Here the late Dr. Alan Marlatt explains harm reduction for alcohol abuse. He was a pioneer in its development and widespread use.
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 Key
Education is the key to the prevention and minimization of harm related to drinking abuse. It’s unlike prevention programs that focus exclusively on abstinence and promote a zero-tolerance, “just say no” approach.
Programs based on harm reduction help those who have already “said yes” to experimenting. They also help those who are leaning in that direction. Such programs can be in group settings (e.g., prevention programs in schools). They can include discussion of both abstinence and consumption. The decision to drink or abstain is informed by discussing pros and cons of each choice.
Members of our staff had an invitation to visit a private high school. We discussed 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 college freshmen. Most of the high school seniors were planning to attend college within a year and most were already drinking. We gave a harm reduction approach instead of the traditional abstinence program.
We met with members of the senior class with no teachers present. Then 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.”
We explained that we were there to talk about drinking and its risks and benefits. Then 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 discussion, students raised many questions that were easy to address within the framework of harm reduction. For example, how to respond to peer pressure to get drunk or 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 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.” He added “I don’t want to do anything that might slow my reaction time.”
The discussion focused on the advantages and the disadvantages of drinking. It included the effects of alcohol on reaction time, with everyone actively involved. Toward the end of the meeting, several students thanked us for having such an open forum. Their views about drinking were accepted and discussed. This was even though drinking was illegal for these underage drinkers.
Junior High School
Another student told us, “We should be doing this in junior high school.” She said “that’s 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 meeting, school officials invited us to put on several harm reduction workshops for the graduating class. This program reduced harmful drinking patterns greatly over the course of the school year.
Harm reduction views people as responsible for their own choices. They get help “where they are.” Then move from there in small steps to increasing levels of health and safety. And it works.
Dr. G. Alan Marlatt was Professor of Psychology at the University of Washington. He received the Jellinek Award for his work in the field of alcohol studies.