Harm Reduction Works for Alcohol Abuse and Alcoholism

The Harm Reduction approach is based on compassionate pragmatism instead of moralistic idealism. It recognizes that a minority of people have always abused alcohol and always will. It doesn't condone this behavior, but seeks to reduce its incidence and the harm it causes.

Education is the key to the prevention and minimization of harm related to high-risk alcohol use. Unlike prevention programs for youth that focus exclusively on abstinence and promote a zero-tolerance, "just say no" approach, programs based on harm reduction are designed to accommodate those who have already "said yes" (or who are leaning in that direction) when it comes to experimenting. Such programs can be structured in group settings (e.g., prevention programs in schools) to include discussion of both abstinence and consumption of alcohol. The decision to consume or to remain abstinent can be informed by a discussion of the relative pros and cons of each choice.

As an example, members of our staff at the University of Washington Behaviors Research Center were asked to visit a private high school in Seattle to discuss drinking problems with members of the senior class. School officials invited us to put on a program similar to the one we developed to work with University of Washington freshmen. Since most of the high school seniors were planning to attend college within a year, and since most of these students were already drinking, it was decided that a harm reduction approach was the best alternative to traditional abstinence programs.

When we met with members of the senior class (with no teachers present), we asked them what they thought we were going to talk about. One young woman, with a bored expression, replied: "Another 'just say no' lecture. Well, while your doing that, I'm going to be daydreaming about the big party coming up Friday night." After we explained that we were there to talk about drinking and its risks and benefits (as we did with college freshmen), the attitude shifted to one of animated discussion. All but one student in the class of 20 revealed that they were active drinkers; these students spoke freely about their experiences with alcohol, both positive and negative. In this interactive discussion, students raised numerous questions that could easily be addressed within the framework of harm reduction (e.g., How to respond to peer pressure to get drunk, how to help a friend who has overindulged, how males and females respond differently to alcohol, how alcohol affects sexual activity, etc.).

The one student who reported that he was an abstainer was challenged at first by some of the other students, one of whom accused him of being "holier than thou" and "looking down your nose" at students who were not abstinent. "Not at all," he replied. "I'm hoping to make the college sports teams in the fall, and I don't want to do anything like drinking that might interfere with my physical training or slow my reaction time." The ensuing discussion focused on the advantages and the disadvantages of drinking, including the effects of alcohol on reaction time, with everyone actively involved. Toward the end of the meeting, several students thanked us for promoting such an open forum in which their views about drinking were accepted and discussed, even though alcohol consumption was illegal for these underage drinkers. Another student told us, "We should be doing this in junior high school, when most of us started to experiment with alcohol. Maybe some of us seniors could lead the discussion with the ninth-graders, the way you did with us." Following this introductory meeting, school officials invited us to put on several harm reduction workshops for the graduating class. This program was found to reduce harmful drinking patterns significantly over the course of the school year.

Harm reduction views people as responsible for their own choices. They are helped "where they are" and moved from there in small manageable steps to increasing levels of improved self-care, health, safety, and well-being. And it works.

by G. Alan Marlatt, Ph.D.

Dr. G. Alan Marlatt is Professor of Psychology and Director of the Addictive Behavior Research Center at the University of Washington. He is a member of the National Advisory Council on Drug Abuse for the National Institute on Drug Abuse and is a recipient of the Jellinek Memorial Award for outstanding contributions to knowledge in the field of alcohol studies.


  • Baer, J.S., Kivlahan, D.R., Fromme, K., Larimer, M.E., & Williams, E. (1992). An experimental test of three methods of alcohol risk reduction with young adults. Journal of Consulting and Clinical Psychology, 60, 974-979.
  • Baer, J.S., Marlatt, G.A., & McMahon, R.J. (Eds.). (1993). Addictive behaviors across the life span: Prevention, treatment, and policy issues. Newbury Park, CA: Sage.
  • Clear, A. (1997, Spring). Welcoming address: First National Harm Reduction Conference. Harm Reduction Communication, No. 4, pp. 1-13.
  • Davies, D.L. (1962). Normal drinking in recovered alcoholics. Quarterly Journal of Studies on Alcohol, 23, 94-104.
  • Des Jarlais, D.C. (1995). Harm reduction: A framework for incorporating science into drug policy [Editorial]. American Journal of Public Health, 85 (1), 10-11.
  • Dimeff, L.A., Baer, J.S., Kivlahan, D.R., & Marlatt, G.A. (1998). Brief alcohol screening and intervention for college students (BASICS): A harm reduction approach. New York: Guilford Press.
  • DuPont, R. L., & Voth, E. A. (1995). Drug legalization, harm reduction, and drug policy. Annals of Internal Medicine, 123, 461-469.
  • Gordon, J.R. (1998). Harm reduction psychotherapy comes out of the closet. In Session: Psychotherapy in Practice, 4, 69-77.
  • Kishline, A. (1994). Moderate drinking: The new option for problem drinkers. New York: Sharp Press.
  • MacCoun, R.J. (In press). Toward a psychology of harm reduction. American Psychologist.
  • Marlatt, G.A. (1996a). Harm reduction: Come as you are. Addictive Behaviors, 21(6), 779- 788.
  • Marlatt, G.A., Baer, J.S., & Larimer, M.E. (1995). Preventing alcohol abuse in college students: A harm reduction approach. In G.M. Boyd, J. Howard, & R.A Zucker (Eds.), Alcohol problems among adolescents: Current directions in prevention research (pp. 147-172). Hillsdale, NJ: Erlbaum.
  • Marlatt, G.A., & Gordon , J.R. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.
  • Marlatt, G.A., Larimer, M.E., Baer, J.S., & Quigley, L.A. (1993). Harm reduction for alcohol problems: Moving beyond the controlled drinking controversy. Behavior Therapy, 24, 461-504.
  • Marlatt, G.A., & Roberts, L.J. (1998). Introduction to special issue on treatment of comorbid addictive behaviors: Harm reduction as an alternative to abstinence. In session: Psychotherapy in practice, 4, 1-8.
  • Marlatt, G.A., & Tapert, S.F. (1993). Harm reduction: Reducing the risks of addictive behaviors. In J.S. Baer, G.A. Marlatt, & R. McMahon (Eds.), Addictive behaviors across the lifespan (pp. 243-273). Newbury Park, CA: Sage.
  • Marlatt, G.A., & Vandenbois, G.R. (1997). Addictive behaviors: Readings on etiology, prevention, and treatment. Washington, DC: American Psychological Association. Miller, W.R., & Page, A.C. (1991). War, turkey: Other routes to abstinence. Journal of Substance Abuse Treatment, 8, 227-232.
  • Peele, S. (1993). The conflict between public health goals and the temperance mentality. American Journal of Public Health, 83, 805-810.
  • Plant, M., Single, E., & Stockwell, T. (Eds.). (1997). Alcohol: Minimizing the harm-what works? London: Free Association Books.
  • Reuter, P., & MacCoun, R. (1995). Drawing lessons from the absence of harm reduction in American drug policy. Tobacco Control, 4, S28-S32.
  • Shore, E.R., Gregory, T., & Tatlock, L. (1991). College students' reactions to a designated driver program: An exploratory study. Journal of Alcohol and Drug Education, 37, 1-6. Single, E. (1996). Harm reduction as an alcohol-prevention strategy. Alcohol Health and Research World, 20, 239-243.
  • Somers, J.M. (1995). Harm reduction and the prevention of alcohol problems among secondary students. Unpublished doctoral dissertation, University of Washington.

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