ReviewOverview of harm reduction treatments for alcohol problems
Section snippets
Recognising alcohol-related harm
Individuals and society as a whole suffer from the many consequences of alcohol abuse and dependence. The World Health Organization (WHO) recently published the Global Status Report on Alcohol (World Health Organization [WHO], 2004), which describes international and country-specific data on the health, social, and economic costs of alcohol abuse. According to the WHO report, approximately 76.3 million people worldwide have a diagnosable alcohol use disorder. Roughly, 1–5% of the gross domestic
Why and how people change
In order to reduce alcohol-related harm and the disease burden associated with excessive alcohol use, researchers and clinicians need to develop a much greater understanding of why and how people change with and without treatment. Most alcohol treatment researchers and clinicians agree that treatment is effective (Miller, Walters, & Bennett, 2001). Yet, very little is known about the mechanisms by which treatment is effective (Morgenstern & Longabaugh, 2000), and even less is known about how
Getting into treatment
As alcohol treatment researchers, one of the commonly asked questions that we hear is: ‘How can I help my friend who is drinking too much?’ It is often believed that friends who are concerned about another friend's drinking need to get a group of loved ones together to have an ‘intervention’. Johnson (1986) developed a systematic method for loved ones to intervene by encouraging entrance into treatment in a caring and supportive manner, with sanctions to the individual for failing to do so.
Self-help and self-administered treatments
Alcoholics Anonymous (AA) is the most widely used self-help intervention worldwide. More than two million people belong to AA worldwide (Alcoholics Anonymous, 2006). Unfortunately, AA is not the most desired treatment for many individuals. In a recent study on treatment preferences, Dillworth (2005) found that more than 60% of individuals in a community sample stated they would prefer alternative treatments to AA and would be unlikely to attend AA, even if they had concerns about their
Behavioural treatment interventions with moderation goals
Two recent commentaries published in the Canadian Journal of Psychiatry (el-Guebaly, 2005, Hodgins, 2005) provided a description of the controlled drinking controversy (Heather & Robertson, 1983; Marlatt, 1983; Sobell & Sobell, 1995) and the state of the controlled drinking debate today. el-Guebaly (2005) acknowledged that ‘a harm reduction strategy has currently subsumed the CD movement’ (p. 268). Hodgins (2005) presented the following charge: ‘Our challenge is to allow our experiences to move
Harm reduction treatment in medical settings
The American Medical Association (AMA) and American College of Surgeons (ACS) are two credentialing organisations that have provided support for comprehensive harm reduction approaches to the identification and treatment of problem drinkers within primary care (American Medical Association, 1999) and trauma centres (American College of Surgeons, 2000). Recommendations from the AMA are based on a series of randomised controlled trials demonstrating the effectiveness of brief interventions in
Pharmacological interventions
With the development of new pharmacological agents, there is increased opportunity for reducing harmful drinking and improving controlled drinking attempts. The first drug therapy to be developed for alcohol dependence was disulfiram (Antabuse), which prevents the metabolism of alcohol and makes the experience of drinking unpleasant due to the excess of acetaldehyde. Disulfiram is only effective to the extent that individuals are compliant with taking the medication, even when they are planning
Harm reduction psychotherapy
Over the past 4 years, there has been a large increase in the number of resources for clinicians who are interested in practicing harm reduction psychotherapy for clients with alcohol-related problems. Marlatt (1998) edited the first harm reduction text entitled, Harm Reduction: Pragmatic Strategies for Managing High-Risk Behaviors, which included a collection of scholarly papers on the application of harm reduction to alcohol and a variety of substance and non-substance use problems. Denning
Summary and conclusions
Harm reduction is no longer a minority movement and may soon be accepted as mainstream practice in the research and treatment of addictive behaviours (el-Guebaly, 2005). The empirical data and qualitative reports support the effectiveness and efficacy of harm reduction approaches to alcohol treatment and demonstrate that abstinence-only approaches may actually deter alcohol-dependent individuals from seeking treatment. AA remains the most widely available treatment worldwide, but Internet
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Cited by (32)
Expanding the continuum of substance use disorder treatment: Nonabstinence approaches
2022, Clinical Psychology ReviewCitation Excerpt :Most harm reduction-focused treatments that have been empirically evaluated are specific to AUD. Multiple such models have strong empirical support and have been described in previous reviews (Marlatt & Witkiewitz, 2002; Witkiewitz & Alan Marlatt, 2006). These include cognitive-behavioral and skills-focused drinking interventions (e.g., Behavioral Self-Control Training), brief interventions for primary care settings, and alcohol risk reduction interventions for college students (e.g., Alcohol Skills Training Program and Brief Alcohol Screening and Intervention for College Students).
Are non-abstinent reductions in World Health Organization drinking risk level a valid treatment target for alcohol use disorders in adolescents with ADHD?
2020, Addictive Behaviors ReportsCitation Excerpt :The central focus on abstinence from alcohol during AUD treatment in youth makes sense, given strong evidence indicating the increased risk for alcohol-related negative sequelae and disruptions in developmental trajectories related to adolescent as compared to adult alcohol use (Lisdahl et al., 2013). At the same time, only focusing on abstinence-based treatments limits treatment options and likely turns youth who may be experiencing alcohol-related problems but who prefer to reduce their drinking away from seeking treatment (Witkiewitz & Alan Marlatt, 2006). Non-abstinence alcohol reduction endpoints have gained acceptance as a treatment target for adult AUD over the past decade (Hasin et al., 2017), building on the foundation of earlier harm reduction models (Witkiewitz & Alan Marlatt, 2006).
On the outside looking in: Finding a place for managed alcohol programs in the harm reduction movement
2019, International Journal of Drug PolicyAlcohol abstinence or harm-reduction? Parental messages for college-bound light drinkers
2015, Addictive BehaviorsProtective behavioral strategies for reducing alcohol involvement: A review of the methodological issues
2013, Addictive BehaviorsCitation Excerpt :Further, important distinctions can be drawn among the goals of targeting the reduction of negative alcohol-related consequences, the reduction of alcohol consumption, and targeting both alcohol use and alcohol-related consequences. Beginning with the well-known controlled-drinking controversy of the 1970s (for review see Sobell & Sobell, 1995), alcohol interventions have become increasingly focused on harm reduction (for review see Witkiewitz & Marlatt, 2006). Implicit to the harm reduction model is a focus on reducing or attenuating negative alcohol-related consequences, which may or may not result from reductions in alcohol consumption.
Perspectives of clinical stakeholders and patients from four VA liver clinics to tailor practice facilitation for implementing evidence-based alcohol-related care
2024, Addiction Science and Clinical Practice