Harm reduction is an ancient and natural plan for minimizing the unpleasant and harmful effects of dangerous behavior. Addictions certainly are dangerous behaviors, and some experts have championed the idea of a harm reduction strategy for addictive behavior. Unfortunately, there is a great deal of misunderstanding about what harm reduction means for the addict and for the recovery movement.

At different times in the history of warfare using a shield in battle was thought to be cowardly and unfair, but the intelligent warrior, finding honor in survival, decided shields were invaluable. Taking cover in combat is also an obvious and valuable harm reduction method, but there was a time when firing on the enemy from behind a tree was viewed as dishonorable. In about 1960, automobile seat belts began to appear as options; they were condemned as foolish and laughed at by most drivers. Now they are the law. Next, our national fifty-five mile per hour speed limit came and went for reasons that go well beyond the issues of harm reduction and public safety. All of this demonstrates the inseparability of harm reduction, money, ego, and politics. But, it also shows that harm reduction works in many areas of human behavior.

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Harm reduction efforts for potentially dangerous behavior and events range from water fluoridation to limits on Wall Street trading, from earplugs to vaccinations, from food labels to emission control for gas engines, and from clean needle exchanges for drug addicts to disk drive back-ups on computers. Far from being some new and radical form of therapy or psychological theory, harm reduction is simply a useful new name for a very old set of survival mechanisms. We have rediscovered the obvious. Don’t forget your umbrella, stay out of cold drafts, and eat your spinach. If you reduce the effect of harmful things, you maximize long life and health.

The actual existence of the harm we seek to reduce or avoid is sometimes unclear, as in the case of imaginary damage caused by exposure to the harmless magnetic fields of cell phones and power lines. Worthless harm reduction treatments are freely sold to the public in the absence of any documented effectiveness; these include deep bowel cleansing, mega vitamin therapy and clumsy attempts at prohibition or micromanagement of addictives. The evils of early sex education, for example, have yet to be proved by research, yet this has no impact on those who are very sure it must be banned. At the extreme of foolishness we find some groups campaigning vigorously against voluntary euthanasia for terminally ill, pain-ridden patients, but from what harm we hope to protect these dying patients no one seems able to document or even articulate. Clearly, harm reduction has as much potential for foolish misuse as the medical, moral and disease models of addiction so vigorously rejected by some harm reduction theorists.

A few writers suggest the idea that harm reduction is a valiant and novel rebellion against some kind of ancient and powerful opposition. Marlatt, (1998, p. 49), for example, in reviewing his own opinions and those of others, stated: “Harm reduction is a public health alternative to the moral/criminal disease models of drug use and addiction.”

There seem to be two important classes of harm reduction: social policy and self-imposed control strategies. I refer to the latter as auto-regulation or self-regulation. It is amazing to me that so many recovering addicts and mental health experts—people with no experience or training in political science—suddenly come forth with recommendations for social action. I rather like the idea of self-regulation through study and growth as the first step.

Should we apply harm reduction to addictive behavior? Of course, but Yes is too complicated an answer. If we want simple answers we have to ask simple questions, especially when it comes to badly needed research.

Should total abstinence be the only goal of treatment for addicts? Probably not, but that might depend on many situations, not on one’s allegiance to the idea that addictions are medical diseases. Please remember that the first addiction treatment programs were established in psychiatric hospitals where there was zero tolerance for drug and alcohol abuse out of concern for patient and staff safety. Even today, I do not think that inpatient units would be willing to accept the general risks of allowing selected or special patients to violate basic institutional abstinence rules. When you’re in the hospital you don’t usually get to drink alcohol, smoke, or take recreational drugs. Use-tolerant programs would probably have to be moved away from the main psychiatric campus. In the 1970s, if we wanted to treat gamblers, we had to accept the abstinence goal, and it was certainly a good way to start considering the very severe and advanced forms of addiction we saw in clients.