Evidence has shown that strategies promoting abstinence, or encouraging a zero-tolerance approach to substance abuse, have little impact on curbing risky behaviors. Harm reduction is an approach that accepts that behaviors such as substance abuse are inevitable in society and instead focuses on working to meet people where they are in their struggle or recovery. It targets at-risk populations and primarily focuses on the social, health and economic well-being of the community, rather than, for example, measurement of drug consumption.
As we know, there is an epidemic of substance abuse in the United States. The number of Americans using, abusing and facing serious health impacts from substance use continues to increase. About 20 percent of Americans 12 and over who drink have an alcohol-use disorder, the annual overdose rate increases at a rate of four percent and 25 percent of illegal drug users have a drug disorder.
College students are a population incredibly vulnerable to the risk of substance use, abuse and health impacts. Drug use is highest among people ages 18-25 at 39 percent, and 35 percent of college students describe using illegal drugs instead of prescription drugs. Students often report utilizing substances to cope with stress or emotional turmoil, as they frequently experience emotional impacts from various obstacles faced at college.
Historically, the United States addresses substance abuse through endorsing programs which completely discourage the behavior and promote abstinence. Programs such as D.A.R.E. were previously funded by hundreds of millions of dollars. However, there have been no large-scale evaluations which detail or support the effectiveness of abstinence programs such as this.
Many harm reduction programs conduct outreach that aims to relieve populations at risk of negative health consequences from drug use. Within the last few years, overdose prevention sites have been established. These provide drug users with an environment equipped to provide life-saving assistance in the case of overdose or other health impacts. Other programs hand out free syringes, fentanyl tests, naloxone kits and sterile injection or smoking equipment.
Opponents to harm reduction argue that providing substance users with these resources may incentivize drug use. However, drug users will likely use substances whether they have the appropriate resources or not. Withholding safe resources will not prevent people from using drugs, but rather only makes it more dangerous.
Harm reduction programs that aim to help adolescents may utilize motivational interviewing, and guidance that recognizes the individual’s goals. Motivational interviewing supports an individual’s change in a way that is parallel to the individual’s personal values and goals. Rather than coercively imposing change on an individual, it works to identify, examine and resolve an individual’s ambivalence about changing their behavior.
The Alcohol Skill Training Program (ASTP) and Brief Alcohol Screening and Intervention of College Students (BASICS) are programs which explicitly use harm reduction principles. They are used to help college students in managing their alcohol use and abuse and utilize strategies such as motivational interviewing, one-on-one guidance, information dissemination and other prevention strategies. Both programs have evidence which supports their efficacy in reducing the consequences associated with drinking among college students.
UMass provides the BASICS programs to at-risk students and any other student who feels they need assistance. This is a great step in the direction of utilizing harm reduction to aid college students in reducing the prevalence of substance use/abuse and associated impacts—however, I feel that more must be done. College campuses in the United States should make programs such as BASICS or ASTP available to students in need of guidance in alcohol use and abuse. This should be done in addition to other harm reduction strategies within campuses to aid college students with other substance use.
Harm reduction challenges the notion that a zero-tolerance approach effectively confronts the prevalence of substance abuse and acknowledges that this approach does not decrease the demand, use or negative impacts of substance abuse. Especially among college students, substance use is inevitable. Rather than trying to eliminate substance use, we must work with students to reduce the prevalence of using substances and consequences associated with substance use.
Juliette Perez can be reached at [email protected].
