Cited by 220Substance Abuse Treatment and OutcomesHIV, Drug Use, Sexual RiskHomelessness and Social Issues

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Update on Harm-Reduction Policy and Intervention Research

Marlatt, G. Alan, Witkiewitz, Katie·2010·Annual Review of Clinical Psychology

DOI 10.1146/annurev.clinpsy.121208.131438

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Abstract

Harm reduction is a pragmatic approach to reduce the harmful consequences of alcohol and drug use or other high-risk activities by incorporating several strategies that cut across the spectrum from safer use to managed use to abstinence. The primary goal of most harm-reduction approaches is to meet individuals “where they are at” and not to ignore or condemn the harmful behaviors but rather to work with the individual or community to minimize the harmful effects of a given behavior. The current review addresses some of the newest developments with respect to harm-reduction policy, prevention, and treatment. In particular, this review highlights policies and programs that have been evaluated in peer-reviewed journals and shown to be effective at reducing the harms associated with alcohol and drug use. The overall goal of this review is to present some of the most recent developments in the field of harm reduction.

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Alcohol Intervention for Adolescents with Fetal Alcohol Spectrum Disorders: Project Step Up, a Treatment Development Study
O’Connor, M. J., Quattlebaum, J., Castañeda, M., & Dipple, K. M. (2016) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.13111 · Cited by 23
Substance use stigma: A systematic review of measures and their psychometric properties
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“Structural stigma also impedes effective harm reduction policies such as safe consumption sites (Ahrens, 2020; Hawk et al., 2015; Marlatt and Witkiewitz, 2010).”
Background
Homelessness & Health in Canada
Guirguis‐Younger, M., Hwang, S. W., & McNeil, R. (2014) · University of Ottawa Press eBooks · doi:10.26530/oapen_515362 · Cited by 22
Harm Reduction for Women in Treatment for Alcohol Use Problems: Exploring the Impact of Dominant Addiction Discourse
Brown, C. G., & Stewart, S. H. (2020) · Qualitative Health Research · doi:10.1177/1049732320954396 · Cited by 21
“…evidence that shows harm reduction as a realistic alternative for individuals struggling with alcohol use problems (Davis & Rosenberg, 2013; Marlatt & Witkiewitz, 2010; Pauly et al., 2018; Sobell & Sobell, 1995; Stockwell et al., 2018; Vallance et al., 2016), harm reduction struggles to…”
BackgroundInfluential
Interventions for Alcohol and Drug Use Disorders in Young People: 10 Key Evidence-Based Approaches to Inform Service Delivery
Christie, G. I. G., Cheetham, A., & Lubman, D. I. (2020) · Current Addiction Reports · doi:10.1007/s40429-020-00336-6 · Cited by 20
Alcohol Prevention and School Students
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“A harm minimization approach is arguably more relevant to students, as it permits an overt focus on the types of drug use decisions young people make (Marlatt & Witkiewitz, 2010).”
Background
Motivation Precedes Goal Setting in Prediction of Cannabis Treatment Outcomes in Adolescents
Spinola, S., Park, A., Maisto, S. A., & Chung, T. A. (2016) · Journal of Child & Adolescent Substance Abuse · doi:10.1080/1067828x.2016.1237917 · Cited by 19
Evaluation of a Brief Personalised Intervention for Alcohol Consumption in College Students
Clarke, N., Field, M., & Rose, A. K. (2015) · PLoS ONE · doi:10.1371/journal.pone.0131229 · Cited by 20
“Secondly, general harmreduction strategies rarely fit the population as a whole, therefore policies may be more effective if personalised to the individual [13].”
Background
Goal commitment predicts treatment outcome for adolescents with alcohol use disorder
Kaminer, Y., Ohannessian, C. M., McKay, J. R., Burke, R. H., & Flannery, K. M. (2017) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.07.035 · Cited by 18
Brain-Derived Neurotrophic Factor Prevents Depressive-Like Behaviors in Early-Symptomatic YAC128 Huntington’s Disease Mice
da Fonsêca, V. S., Colla, A. R. D. S., Nascimento-Castro, C. D. P., Plácido, E., Rosa, J. M., Farina, M., Gil‐Mohapel, J., Rodrigues, A. L. S., & Brocardo, P. S. (2018) · Molecular Neurobiology · doi:10.1007/s12035-018-0890-6 · Cited by 19
Opportunities, challenges and ethical issues associated with conducting community-based participatory research in a hospital setting
Strıke, C., Guţă, A., de Prinse, K., Switzer, S., & Carusone, S. C. (2016) · Research Ethics · doi:10.1177/1747016115626496 · Cited by 18
“Harm reduction is an approach that seeks to reduce the risks associated with substance use (Marlatt and Witkiewitz, 2010).”
Background
Identifying barriers and facilitators for implementing harm reduction strategies for methamphetamine use into hospital settings
Forchuk, C., Serrato, J., & Scott, L. (2023) · Frontiers in Health Services · doi:10.3389/frhs.2023.1113891 · Cited by 17
“Gaining acceptance from frontline staff could be challenging, particularly as current policy and legislation focus on substance supply and demand reduction which may lead to health care providers feeling contradictory, immoral, or enabling (27, 28).”
Background
Mindfulness in Pregnancy: A Brief Intervention for Women at Risk
Abatemarco, D. J., Gannon, M., Short, V. L., Baxter, J., Metzker, K. M., Reid, L., & Catov, J. M. (2021) · Maternal and Child Health Journal · doi:10.1007/s10995-021-03243-y · Cited by 16
Participation in Canadian Managed Alcohol Programs and Associated Probabilities of Emergency Room Presentation, Hospitalization and Death: A Retrospective Cohort Study
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Consumer and Practitioner Perceptions of the Harm Reduction Approach in a Community Mental Health Setting
Mancini, M. A., & Wyrick-Waugh, W. (2011) · Community Mental Health Journal · doi:10.1007/s10597-011-9451-4 · Cited by 18
“Studies of this approach, such as the ‘‘Housing First’’ model, have demonstrated higher rates of engagement and retention, stable housing, perceived choice, and client satisfaction of homeless persons with COD without increasing drug and alcohol use (Marlatt and Witkiewitz 2010; Padgett et al. 2006, 2008; Tsemberis et…”
Method
Perceptions of stigma among people with lived experience of methamphetamine use within the hospital setting: qualitative point-in-time interviews and thematic analyses of experiences
Forchuk, C., Serrato, J., & Scott, L. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1279477 · Cited by 13
Harm reduction acceptability and feasibility in a North American indigenous reserve community
Goldstein, S. C., Spillane, N. S., Nalven, T., & Weiss, N. H. (2022) · Journal of Community Psychology · doi:10.1002/jcop.22859 · Cited by 13
The color of safety: Ingroup-associated colors make beer safer
Loersch, C., & Bartholow, B. D. (2010) · Journal of Experimental Social Psychology · doi:10.1016/j.jesp.2010.09.001 · Cited by 13
“…a number of “ party safe ” or harm-reduction techniques (e.g., counting drinks, appointing a designated driver, and using a buddy system; for review see Marlatt & Witkiewitz, 2010) and was modi ﬁ ed here to contain a large image of three drink cans (Coca-Cola®, ginger ale, and a focal beverage)…”
Substance use profiles among gang-involved youth: Social ecology implications for service approaches
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Development of a Telephone-Delivered Acceptance and Commitment Therapy Intervention for People Living with HIV who are Hazardous Drinkers
Woolf-King, S. E., Firkey, M., Foley, J. D., Bricker, J., Hahn, J. A., Asiago-Reddy, E., Wikier, J., Moskal, D., Sheinfil, A. Z., Ramos, J., et al. (2022) · AIDS and Behavior · doi:10.1007/s10461-022-03649-x · Cited by 10
“The primary changes at this stage were related to: (1) shifting from an abstinencebased approach to a harm reduction approach, and assuming variability in motivation to change, rather than a desire to initiate a quit attempt [60].”
Background
Smoked cocaine in socially-depressed areas
Delás, J., Adán, E., Díaz, O., Aguas, M., Pons, M. E., & Fuertes, R. (2010) · Harm Reduction Journal · doi:10.1186/1477-7517-7-27 · Cited by 11
“The primary goal of most harm-reduction approaches is to meet individuals “where they are at” [10].”
Background
Drug testing in child welfare: A systematic review
Lloyd, M. H., & Brook, J. (2019) · Children and Youth Services Review · doi:10.1016/j.childyouth.2019.104389 · Cited by 11
Harm reduction: a public health approach to prison drug use
Belisle, L. A., & Solano-Patricio, E. D. C. (2021) · International Journal of Prisoner Health · doi:10.1108/ijph-06-2021-0053 · Cited by 10
Cannabis and Harm Minimisation Drug Education: Findings from the Drug Education in Victorian Schools Study
Lester, L., Midford, R., Cahill, H., Mitchell, J., Ramsden, R., FOXCROFT, D. R., & Venning, L. (2014) · Journal of Addiction & Prevention · doi:10.13188/2330-2178.1000012 · Cited by 10
“Harm minimisation includes abstinence as a preventative strategy [12]: it is more broadly relevant to students [13] and does not increase up take or level of use [14,15].”
Background
Alcoholism Risk Reduction in France: A Modernised Approach Related to Alcohol Misuse Disorders
Brousse, G., Bendimerad, P., de Chazeron, I., Llorca, P., Perney, P., & Demattéis, M. (2014) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph111111664 · Cited by 9
“up to total and permanent abstinence and passing through a controlled consumption [3].”
Background
Understanding overdose incidents in Canadian federal custody
McKendy, L., Biro, S. M., Miron, M., & Keown, L. A. (2021) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2021.103131 · Cited by 9
Use of Both Alcohol and Cannabis Protective Behavioral Strategies is Associated with Fewer Negative Consequences: A Moderation Analysis
Livingston, N. R., Berry, K. A., Meier, E. M., Looby, A. R., & Harm Reduction Research Team (2023) · Substance Use & Misuse · doi:10.1080/10826084.2023.2201842 · Cited by 8
“PBS are primary components within extant alcohol and other substance use interventions, particularly those tailored to college students (Dimeff, 1999; Marlatt & Witkiewitz, 2010).”
Background
Profiles of alcohol and cannabis protective behavioral strategies use across two large, multi-site college student samples of concurrent alcohol and cannabis users
Richards, D. K., Greń, J. D., & Pearson, M. R. (2023) · Addictive Behaviors · doi:10.1016/j.addbeh.2023.107789 · Cited by 8
Smoking Prevention for Students: Findings From a Three-Year Program of Integrated Harm Minimization School Drug Education
Midford, R., Cahill, H., Lester, L., FOXCROFT, D. R., Ramsden, R., & Venning, L. (2016) · Substance Use & Misuse · doi:10.3109/10826084.2015.1110173 · Cited by 8
“Compared to a singular focus on abstinence, harm minimization is more relevant to students because it can focus flexibly on the contextual nature of drug use decisions by young people (Marlatt & Witkiewitz, 2010).”
Background
Individual differences in distress, impulsivity, and coping motives for use as predictors of problematic ecstasy use
Meikle, S. E., Carter, O. L., & Bedi, G. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106397 · Cited by 8
An Updated Narrative Review on the Role of Alcohol Among Indigenous Communities
Cole, A. B., Lopez, S. V., Armstrong, C. M., Gillson, S. L., Weiss, N. H., Blair, A. L., & Walls, M. L. (2023) · Current Addiction Reports · doi:10.1007/s40429-023-00520-4 · Cited by 7
“Harm reduction approaches represent compassionate and pragmatic strategies applied to policy, populations, communities, or individuals that aim to minimize alcohol-related harm and enhance quality of life without requiring or advising abstinence or use reduction [90, 91].”
Background
The Adolescent Substance Abuse Goal Commitment (ASAGC) Questionnaire: An Examination of Clinical Utility and Psychometric Properties
Kaminer, Y., Ohannessian, C. M., McKay, J. R., & Burke, R. H. (2015) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2015.09.007 · Cited by 7
“These factors adhere to the conceptual framework utilized in the field of SUD (Jellinek, 1960; Marlatt & Witkiewitz, 2002; Marlatt & Witkiewitz, 2010; Vaillant, 2003).”
Background
Addiction syndrome: Relapse and relapse prevention.
Hsu, S., & Marlatt, G. A. (2012) · American Psychological Association eBooks · doi:10.1037/13750-005 · Cited by 7
Self-citation
Repositioning Social Work Practice in Mental Health in Nova Scotia
Brown, C. G., Johnstone, M., & Ross, N. (2021) · DalSpace (Dalhousie University) · Cited by 7
Lessons From the Frontlines of the Overdose Crisis: Exploring the Impact of Harm Reduction Policies on the Roles and Responsibilities of First Responders
Witkowski, K. G. K. (2023) · Public Personnel Management · doi:10.1177/00910260231171055 · Cited by 6
“However, emerging evidence on NEPs shows promising results in reducing the spread of HIV, increasing access to health care, and decreasing mortality rates (Logan & Marlatt, 2010; Marlatt & Witkiewitz, 2010; B. D. Marshall et al., 2011).”
Background
Seeking the middle way: G. Alan Marlatt and harm reduction
Blume, A. W. (2012) · Addiction Research & Theory · doi:10.3109/16066359.2012.657281 · Cited by 6
“Marlatt and Witkiewitz (2010) also suggested that more research be conducted to demonstrate the costeffectiveness of harm reduction.”
Background
Negative Urgency as a Risk Factor for Hazardous Alcohol Use: Dual Influences of Cognitive Control and Reinforcement Processing
Rawls, E., Wolkowicz, N. R., Ham, L. S., & Lamm, C. (2021) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2021.108009 · Cited by 6
Alcohol prevention for school students: Results from a 1-year follow up of a cluster-randomised controlled trial of harm minimisation school drug education
Midford, R., Cahill, H., Lester, L., Ramsden, R., FOXCROFT, D. R., & Venning, L. (2017) · Drugs Education Prevention and Policy · doi:10.1080/09687637.2017.1290788 · Cited by 6
“Taking a harm minimisation, rather than an abstinence approach, to school drug education is arguably more relevant to students, as it permits discussion of drug use decisions young people make (Marlatt & Witkiewitz, 2010).”
Background
Drinking under control programmes: perception of alcohol-related harm reduction measures in Poland. Results of qualitative study among outpatient alcohol treatment providers
Klingemann, J. I., & Klingemann, H. (2017) · Alcoholism and Drug Addiction · doi:10.5114/ain.2017.72310 · Cited by 6

Authors: Marlatt, G. A., & Witkiewitz, K.
Affiliations: University of Washington (US)
ORCID: Witkiewitz, Katie
Venue: Annual Review of Clinical Psychology
Publisher: Annual Reviews
Published: 2010-03-01
Volume: 6
Issue: 1
Pages: 591-606
ISSN: 1548-5943 (ISSN-L)
1548-5951
DOI: 10.1146/annurev.clinpsy.121208.131438
OpenAlex: W2113041994
Cited by: 220
References: 79
Citations by year: 2026: 16 · 2025: 13 · 2024: 20 · 2023: 17 · 2022: 10 · 2021: 18 · 2020: 19 · 2019: 13 · 2018: 10 · 2017: 15 · 2016: 11 · 2015: 12 · 2014: 17 · 2013: 13 · 2012: 8
FWCI: 1.05
Type: journal article
Language: en
Open access: closed
Locations: Annual Review of Clinical Psychology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
Social Sciences › Sociology and Political Science › Homelessness and Social Issues
Keywords: harm reduction, harm reduction policy, alcohol consumption, drug use, substance use prevention, addiction treatment, harm reduction interventions, abstinence
MeSH terms: Mental Disorders, Drug Therapy, Health Policy, Health Promotion, Humans, Psychotherapy, Public Policy, Temperance, Comorbidity, Diagnosis, Dual (Psychiatry), Substance-Related Disorders, Harm Reduction

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Update on Harm-Reduction Policy and Intervention Research

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