The Concept of Harm Reduction and its Application to Alcohol: The 6th Dorothy Black Lecture

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Abstract
Harm reduction has proved to be effective, and has gained increasing official. acceptance in many countries. However, the concept is poorly defined, as virtually any drug policy or programme, even abstinence-oriented programmes, attempts to reduce drug-related harm. The principle feature of harm reduction is the acceptance of the fact that some drug users cannot be expected to cease their drug use at the present time. Harm reduction accords a high priority to short-term realizable goals, but is consistent with a long-term goal of abstention. The trend toward harm reduction in illicit drugs is closely paralleled by a similar trend in alcohol prevention toward measures aimed at reducing the consequences of hea y drinking occasions. Examples of harm-reduction approaches to alcohol are discussed, including measures to reduce non-beverage alcohol consumption by ‘Skidrow’ inebriates, measures to reduce intake of alcohol by drinkers (e.g. promotion of low-alcohol beverages, server training programmes) and measures to reduce the consequences of intoxication. Increased attention is likely to be given to suck prevention measures, which focus on preventing problems associated with drinking rather than restricting access to alcohol. Public support for controls over the availability of alcohol will continue to decline, as evidence regarding the potential benefits of moderate consumption becomes more widely publicized. Further, the trend to harm-reduction approaches for alcohol is supported by new empirical evidence, including results from a recent Canadian national survey indicating that it may be more efiective to target prevention programming toward reducing kea y drinking occasions rather than the individual's level of drinking.