Review
Overview of harm reduction treatments for alcohol problems

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Abstract

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.

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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