Harm reduction is a public health philosophy which shapes and informs policies, interventions and programs which reduce transmission of HIV and the harms of alcohol and other drug use.
Drug and Alcohol addiction is a complex health issue which is not easily treated:
Addiction treatment consists of intensive interventions over a long period of time, which aim to keep a person substance free while also rehabilitating their psychology to teach skills of how to manage life issues without the assistance of drugs or alcohol. Many drug users report having histories of abuse and trauma of which substances assist them to cope and which take time in therapy to achieve optimal health outcomes. Working through these issues with someone seeking to change their substance use is expensive and time consuming, with the nature of therapy and rehabilitation requiring repeated episodes of treatments.
Due to the complex nature of addiction, treatment is not a process with a one-time fix, but a continued process of healing and development in which the individual applies some changes and is supported to practice the application of those changes in the context of their everyday lives, without the use of substances.
Very rarely will one episode of treatment be able to address all the complex issues faced by someone who presents a drug or alcohol addiction. It is possible but more common for people to present for treatment a number of times before being rehabilitated to the point where treatment is no longer necessary.
The nature of addiction recovery is that people relapse, just like any change in behaviour such as dieting; it takes practice and time to achieve full health. In many cases it also takes substantial changes to their everyday lives, like establishing a home and eventually work, which are protective factors to assist people to remain drug and alcohol free.
Addiction specialists work from the foundation of ‘Maslow’s Hierarchy of Needs’ which is a philosophy explaining the hierarchy of human need, that before we can progress in our development first we must establish the foundations of having basic needs met such as safety, food and shelter.
The final achievement in the hierarchy is self realisation, which is what alcohol and drug clinicians are aiming for in the therapy they provide.
The drug and alcohol clinician must work with an individual over an extended period of time to assist the individual to achieve development where self-realisation is possible and to maintain their new skills of managing their lives and keep interventions in place, as they continue in their development of psychological and physical health.
As mentioned previously, this is an expensive time consuming process. It can range from 6 months to 5 years of repeated treatment and support for an individual to establish drug and alcohol free living.
A private admission of a 28 day stay in the Betty Ford Clinic, which is a popular choice for many Hollywood Celebrity’s, costs upward of $22,000. In countries where drug and alcohol treatment is funded by governments, this becomes a very expensive health service to provide to a relatively small number of the public and other options have needed to be considered to assist those experiencing addiction.
There are many different models in place to provide assistance before someone enters treatment, providing an introduction to addiction treatment and some therapy groundwork, to prepare people for better treatment outcomes.
This is where Harm Reduction has its value. It is a cheap, quick intervention which not only assists to keep people alive and disease free while preparing for treatment, but also connects them to treatment services to receive further information, education and interventions in the interim.
Harm Reduction acts as an interim measure to keep people alive and healthy while they go through the process of change, in which they will still be exposed to many risks from their drug and alcohol use. Although governments funding addiction interventions are doing so for a relatively small number of their populations, the health impacts on greater numbers in society are much larger.
Drug and alcohol users also have sexual partners and families, meaning their addiction not only psychologically impacts those members, but also places them at risk of contracting HIV and Hepatitis, which have a high prevalence amongst drug and alcohol users, particularly those who inject drugs or engage in the sex trade to fund their addiction.
Harm Reduction is both health promotion and disease prevention:
It ignores the disparity existing in populations to provide access to health care and interventions to marginalised populations existing in all of our societies.
Examples of harm reduction interventions are education and screening for HIV and sexually transmittable infections, education and access to condoms and the provision of needle and syringe programs, for injecting drug users.
Education forms a key component of harm reduction interventions and makes great use of peer networks to establish & maintain a base from which targeted interventions can flow freely. This also serves to tighten the community connections amongst drug and alcohol users, which improves the establishment of the Harm Reduction message and provides opportunities for drug users to support and educate each other on the risks and nature of addiction.
Lebanon hosted the 22nd International Harm Reduction Conference in 2011, and showcased the fantastic work which is being done throughout the country and the region. It was no surprise that Lebanon was revealed to be the most progressive in the region when it comes to Harm Reduction, having established and supported a diverse range of Harm Reduction and social services.
Further information on Harm Reduction philosophy and local services can be found here, including the Vienna Declaration:
· Vienna Déclaration
· Harm Reduction International
· Skoun, Beirut, Lebanon
· SIDC, Beirut, Lebanon
· MENAHRA, Beirut, Lebanon
· UN Drug Control
Harm Reduction approaches the risks of drug and alcohol use from a public health and human rights perspective, crossing traditional barriers to accessing support and interventions and bringing them to the person, wherever they are and meeting their needs, whatever they may be.
Countries such as The Netherlands, Portugal, The UK, South Africa and Australia have seen great returns on investment when it comes to implementing harm reduction policy, programs and practices, actively managing HIV education and transmission prevention within their regions. Millions of dollars can be saved by preventing harm rather than trying to manage the epidemics once established in populations.
The return on investment report, commissioned by the Australian Government, is used throughout the world to illustrate the vast amounts of money which can be saved by governments in preventing HIV transmission by the use of Syringe Programs, which are also the first point of call for drug and alcohol users to enquire about addiction treatment.
“Syringe Programs return $4.00 for every $1.00 invested:
· Distributing syringes to drug injectors had prevented at least 32,000 HIV infections and 100,000 Hepatitis C infections across Australia in the past 10 years, new research has found.
· The report shows that only 0.1 per cent of drug injectors are HIV positive, but 14 per cent would be if there were not needle and syringe programs throughout thousands of places in Australia.
· Total government funding for NSP nationally was only $27 million a year on average. But, that has saved taxpayers more than $1.3 billion since 2000.”
Prejudice, discrimination and lack of education form barriers to the development and implementation of harm reduction policy, services and interventions.
Laws which impose criminal sanctions for drug addiction constitute major barriers to reaching key populations with HIV services and Harm Reduction advocates for the behaviour to be decriminalized, and states people addicted to drugs should receive access to health services for the treatment of their addiction.
While intervention coverage is increasing globally, the current baseline coverage in many countries remains very low. With a rapid scale-up plan to accelerate coverage, countries can avert new infections among men and women who use drugs, engage in the sex trade and other high risk behaviours which go hand in hand with drug addiction.
In terms of public health, addressing the health needs of vulnerable populations addresses the health needs of the whole population. Everyone in every society is impacted by the levels of blood borne virus transmission which exist locally and globally. Less risk for me means less risk for you and this makes harm reduction everyone’s business.
Why help ?
These populations are members of our communities, wether people like it or not, or if they enjoy freedoms or are ignored and suffer prejudices. Due to this, the existence of transmission risks for blood borne viruses such as HIV and the Hepatitis C Virus are an ignored reality for many people who are unaware of the risks to public health and the interventions which exist to secure public health.
Stemming transmissions, giving access to treatments and the monitoring of population health effectively reduce harms and stop blood borne viruses.
Response to the epidemics is rightfully determined by the local governing bodies and their understanding of public health management. Harm reduction policy demonstrates a commitment to reducing the incidences of blood borne virus transmissions and drug related harms, it educates populations and raises awareness of risks and harms. It is also the standard the United Nations recommends for the development of illicit drug policies.
In 2009, a United Nations press release called for governments around the world to use Harm Reduction informed policy to ensure the protection human rights in the development of illicit drug control regimes.
“Individuals who use drugs do not forfeit their human rights. These include the right to the highest attainable standard of physical and mental health (including access to treatment, services and care), the right not to be tortured or arbitrarily detained, and the right not to be arbitrarily deprived of their life. Too often, drug users suffer discrimination, are forced to accept treatment, marginalized and often harmed
by approaches which over-emphasize criminalization and punishment while under-emphasizing harm reduction and respect for human rights. This is despite the longstanding evidence that a harm reduction approach is the most effective way of protecting rights, limiting personal suffering, and reducing the incidence of HIV. Let me stress that this is particularly the case for those in detention, who are already vulnerable to many forms of human rights violations.”
UN Human rights chief calls for international drugs policy to include focus on human rights and harm reduction