Cited by 491Substance Abuse Treatment and OutcomesAlcohol Consumption and Health EffectsBehavioral Health and Interventions

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Harm reduction approaches to alcohol use

Marlatt, G.Alan, Witkiewitz, Katie·2002·Addictive Behaviors

DOI 10.1016/s0306-4603(02)00294-0

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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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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)
DOI: 10.1016/s0306-4603(02)00294-0
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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