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Making Harm Reduction Work When Treating Women for Alcohol Use Problems

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Abstract

Harm reduction, a concept that challenges the mainstream notion of abstinence as a universal treatment goal for problem substance use, has emerged as a promising approach for women struggling with alcohol use problems. Harm reduction moves beyond the dominant deficit-based, abstinence-focused, disease-oriented interpretations of substance use problems and addiction, and emphasizes empowerment and self-determination. Thus, strategies based on harm reduction are harmonious with women-centered approaches to health care delivery (Bepko, r99U Dennin g, zooo; Pasick &White, r99r). In this chapter we discuss several issues related to harm reduction approaches to alcohol use, review the research findings on controlled drinking and present our own research on the topic of influences and considerations that affect women's success in reaching harm reduction goals. Our research reveals that many women in alcohol-use treatment have deeply internalized the dominant social ideology on sub$tance use and treatment (i.e., that abstinence is the only treatment goal). Currently, harm reduction approaches do not recognize the impact of this widespread internalization of mainstream addiction discourse. For controlled drinking to be a real option for women who have problems with alcohol use, it is not enough for programs to simply offer the choice of abstinence or controlled use as outcome goals. Instead, they must offer education and training in skills for controlled drinking that would make harm reduction goals a real choice for problem drinkers. 431
Chapter 37
Making
Harm Reduction
Work
\Mhen Treating
Women
for
Ncohol
Use
Problems
CATRINA G. BROWN AND SHERRY H. STEWART
Harm reduction,
a concept
that challenges
the mainstream notion of abstinence
as a
universal treatment
goal
for problem
substance use,
has emerged as a promising
approach
for women
struggling
with alcohol use problems.
Harm reduction moves
beyond the dominant
deficit-based,
abstinence-focused,
disease-oriented
interpreta-
tions
of substance
use problems
and
addiction, and emphasizes
empowerment and
self-determination.
Thus,
strategies
based on harm reduction
are harmonious with
women-centered
approaches
to
health
care delivery
(Bepko,
r99U Dennin
g,
zooo; Pasick
&White,
r99r).
In this chapter
we discuss
several
issues related to harm
reduction
approaches to
alcohol
use, review the
research
findings on controlled
drinking
and present
our own
research on the topic
of influences
and
considerations that affect women's success
in
reaching
harm reduction
goals.
Our research
reveals
that
many women in alcohol-use
treatment
have deeply
internalized
the dominant social
ideology
on sub$tance use
and treatment
(i.e.,
that abstinence
is the only treatment
goal).
Currently,
harm
reduction approaches
do not recognize
the impact of this widespread internalization
of mainstream
addiction
discourse.
For controlled drinking to be a real option for
women
who have problems
with alcohol
use, it is not enough for programs to simply
offer the
choice
of abstinence
or controlled
use as outcome
goals.
Instead,
they
must
offer education
and training in skills
for controlled
drinking that would make harm
reduction goals
a
real choice
for problem
drinkers.
431
Section 6 Challenges
and Opportunities
Harm Reduction
and Controlled Drinking
Initially, the concept
of harm reduction provoked
a storm of controversy;
the very
idea
challenged the dominant
disease-based addiction discourse.
The
possibility
of con-
trolled drinking for those
with alcohol problems confronts the notion, which has long
been a core
societal
belief, that addiction
is
a primary and progressive
chronic disease
(Fingarette,
1988;
Marlatt et al.,
1993; Peele,
r985a, r985b;
Witkiewitz & Marlatt, zoo6).
Notably,
whbn alcohol
addiction
is
considered
a
primary
disease, alcohol use as a sec-
ondary
response to trauma,
anxiety or depression
is entirely discounted. Current
evi-
dence suggests that some
individuals
have
better
treatment success with controlled or
moderate drinking
than they
do with abstinence
(Rosenberg,
1993), and that, specifi-
cally,
women with substanbe
use problems
are found to have
greater
success with a
moderate, or controlled,
drinking
approach.
This knowledge is significant for ensuring
that women's treatment
programming
most appropriately
meets
women's
needs
(Connors
& Walitzet
1997;
Heather & Robertson, r98r; Kosok, zoo6; Marlatt, 1983,
1998;
Marlatt
et al.,
1993;
Miller & ]oyce,
1979; Rosenberg,tgg3; Sanchez-Craig et al.,
1989;
Sanchez-Crarg et
al.,
r99r).
Kosok
(zoo6)
explores
what type
of drinker seeks controlled drinking and reports
that
moderation management
of alcohol
use
may
be
more
attractive for women
than
men because they tend
to seek treatment
more readily and at an earlier stage
in an
alcohol-use problem.
She
further reports
that 66 per cent of those surveyed in her
study
who were using
moderation
management
groups
were women.
(Contrast
this
with Alcoholics Anonymous
groups,
which are based on abstinence, and have only
33
Per
cent
female membership.)
While supporting
harm reduction strategies, Ettorre
(zoo4)
suggests
that
harm
reduction programming
needs
to be revised to be more
gen-
der sensitive.
She draws
our attention
to important
gender
issues
such as
pregnancy,
mothering, relationships,
sex-trade
work and
low-self
esteem.
HARM REDUCTION IN CANADA
While Canadian
health
authorities
have
formally supported harm reduction since
1987'
(Erickson,
1999;
Fischer,
r99Z; Miller,
1986; Riley & O'Hare, zooo; Riley et al.,
1999),
research suggests
that
alcohol and
other drug programs across the country
con-
tinue to reflect an abstinence-oriented
approach.
In Quebec,
for instance,
96.3
per
cent
of substance
use treatment
centres permit
only abstinence-based
goals
(Brochu,
r99o).
The bias toward
abstinence
also exists
in Ontario,
although
it is not as pronounced:
643 per
cent of that province's
substance
use treatment centres support
only absti-
nence as a treatment goal
(Rush
& Ogborne,
1986).
l. While American policy continues to promote zero tolerance
despite
international trends, the Canadian government adopted
harm reduction as
its official policy in 1987
(Fischeq
rgSZ;
Miller, rgae).
Chapter 37 Making Harm Reduction
Work When Treating
Women for Alcohol
Use Problems
THE SUCCESS
OF CONTROLLED DRINKING
Most research suggests
that successful
controlled drinking is generally related
to lower
dependence severity,
younger age, regular employment, the drinker's confidence in
his or her ability to abstain, a shorter
history of drinking problems and greater post-
treatment
social support
(Heather
& Robertson,
r98r;
Ogborne, r987; Rosenberg,
r993).
Greater success with controlled
drinking is also
related
to "less
contact with Alcoholics
Anonymous,
and
more
ideological
flexibility about treatment'l
(Heather
& Robertson,
r98r, p. 478). In contrast,
prior efforts
at abstinence,
greater
involvement
with
Alcoholics
Anonymous,
physician
referral
and self-definition
as an "alcoholic"
are
more likely to predict
successful
abstinence
(Heather
& Robertson,
r98r).
Personal ideology and confidence
in the
chosen
approach also appear
to signifi-
cantly determine success
with either abstinence or controlled-use
goals
for alcohol
treatment
(Marlatt
et al,,
1993; Orford
& Keddie, 1986). The
"persuasion
hypothesis,"
which maintains
that controlled drinking is most likely to be successful
for people
who
believe
it is
possible
(Rosenberg,
1993),
is
supported by
the
finding
that
the
more
people
are exposed
to,
and
internalize, the dominant traditional notions
of substance
use
and
addiction, the more they are
likely
to develop identities
as
"alcoholics"
and
believe that abstinence
is the only viable treatment route. Individuals who are less
influenced by the dominant
disease
discourse appear to have
better
success with the
controlled drinking
approach
(Heather
& Robertson, r98r;
Rosenberg, 1993).
In other
words, if people
believe
controlled
drinking
is possible, they are more likely to have
success
at it.
While
most
research on harm
reduction and
controlled
drinking has focused
on
men
(Rosenberg,
1993), and thus
cannot
necessarily
be generalized to women
(Najavits,
zooz; Pirisi, zooo;
Plant,
rgg7), available
findings that do include women
suggest that
women do very well in harm reduction-based programming
compared to men
(Heather
& Roberston,
r98r; Rosenberg,
7g%)'.
What remains
unknown is why
women appear to have this
greater
success.
Our Research
Our own research on harm reduction draws
attention to this bias
toward the
"choice"
of abstinence,
for although
all of the
women
participating
in our study were involved
in harm
reduction-based
treatment,
many did not understand
what harm reduction
was, and
most believed that abstinence
was
the only way they would be able to address
their problems
with alcohol.
As
there
is currently a
lack of deliberately designed harm
2. Experienced
therapists
had the lowest dropout rate and the greatest
number of clients
who were moderate or problem-free
drinkers at follow up. Sanchez-Craig et al. (rgg1)
suggest
that this may reflect not only more experienced therapists'greater
ability at treatment delivery,
but their greater
confidence
in the potential success of controlled drinking and brief treatment.
Women were more successful with both experienced
and inexperienced therapists
(75
per cent and 59
per cent success,
respec-
tively), than men were
with experienced
and inexperienced therapists (5o per cent and 20 per cent success, respectively).
433
Section 6 Challenges and
Opportunities
reduction
programming
in Canada to address the specific needs
and experiences of
women
(Marlatt,
1998),
we hope to contribute
toward
the ongoing
improvement of
current
harm reduction treatment
models.
In this study,
we examined perceptions
and experiences of harm reduction
among
women receiving treatment
for an
alcohol-use
problem.
These findings
constitute one
part of a larger community-based
study
(Stewart
et
al.,
zoo3).r
METHODS
Fifty-eight women aged
r8
years
or older who were seeking treatment for alcohol prob-
lems or dependence at Addiction
Prevention and Treatment
Services of the Capital
District Health Authority in Halifax, Nova Scotia, were recruited for this study. To be
eligible, women
had to:
. be in treatment for a substance
use problem
. self-identiff as
having an alcohol use problem
' screen
positive for a
clinically
significant alcohol use problem using
the
ro-item
Brief
Michigan Screening
Test
(the
Brief vresr
[Pokorny
et al.,
g7z]).
Data was
gathered
through
standardized questionnaires, semi-structured
qualita-
tive interviews and
a focus group.
A subsample
of z8
women who participated
in the quantitative
portion of the
study were eligible
and agreed
to participate
in qualitative interviews.
Of these z8
women,
we
were able
to contact
and arrange
interviews
with 18. Subsequently,
three of
these
r8 women participated
in a focus group.+
Women interviewed
had an average
education
level of 14
years
and
most
described
themselves as Caucasian.
The mean age
of the women participating
in the open-ended
interviews
was
38
years,
and
limited
income and unemployment
were concerns
for r3
of the
r8
women.
In general,
the women
interviewed
demonstrated severe drinking
problems, with
a median score
of z3 on the
Brief
lresr. Scores of O
and
higher
are indicative
of severe
drinking
problems,
which
are
generally
associated with decisions
to adopt an absti-
nence
goal
rather than a controlled-use
goal
(Rosenberg,
iggf). This
trend
was evident
within our study, where
most
women
(r4 out of r8) chose
abstinence
as a treatment
goal.
On average, the
four
women
who chose a controlled-drinking
goal
scored
signif-
icantly
lower on the
Brief
uesr than
those
in the abstinence-goal
group
(mean
Brief
MAsr
scores
= 11.3
lstandard
deviation
= 3.6]
versus 23.7
[standard
deviation
= 5.5]
respectively; t [16]
= 4.24,p
< .oor),
indicating that
those women
who chose abstinence
reported
higher levels of alcohol
problems
than those
who chose controlled drinking.
The qualitative
interviews
and the focus group both emphasized women's own
stories
about their choice
of treatment goal,
and their perceptions
of harm reduction
approaches to treatment
(Kitzinger,
1994i
Mies, 1983, r99r; Reinharz,
r99z; Stanley
&
Wise, t99o). An analysis
of the interviews
and
focus
group
illustrated how
beliefs and
3. This larger study explored the relationship between
binge eating and heavy
drinking. Among the 58
participants recruited for
the research,
4r had a o-existing problem with binge eating and binge drinking.
4. Greater detail on the results ofthis study can be found in Brown et al..(2005) and Stewart et al. (2006).
434
Chapter 37 Making Harm Reduction
Work When
Treating Women for Alcohol Use Problems
Perceptions
of control over drinking underlie women's
alcohol use and treatment
choices
(Strauss
& Corbin,
r99o).
BELIEFS
ABOUT CONTROL
The women
interviewed
for this study
were all participating
in harm reduction-based
programming
and were
informed
that they could
choose among abstinence, step-
down
or controlled-treatment
goals,
All were
part of a women's treatment
program
(the
Matrix program),
or one
that
had
women-specific components
(the
Core program).
Although
harm reduction
was discussed
during the initial group
orientation,
the
inter-
views revealed that many women were unclear about what it was. Further, most
women
interviewed
did not support
the idea of harm reduction for binge drinking
problems.
As Shelley explained,s
"you'll find that . . . anybody that takes groups
seriously
are
in abstinence
and
aren't using."
Abstinence was
considered preferable
to controlled-drinking treatment
outcomes
by most women
because
they
strongly
believed that they
had very little, if any, control
over
alcohol.
Accordingly,
it was
common
for women to adopt totalizing definitions of
themselves
as alcoholics:
Molly-Anne
stated,
"I think'once an alcoholic always
an alco-
holic':
I can't
see
going
back to being a social
drinker."
Paula
shared similar
feelings,
identiffing
her
belief that
she
had no control
over alcohol:
"The
alcohol takes a
hold of
me. I have
no control
over
it anymore.
, . ."
sarah also expressed her experiences
of a
lack of control over
her drinking:
And every
time I drank,
I'd binge drink.
I couldn't
have
just one,
I
don't
think personally
one
drink
for me is ever going
to work. I know
that
I'11
never be able
to drink socially.
And Ginnie
reported
a similar
perceived
lack of control:
Sometimes
I would be able
to just have a few drinks and not get
drunk, but it never felt like it was in my control. The feeling was I
could never
say,
I'm going
to have
a few drinks and then stop
. . . as
soon as
I started
drinking.
. .
.
it wasn't my decision any
more.
. .
.
While
most women
chose
abstineiice,
some
women did
feel
that controlled
drink-
ing was possible,
and
this strategy
was their
preference.
Iris commented that,
to me that
model
sounds
ideal,
and
it fits, most of how I see
myself.
. . . It is hard to say
no forever. . . . I don't think it would be hard to
moderate..
. .I harm
reduced
myself basically.
5. Participants'
real names are not used
in this discussion.
Pseudonyms were chosen by each of the women interuiewed.
435
Section 6 Challenges
and Opportunities
Supporting
harm reduction
and controlled drinking, Molly stated:
I think it's grand.
I really hate
Alcoholics Anonymous because of the
attitude-I'm an
alcoholic.
I'll always
be
an alcoholic, there's
nothing
I can do.
It's kind of a defeatist
attitude to me. It's like-I'm not an
alcoholic.
I'm more
than that.
I'm not even an alcoholic.
That's not
all
of me. . . . Puts
you
in a box,
Moragr who also
supported
controlled-drinking
strategies, said:
And
so
by addressing
the
whys, by empowering
the
person
with skills,
lending the
thought
that
you
won't need to drink next
time. . . .
I see
that they do harm reduction that way. By dealing with the actual
issues
that may be causing
the drinking rather than-okay drinking
isbad....
Research demonstrates
that beliefs about
controlled drinking or abstinence are
predictive
of successful
treatment
outcomes.
While the
women in our study were still
in treatment,
our findings
show a clear
link between beliefs about the source
of alcohol
problems
and the treatment
goal
choice.
Not only did the women in our study gener-
ally have severe
drinking problems,
they most often
identified as alcoholic. Thus, the
experiences and
perceptions
of women
in this study were consistent with the persua-
sion hypotheses
for predicting
treatment
choice.
Almost all of the women
in the
study
chose
abstinence, and
those
few who did choose controlled drinking
had less
severe
drinking problems
and
believed that
controlled
drinking
was
possible.
IMPLICATIONS
These
findings have significant
implications
for
treatment
services and
program
devel-
oPment.
Most of the
women
interviewed
reported that
if they
had
one drink they
lost
control
over
their
drinking.
Not only did they
feel they
had no control
over their alcohol
use,
but they
reported
little
sense of choice
or agency around their drinking behaviour
generally.
While this
experience
is
most often totalized
as evidence of being an
"alco-
holic," and thus inevitable
and unchangeable,
it is possible
that if harm reduction
education
actually
provided
training and skills
in controlled drinking by skilled,
con-
fident and experienced
clinicians,
it might be a more viable and ultimately
more
successful option for women. Without training in such skills,
however,
abstinence
appears
to feel
like the only
available
choice
for most women.
The appearance
that
abstinence
is the
only treatment choice is exacerbated by the
dominant
disease-based
model,
which emphasizes
the necessity
of abstinence and
closes the door to alternatives.
Thus,
fear of losing control over drinking behaviour,
along
with an internalization
of the dominant
disease
model, make
women
more likely
to choose abstinence
as their
treatment
outcome goal
despite being
given
the choice of
$6
Chapter 37 Making
Harm Reduction
Work When
Treating Women for Alcohol Use
Problems
controlled
drinking. To
increase the success
of harm reduction strategies that promote
treatment choice
for women with alcohol
use
problems,
both program design and
delivery
need to contend
with these
influences and constraints
on choice.
An effective
harm reduction strategy
for treating problem alcohol use among
women
may demand
a more proactive
approach to health education on harm reduc-
tion, as well as
more
purposeful
integration
of its principles
into treatment practices.
Feminist approaches
to working with women's use
of alcohol and other substances
from a harm reduction paradigm
need
to challenge discourses
that may be harmful
to women.
Further,
harm reduction
may
need to address the internalization
of the
dominant
discourse
on
"alcoholism"
and
the
medicalization of "addiction,"
both con-
cepts
that are
often adopted
by women
who seek treatment;
this discourse can have
disempowering
effects,
including individualistic,
often self-blaming, and socially
decontextualized
understandings
of alcohol problems.
As well, many
women are
faced
with contradictory expectations
when the child welfare or criminal justice system
mandates
abstinence
outcomes
while the
service delivery
program itself offers a choice
between
controlled-drinking
and abstinence
treatment
goals.
In such instances,
women
have
very
little actual
choice,
especially
if they
wish to regain
or retain custody
of their
children.
Future
Research
Future
research
in this
area
needs
to explore
whywomen
have
greater
success
with con-
trolled
drinking
than
do
men, and
how
harm-reduction approaches can contribute
to
successfrrl
treatment
outcomes
for women.
In addition,
it should
seek a
clearer under-
standing
about
how
women
make choices
between abstinence and controlled drinking
within flexible
Programs,
and
what the
role of the clinician
is in this process.
Finally,
research
needs to explore
in greater
depth
the
cultural processes that shape
women's
beliefs about
their drinking problems,
how these
beliefs determine their treatment
choices, and
what potential
these
choices
have
for treatment
success.
Conclusion
Despite close
to 30
years
of research
that
has
strongly
established the effectiveness
of
controlled
drinking in comparison
to abstinence-based
approaches
(Marlatt
et al.,
1993;
Miller r98l; Sobell
& Sobell,
1995), the
landscape of harm reduction
program-
ming for women in Canada
remains
unclear.
The literature on controlled drinking,
along
with our own
research
findings,
suggests
that for harm
reduction to work
most
effectively people's
choices
about
dealing
with their alcohol use
problems
need to be
better
informed.
As it stands,
harm
reduction,
which centres
on
the notion of an individual choos-
ing between
abstinence
and
controlled-use
treatment goals,
fails to recognize the
wide-
437
Section 5 Challenges
and Opportunities
spread
internalization of dominant addiction discourse. Psychoeducation
and skills
training are needed to counterbalance
the dominance of disease-based
abstinence
approaches
and to encourage
a full range
of choice within services that include harm
reduction
approaches.
Knowledge of women's success at controlled
drinking, and the
association between drinking severity and belief in controlled drinking as a viable
treatment
goal,
should provide
guidance
in shaping
alcohol treatment
programming
for women.
This research
was supported through
a generous
grant
from the Nova Scotia Health Research Found-
atibn to the
authors.
We,
the authors, would like to acknowledge
the assistance
of service
providers
and the
program
direc-
tors
for their contribution to the
project,
including their assistance in proilding access
to the women in
their treatment
services and their assistance in participant recruitm.ent. We would also
like to thank
Sarah
Larsen
and
Jennifer
Thealcston
for their research assistance. And of course, we extend our thanks
to the
women receiving services
at these
programs
for their
paricipation in the
study.
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... A primary conceptual dilemma for working with harm reduction for alcohol treatment is the internalization of the dominant abstinence discourse among those seeking and providing treatment (C. Brown et al., 2005;C. Brown & Stewart, 2007). Research suggests abstinence-oriented treatment dominates alcohol and other substance use treatment programs in Canada, alongside shifting periods of support by Canadian health authorities (Canadian Drugs and Substances Strategy [CDSS], 2016;Health Canada, 2018;Paradis, 2016). Despite some change in social attitudes, this continues to ...
... ume that alcohol is the primary problem (Herman, 2015;Ross & Morrison, 2020;Stewart & Isreali, 2003). Feminist approaches have emphasized the importance of exploring the social context of women' lives to make sense of why women use alcohol to cope rather than pathologizing women's drinking as an individual deficit or disease (C. Brown et al., 2020;C. Brown & Stewart, 2007;Burstow, 1992; "Echo: Improving Women's Health in Ontario," 2011; Najavitis, 2015;Poole & Greaves, 2007). Rush and Ogborne's (1986) survey of Ontario treatment services and Brochu's (1990) survey of private treatment in Quebec found that about half supported nonabstinence treatment goals. A Canadian-wide survey found support for patient ...
... An extensive amount of Canadian and international literature links substance use problems with violence, suggesting prior experiences of violence, including sexual assault, childhood sexual abuse, and other traumatic experiences, create vulnerability to substance use problems (C. Brown & Stewart, 2007;Parker & McCaffree, 2013;Plant, 2008;. Alcohol dependency is up to 15 times higher for women affected by violence, and women who experience violence at the hands of their partners are 6 times more likely to be depressed and 4 times more likely to use psychoactive drugs. ...
Article
Full-text available
The objectives of this study were to profile the landscape of women’s alcohol use programs in Canada. We explored service users’ and providers’ beliefs about alcohol use problems and how this affected treatment choices for alcohol use problems. Data were collected through standardized measures alongside in-depth semi-structured narrative interviews in six women’s alcohol treatment sites in Canada. Findings demonstrated that service users and service providers often supported an abstinence choice and were ambivalent about the viability of controlled or managed use in both abstinence- and harm reduction–based programs. Findings showed that women service users in this study had significant rates of trauma and depression which were associated with their alcohol use; the majority still adopted dominant alcohol addiction discourse which emphasizes the need for abstinence. We offer a number of recommendations to improve the viability of harm reduction for alcohol use in women’s treatment programs.
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The purpose of this paper is ‘to revision’ our approach to women's use of drugs – which means to let go of how we have seen in order to construct new perceptions. Women use a variety of substances for a range of reasons, including pleasure. Yet, women who experience problems are left feeling stigmatised, marginalised and demoralised. The paper includes three inter-related discussions. First, two co-existing approaches to drug use, the classical and the postmodern, are explained. Second, after demonstrating how the postmodern approach is more valuable for the development of a gender-sensitive perspective, I will, with special reference to drug use, explain the complexities of two contemporary concepts, gender and embodiment. Here, I attempt to generate a deeper appreciation of these concepts in the postmodern approach. Third, I ask, ‘How can we develop a gender-sensitive, harm reduction approach’? The contention is that while harm reduction philosophies are admirable, these need to be gender-sensitive in order to be effective. A multi-levelled, ‘gender-sensitive’ view of harm reduction is put forward, as harm reduction is examined at the subjective, treatment, relationship, occupational and leisure levels.
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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)
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[This book] also points out the need for a major reevaluation of prevalent, but futile, treatment methods and of harmful public policies, all based on incorrect assumptions about addictive behavior. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
As evidenced by the tremendous range of scholarly articles included in this special issue, it is readily apparent that harm reduction is more than a theory, treatment approach, or policy. Rather, harm reduction is an orientation and belief system that has widespread empirical support as a means to improve the lives and functioning of individuals who use and abuse alcohol. In this article, we review recent empirical articles and scholarly reviews of harm reduction treatments for alcohol abuse and dependence. We focus this review on peer-reviewed articles published in the last 3 years, with a particular emphasis on interventions designed to reduce alcohol-related harm, including overall levels of consumption and alcohol-related problems. We conclude with a section on books, Web sites, and training and treatment centres devoted to harm reduction psychotherapy.