs) have also shown significant promise for treating comorbid psychiatric conditions (e.g., depression), and PTSD. However, more large-scale research with acceptance and mindfulness-based therapies is needed on substance use and relapse prevention outcomes, ideally with limited study attrition and treatment dropout, increased effect sizes, comparisons with first line treatments (including traditional CBT), and rigorous study designs (e.g., double blinded). Additionally, more research is needed on the cultural appropriateness of these therapies with diverse samples from substance use and other addictive behavior populations. The budding interest in and preliminary efficacy for acceptance and mindfulness therapies to treat a host of addictive disorders (e.g., internet and phone addictions) make them highly attractive to therapists, providing broad application and significant potential for improved outcomes.KeywordsThird wave therapiesThird wave behavior therapy for alcohol use and substance use disordersThird wave cognitive behavior therapyAcceptance and commitment therapyMindfulness-based interventionSubstance use disordersAlcohol use disordersAddictive disorders
This chapter discussed the theoretical, preclinical, and clinical accumulation of evidence with respect to the underlying behavioral mechanisms employed in Community Reinforcement Approach (CRA) and its novel variants as exemplars of first wave behavior therapy for substance use problems. This ‘family’ of CRA [i.e. Adolescent version of Community Reinforcement Approach (ACRA) & Community Reinforcement and Family Training (CRAFT)] targets specific populations with various substance use disorders, including comorbid psychiatric conditions and/or patients that reside in the (juvenile) justice system. Also the surplus value in term of therapeutic efficacy of the combination of CRA and contingency management (CM), another notable exemplar of first wave behavior therapy for those with substance use problems, has been highlighted in this chapter. The ‘family’ of CRA is applied to individuals with a wide range of ethnic populations and different age groups such as adults (CRA) and adolescents (A-CRA), but also targets family members (CRAFT). Since this comprehensive and complementary treatment package does not exclusively reduce substance abuse but also addresses psychiatric and forensic problems, it has certainly transdiagnostic value. That said, it has shown efficacy in both in- and outpatient facilities and outreach teams and the dissemination of the ‘family’ of CRA is moving forward in many places throughout the world.
A pilot study of the Safety First: Real Drug Education for Teens curriculum showed significant results pre to post with high school freshmen. Negative outcomes of drug education are linked to a failure to engage students because of developmentally inappropriate materials that include activities that have no relevance to the real experiences of young people. A few harm reduction studies showed significant increase in student's drug related knowledge. Students were less likely to consume substances, and less likely to consume to harmful levels. More studies are necessary to evidence harm reduction efficacy in the classroom. The goal of this study was to measure harm reduction knowledge and behaviors, including drug policy advocacy, before and after Safety First. Data were analyzed using AVOVA, linear regression, t-tests and thematic coding. Survey results, corroborated by the qualitative findings, showed a significant increase (p < .05) in high school freshmen harm reduction knowledge and behaviors in relationship to substance use pre to post Safety First. This increase related to a decrease in overall substance use. Harm reduction is often perceived as a controversial approach to substance use. These findings have implications for further study of what could be a promising harm reduction-based substance use intervention with teens.
El siguiente artículo expone una discusión teórica referente a la implementación del programa Energy Control en un municipio de Castilla y León (España), a través del paradigma de la biopolítica, partiendo de una investigación etnográfica previa sobre las adicciones en dicha localidad. La aplicación de dicho referente teórico genera importantes reflexiones acerca del consumo de drogas en el entorno lúdico juvenil y el actual modelo hegemónico de intervención biomédico. Energy Control es un programa asistencial español que desarrolla estrategias de reducción de riesgos dirigidas a personas con consumos de droga no problematizados, en contextos de ocio. Su fin no es eliminar el consumo, tal y como persiguen otros recursos contemporáneos. Se concluye, no obstante, que Energy Control también se encuentra enmarcado dentro del modelo hegemónico de intervención sobre drogas, promoviendo lógicas neoliberales que influyen en lo corporal y lo subjetivo, desde un tipo de salud determinado.
Dieses Handbuch wurde mit dem Hauptziel entwickelt, als Referenzmaterial für das Qualifizierungsprogramm zum Europäischen Präventionscurriculum (EUPC) verwendet zu werden. Interessierten Lesern bietet es unabhängig davon eine allgemeine Einführung in die Präventionsforschung und insbesondere in wissenschaftsbasierte Interventionen. Dieses Handbuch darf nur dann im Rahmen von Weiterbildungen oder anderen Bildungsveranstaltungen eingesetz werden, wenn die hierzu notwendige Qualifizierung erfolgreich absolviert wurde. Die Kriterien für die Durchführung der EUPC-Kurse finden Sie unter http://www.emcdda.europa.eu/best-practice/european-prevention-curriculum, zusammen mit Angaben zu aktuellen Anbietern - in Deutschland die gemeinnützige FINDER Akademie in Berlin. Kontaktieren Sie info@finder-akademie.de oder eupc@emcdda.europa.eu für weitere Informationen und Feedback.
Justification thinking (using excuses to "allow" giving into temptation) has been identified as a potential link between negative affect and self-control failure. We hypothesised that negative affect would prompt greater justification thinking, specifically deservingness thinking (i.e. "I deserve a treat"), and tested this for both inhibitory (temptation is to approach reward; self-control is to inhibit) and initiatory (temptation is to refrain from action, self-control is to initiate action) hypothetical self-control dilemmas. We found that only for inhibitory self-control (Study 1; N = 105) but not initiatory (Study 2; N = 116), negative affect resulted in greater deservingness thinking compared to neutral affect. We also hypothesised that negative mood coupled with justification would prompt greater likelihood of imagined self-control failure. We found that for inhibitory self-control (Study 3; N = 569), participants in negative affect (vs. neutral) and justification (vs. no justification) conditions were independently more likely to report they would fail at self-control. For initiatory self-control (Study 4; N = 321), we found an effect of negative affect on hypothetical self-control failure but no effect of justification. Overall, these studies confirm the role of negative affect in self-control processes and highlight differences between inhibitory and initiatory self-control situations.
ResearchGate has not been able to resolve any references for this publication.