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Harm reduction approaches to alcohol use
Abstract
Harm reduction approaches to alcohol problems have endured a controversial history in both the research literature and the popular media. Although several studies have demonstrated that controlled drinking is possible and that moderation-based treatments may be preferred over abstinence-only approaches, the public and institutional views of alcohol treatment still support zero-tolerance. After describing the problems with zero-tolerance and the benefits of moderate drinking, the research literature describing prevention and intervention approaches consistent with a harm reduction philosophy are presented. Literature is reviewed on universal prevention programs for young adolescents, selective and indicated prevention for college students, moderation-based self-help approaches, prevention and interventions in primary care settings, pharmacological treatments, and psychosocial approaches with moderation goals. Overall, empirical studies have demonstrated that harm reduction approaches to alcohol problems are at least as effective as abstinence-oriented approaches at reducing alcohol consumption and alcohol-related consequences. Based on these findings, we discuss the importance of individualizing alcohol prevention and intervention to accommodate the preferences and needs of the targeted person or population. In recognizing the multifaceted nature of behavior change, harm reduction efforts seek to meet the individual where he or she is at and assist that person in the direction of positive behavior change, whether that change involves abstinence, moderate drinking, or the reduction of alcohol-related harm. The limitations of harm reduction and recommendations for future research are discussed.
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“however, these approaches may not be clinically indicated for individuals adverse to the disease model of addiction (6) or whose spiritual beliefs and/or lifestyle are in conflict with the 12-step philosophy.”
From Mindfulness-Based Relapse Prevention for Substance Use Disorders: A Pilot Efficacy Trial (2009) · cites this paper as [6]
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Metadata
- Authors
- Marlatt, G. A., & Witkiewitz, K.
- Affiliations
- University of Washington (US)
- Corresponding author
- Marlatt, G.Alan
- ORCID
- Witkiewitz, Katie
- Venue
- Addictive Behaviors
- Publisher
- Elsevier BV
- Published
- 2002-11
- Volume
- 27
- Issue
- 6
- Pages
- 867-886
- ISSN
- 0306-4603 (ISSN-L)
- OpenAlex
- W1261242356
- Cited by
- 491
- References
- 120
- Citations by year
- 2026: 10 · 2025: 13 · 2024: 20 · 2023: 15 · 2022: 23 · 2021: 32 · 2020: 78 · 2019: 16 · 2018: 21 · 2017: 17 · 2016: 25 · 2015: 24 · 2014: 19 · 2013: 23 · 2012: 21
- FWCI
- 1.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Addictive Behaviors (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- harm reduction, alcohol consumption, abstinence, zero tolerance policy, alcohol prevention, university students, adolescents, primary care, pharmacotherapy, psychosocial interventions, self-help, personalized interventions, behavior change
- MeSH terms
- Adolescent, Adult, Aged, Alcohol Deterrents, Alcohol Drinking, Alcoholism, Behavior Therapy, Female, Health Education, Health Promotion, Health Services Accessibility, Humans, Male, Middle Aged, Preventive Health Services, Randomized Controlled Trials as Topic, Adolescent Health Services, Harm Reduction
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