Having formally emerged in the United States in the 1990s, harm reduction is a public health approach to managing substance use and other behaviors that pose risk of harms to the individual and society.  Initial efforts in the U.S. were pioneered by the late Alan Marlatt—an internationally-renowned professor at the University of Washington who in 1998 published the seminal textbook on harm reduction¹. 

Dr. Marlatt drew inspiration from the compassionate pragmatism inherent in successful public health examples occurring at that time in the Netherlands, Switzerland, the United Kingdom, Canada, and Australia.  He distilled this set of principles, that harm reduction:

• Is a public health alternative to the moral and disease models of addiction
• Recognizes abstinence as a helpful goal, but accepts other goals that reduce harm
• Emerged primarily as a ‘bottom-up’ movement based on approach based on advocacy by persons with lived experience
• Promotes low-threshold access to services as an alternative to traditional approaches
• Reflects tenets of compassionate pragmatism instead of moralistic idealism  

Another renowned proponent of harm reduction, Andrew Tatarsky, later proposed additional values underlying the harm reduction approach for persons who provider therapeutic services².  These are to: 

• See the client as an individual
• Start where the client is ("meet them where they are")
• Assume the client has strengths that can be supported
• Accept incremental changes as steps in a helpful direction
• Do not hold abstinence (or other preconceived notions) as a precondition
• Develop a collaborative, empowering therapeutic relation
• Avoid stigmatizing substance use behavior, and persons who engage in it

With passage of time, public opinion has become more accepting of harm reduction principles and values, Though what the public embraces as harm reduction services or resources continues to evolve, two persistent pillars that define harm reduction—compassion and pragmatism—should continue to guide efforts to reduce personal harms to individuals and macro-harms to society³.  Such efforts are now promoted amongst prominent American institutions like the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of National Drug Control Policy, and Centers for Disease Control and Prevention, among others.        

1. Marlatt, G.A, (1998).  Harm reduction: Pragmatic strategies for managing high-risk behaviors (1^st Ed.).  Guilford Press, New York.
2. Tatarsky, A. (2002).  Harm reduction psychotherapy.  Aronson, Northvale, NJ.
3. Marlatt, G.A., Larimer, M.E., & Witkiewitz, K. (2012).  Harm reduction: Pragmatic strategies for managing high-risk behaviors (2^nd Ed.).  Guilford Press, New York.   

Looking for Harm Reduction Trainings and Technical Assistance?

If you are interested in harm reduction training or technical assistance please contact us at [email protected].

Harm Reduction in Practice:  Integration Principles into Practice

Harm Reduction, within the context of clinical care, aims to decrease the unwanted impacts of substance use and other behaviors on the lives of our clients. While Harm Reduction is gaining traction and interest throughout behavioral health, the integration of Harm Reduction principles may be challenging for some as many evidence-based practices utilized by the field may be perceived to be at odds with a perspective that isn’t strictly aiming for abstinence as the end result of care.

This 6-hour training is designed to pull together familiar practices and concepts like Motivational Interviewing and the Stages of Change to provide a framework for how to integrate the principles of Harm Reduction into an existing clinical practice.

Learning Objectives:

• Gain an understanding of the principles of harm reduction
• Be able to describe HR in practice and as a framework
• Understand the role of ambivalence as it relates to Harm Reduction
• Gain an understanding of change planning within the context of Harm Reduction, utilizing MI skills.

Beyond Clean Needles: How Peers Talk About Harm Reduction

This 3-hour virtual training examines how Recovery Mentors, Recovery Coaches, and Peer support specialists may talk to the people they serve using the language of harm reduction. This interactive training aims to support those in the recovery field who utilize their own lived experience but may be seeking additional support to aid the peers/ community members they support through a lens of harm reduction by providing opportunities for learning, discussion, and practice of related skills.

Learning Objectives:

• Learn trauma informed language for harm reduction
• Explore harm reduction practices for opioids, methamphetamine, alcohol, benzodiazepines, and cocaine
• Discuss the importance of leading from a place of compassion and advocacy in these conversations.

Additional Resources

From Northwest ATTC

Northwest ATTC Webinar Series

• Harm Reduction Efforts in Idaho. Marjorie Wilson. October 2022.
• Harm Reduction: Past, Present, and Future. Paul LaKosky, PhD. April 2023.
• Beyond Clean Needles: How Peers Talk About Harm Reduction. Sean Mahoney. December 2022.
• Harm Reduction in Rural Alaska. Sarah Spencer, DO, FASAM. April 2022.
• Becoming a Harm Reductionist. Callan Fockele, MD, MS. December 2021.
• Harm Reduction Service Use and Delivery: Lessons Learned from Vancouver, Canada. Jenna van Draanen, PhD, MPH. July 2021.
• Harm Reduction: An Organizing Framework to Address the Opioid Epidemic. Susan E. Collins, PhD. October 2018.
• Browse more webinars from the Northwest ATTC

Talking to Change: A Motivational Interviewing Podcast.

•  Episode #71 – MI and Harm Reduction with Dr. Kasey Claborn
• Episode #44: MI and Social Support for Opioid and Stimulant Use Disorders with Paul Delaney.
• Episode #42: MI for People with Opioid Use and Stimulant Use Disorders with Roy Stein, MD.
• Browse more episodes of Talking to Change.

From ATTC Network

• Webinar: Practicing Harm Reduction for Justice Involved Clients. Northeast & Caribbean ATTC. November 2023.
• Harm Reduction: A Pragmatic, Clinical Model for the Treatment of Persons with Substance Use Disorders. Northwest & Caribbean ATTC. September 2023.
• Webinar: The Perfect and the Good: Engaging People Around Harm Reduction and Non-Abstinence Based Goal Setting. Mountain Plains ATTC. June 2023.
• Webinar series: Building Bridges Between Harm Reduction & Treatment for People with Substance Use Disorders (part one and part two). Northeast & Caribbean ATTC. May 2023.
• Harm Reduction Awareness for Latino Communities: Infographic. National Hispanic and Latino ATTC. August 2022.

From other SAMHSA-Funded Entities

• SAMHSA Harm Reduction Framework
• National Harm Reduction Technical Assistance Center (NHRTAC) (CDC and SAMHSA collaboration)