Harm reduction: An approach to reducing risky health behaviours in adolescents

National Institute of Health | January 13, 2008

INTRODUCTION
Harm reduction is a public health strategy that was developed initially for adults with substance abuse problems for whom abstinence was not feasible. Harm reduction approaches have been effective in reducing morbidity and mortality in these adult populations. In recent years, harm reduction has been successfully applied to sexual health education in an attempt to reduce both teen pregnancies and sexually transmitted diseases, including HIV. Programs using a harm reduction philosophy have also successfully lowered risky alcohol use. The target patient population and the context in which harm reduction strategies are delivered influence the specific interventions used. Health care practitioners (HCPs) who provide care to adolescents should be aware of and familiar with the types of harm reduction strategies aimed at reducing the potential risks associated with normative adolescent health behaviours.

The goal of the present statement is to provide HCPs with a background and definition of harm reduction as a public health policy, and to describe how HCPs can effectively use harm reduction with their adolescent patients.

BACKGROUND
Harm reduction can be described as a strategy directed toward individuals or groups that aims to reduce the harms associated with certain behaviours. When applied to substance abuse, harm reduction accepts that a continuing level of drug use (both licit and illicit) in society is inevitable and defines objectives as reducing adverse consequences. It emphasizes the measurement of health, social and economic outcomes, as opposed to the measurement of drug consumption (1–5).

Harm reduction has evolved over time, from its initial identification in the 1980s, as an alternative to abstinence-only focused interventions for adults with substance abuse disorders (6). At the time, it was recognized that abstinence was not a realistic goal for those with addictions. In addition, those individuals who were interested in reducing, but not eliminating, their use were excluded from programs that required abstinence.

There is persuasive evidence from the adult literature that harm reduction approaches greatly reduce morbidity and mortality associated with risky health behaviours. For example, areas that have introduced needle-exchange programs have shown mean annual decreases in HIV seroprevalence compared with those areas that have not introduced needle-exchange programs (7). Access to and use of methadone maintenance programs are strongly related to decreased mortality, both from natural causes and overdoses, which suggests that these programs have an impact on overall sociomedical health (8). The most recent addition to the harm reduction continuum is that of supervised injecting facilities, which have been successfully implemented in Switzerland and the Netherlands, and more recently in Vancouver, British Columbia. HCPs play important roles in many of these harm reduction initiatives.

CONCLUSION
Harm reduction is a developmentally congruent approach to the primary and secondary prevention of risky behaviour in the adolescent population. HCPs are well positioned to deliver harm reduction messages to their adolescent patients. Surveys of adolescents have supported the fact that adolescents identify HCPs as credible sources of health information (26–28). Acknowledging the adolescent’s role in decision-making about his or her health behaviour is an important component to the provision of this education. Avoiding judgment about potentially risky behaviours enhances the ability of the HCP to deliver important messages about risk reduction.

Read the complete study and findings here.