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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Harm Reduction Approaches
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Background
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Background
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“…to begin a clinical encounter with someone whose behavior needs to change by accepting their point of view non-judgmentally and gradually building an alliance that would permit the participant to consider new points of view Brown and O'Leary 2000; Marlatt and Witkiewitz 2010; Stratyner 2010).”
Background
Psychology and Population Health Management
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“…reduction paradigm rests on the assumption that substance use disorders are strictly a public health issue, that drug prohibition laws are therefore inappropriate (if not unjust), and that the traditional abstinence-focused approach to treating addiction is misguided (Marlatt & Witkiewitz, 2010).”
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“Harm reduction strategies, including medications for opioid use disorder, syringe exchange, naloxone distribution, and safe injection sites have proven to substantially reduce the likelihood of experiencing overdose and improve substance use treatment retention.(20) Access to harm reduction services is essential for f…”
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“…the harms associated with injecting drugs in the context of the illicit unregulated drug market in North America [25], offering access to sterile syringes and related supplies, thereby reducing the risk of infectious diseases and promoting safer injection practices for people who inject drugs [16].”
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Empirical Foundations and Conceptual Pathways for Social Worker-Led Emotional Intelligence Interventions in Healthcare
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From Comprehensive Distrust to Unquestioned Trust in Street-based Outreach Work With People Who Use Drugs in Finland
Ranta, J., Kuusisto, K., & Shorter, G. W. (2026) · Contemporary Drug Problems · doi:10.1177/00914509261469791 · Cited by 1
Application of Harm Reduction Interventions to Recreational Drug Use
Fernández‐Calderón, F. (2014) · Journal of Socialomics · doi:10.4172/2167-0358.1000e123 · Cited by 1
“One of these circumstances is drug consumption, where intervention under this approach is designed to minimize the potential risks associated with drug use rather than eliminate it [1,2].”
Background
Addictive Disorders: Problems and Interventions at Workplace
Veltrup, C., & John, U. (2020) · Springer eBooks · doi:10.1007/978-3-030-24334-0_28 · Cited by 1
WITHDRAWN: Can providing alcohol to drinkers reduce harm? an evaluation of a canadian managed alcohol program
Vallance, K., Stockwell, T. R., Pauly, B., Chow, C. M., Gray, E., Krysowaty, B., Perkin, K., & Zhao, J. (2014) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2014.12.008 · Cited by 1
EFFICACY OF HARM-REDUCTION THERAPY IN REDUCING ALCOHOL-RELATED PROBLEMS AMONG UNDERGRADUATES IN OWERRI, NIGERIA
Madukwe, A. U., Iwuh, I. I., Uwaoma, N. C., & Njoku, J. C. (2015) · European Scientific Journal ESJ · Cited by 1
Do psychological characteristics of addiction treatment professionals predict acceptance of harm reduction interventions
Lauritsen, K. J. (2017) · OhioLink ETD Center (Ohio Library and Information Network) · Cited by 1
Technology to support relational care for people who use drugs at home: Literature review and key informant content
Szelest, I., Motluk, L., Jennens, H., Lagassé, J., Tailleur, M., & Salvalaggio, G. (2019) · Healthcare Management Forum · doi:10.1177/0840470419836266 · Cited by 1
Intervene to moderate pandemic drinking by university students
Rosansky, J. A., & Rosenberg, H. (2021) · Journal of American College Health · doi:10.1080/07448481.2021.1942888 · Cited by 1
Taking It To The Streets: A Comparative Analysis Of Violent Victimization, The Victim-Offender Overlap, And The Victim-Fear Relationship Among School And Street-Involved Youth In Toronto
Cook, S. (2017) · TSpace (University of Toronto) · Cited by 1
Harm Reduction and Risky Behaviors
Shannon, S. (2017) · doi:10.1093/obo/9780195396607-0222 · Cited by 1
Clients perspectives of managed alcohol programs in the first six months and their relational shifts
Hall, S. A. (2019) · UVic’s Research and Learning Repository (University of Victoria) · Cited by 1
A critical exploration of professional perceptions of harm reduction policy and practice in Vietnam
Truong, T. D. (2019) · doi:10.26686/wgtn.17136515.v1 · Cited by 1
“Although the disease model does not try to blame people who use drugs, as it focuses on factors beyond the control of users such as family history, genetics, and biological vulnerability, there is still a coercive element to treatments and official responses (Marlatt & Witkiewitz, 2010).”
Background
Differential Policy Mobilities: Transnational Advocacy and Harm Reduction Drug Policy
Temenos, C. (2014) · Summit (Simon Fraser University) · Cited by 1
How to stop touching your face to minimize spread of coronavirus and other germs
Benning, S. D., Barchard, K. A., & Labus, B. (2020) · The Conversation · doi:10.64628/aai.kqxnswt9h · Cited by 1
From Response to Prevention: Enhancing EMS Impact With Harm Reduction and HIV Education
Traylor, D. (2024) · Cureus · doi:10.7759/cureus.68884 · Cited by 1
“Harm reduction strategies, such as distributing sterile syringes to prevent HIV and hepatitis C transmission, establishing supervised injection sites, and providing naloxone to reverse overdoses, are proven approaches to mitigating this crisis [3,4].”
Background
Substance Use, Misuse, and Dependence
Lemsky, C. M., & Bogner, J. A. (2025) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197525456.013.0013 · Cited by 1
The Influence of Gender on Perceived Treatment Need among a Community Sample of Substance Users
Vakharia, S. P. (2013) · doi:10.25148/etd.fi13080716
“A number of factors have been attributed to these problems in substance use treatment (Coulson et al., 2009; Marlatt & Witkiewitz, 2010; Tatarsky, 2003).”
Background
Proposals for the Treatment of Users of Alcohol and Other Drugs: A Psychoanalytic Reading
Teixeira, C., & Fernandes, A. H. (2012) · InTech eBooks · doi:10.5772/50643
“…although the zero-tolerance policy to drug use still prevails in some countries, many other, especially in the European Union, adopt the harm reduction approach in the prevention and treatment of drug addiction as well as in the problem arising from it (Marlatt & Witkiewitz, 2010; OEDT, 2011).”
Influential
Nalmefene in Supporting Alcohol Reduction: Observations from a Clinical
Thompson, A., Pirmohamed, M., & Ian, I. (2015)
Factors Associated With Harm Reduction Model Use Among Substance Abuse Counselors
Madden, T. (2016) · ScholarWorks (Walden University)
Prescription Diacetylmorphine Hydrochloride Injections: A Form of Harm Reduction for Chronic Heroin Addicts
Clark, P. A. (2016) · The Internet Journal of Public Health
Abortion in Northern Ireland: rights and regrets.
Naughton, L. (2013) · PubMed
Developmental trajectories of adolescent risky drinking: predictors from the Drug Education in Victoria Schools (DEVS) study
Lester, L., Midford, R., FOXCROFT, D. R., & Cahill, H. (2018) · International Journal of Health Promotion and Education · doi:10.1080/14635240.2018.1478744
“…from previous research that teaching harm minimisation strategies, which aim to meet students at their individual level of experience and knowledge in relation to alcohol and drug use, does not increase consumption or uptake (McBride et al. 2004; Marlatt and Witkiewitz 2010; Hamilton et al. 2007).”
Background
Making a “Pledge”: Moral Suasion and Health Promotion Practice
Laverack, G. (2018) · Challenges · doi:10.3390/challe9020039
Abstinence vs. Harm Reduction for Youth with Substance Use Disorders: “You Can’t Always Get What You Want”
Bagot, K. S., & Kaminer, Y. (2020) · Adolescent Psychiatry · doi:10.2174/2210676610666200327164503
Youth Perspective Towards LGBT’s Behavior Based on Gender: Implications on Social Work
Hassan, A., Halim, A., Maliki, A. B. H. M., Kalfin, K., & Yuningsih, S. H. (2021) · Advances in Social Science, Education and Humanities Research/Advances in social science, education and humanities research · doi:10.2991/assehr.k.210312.092
In pursuit of harm reduction in the Alaskan context: patient cultural explanatory models of addiction and treatment outcomes for a medically-assisted program utilizing a buprenorphine/naloxone formulation
Vásquez, Á. R. (2020) · ScholarWorks - UA (University of Alaska System)
Meso Level
(2021) · Cambridge University Press eBooks · doi:10.1017/9781108976213.013
Bioethical Issues in Healthcare
Clark, P. A. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.95187
Addictive Behavior
Sher, K. J., & Verges, A. J. (2013) · Oxford University Press eBooks · doi:10.1093/obo/9780199828340-0126
Drug Control
Bouchard, M., & Anamali, M. (2012) · doi:10.1093/obo/9780195396607-0129
(Re)Inventar a intervenção social em contexto de pandemias
(2020) · Faculdade de Letras da Universidade do Porto eBooks · doi:10.21747/978-989-8969-56-9/cad4
Harm Reduction
Laverack, G. (2014) · doi:10.1007/978-1-137-35049-7_26
An Examination of Safe Injection Sites and Ethical Issues in Philadelphia, United States
Clark, P. A., & Grana, D. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.104565
Pilot Study: An Exploration of Medication Assisted-Treatment (MAT) for Indigenous Americans Within Tribal Healing to Wellness Courts
University, F. F., University, L. S., Mexico, V. C., Institute, M. G., & University, F. T. (2023) · Journal of Qualitative Criminal Justice & Criminology · doi:10.21428/88de04a1.d21bf9fc
Gender Gaps in Harm Reduction Services: Understanding Women’s Experiences with Supervised Consumption Sites
Carpino, T. (2023) · doi:10.22215/etd/2023-15590
References
(2018) · Wiley eBooks · doi:10.1002/9781394258963.refs
Examination of the Attitudes Toward Substance Use Treatment Approaches by Substance Use Professionals
Ortega, C. L., Kim, J. H., Reed, B. J., & Grizzell, S. T. (2024) · Journal of Applied Rehabilitation Counseling · doi:10.1891/jarc-2023-0011
A preventive mental health service for substance use disorder: harm reduction
Gedik, İ. (2024) · Journal of Nursing Care Research · doi:10.51271/jncr-0004
“I knew where help was.” Identifying Substance Use Patterns, Associated Predictors of Harm, and Barriers to Help Seeking among Music Festival Attendees: The Development of a Targeted Harm Reduction Intervention
Rayner, C. L. (2024) · Cronfa (Swansea University) · doi:10.23889/suthesis.66311
Rural suicide in Newfoundland and Labrador: A qualitative exploration of health care providers’ perspectives
Pritchard, T. R., Buckle, J. L., Thomassin, K., & Lewis, S. P. (2024) · PLoS ONE · doi:10.1371/journal.pone.0306929
Preference for Abstinence-Based Recovery and Public Stigma Toward Substance Use
Meadows, D. C., Moore, K. E., Taylor, B. G., Lamuda, P. A., Schneider, J. A., & Pollack, H. A. (2025) · Substance Use & Misuse · doi:10.1080/10826084.2025.2501171
“Harm reduc tion strategies, on the other hand, encompass recovery approaches that aim to reduce substance use or the harmful consequences of use (Marlatt & Witkiewitz, 2010).”
Harm Reduction in Substance Use Research, Policy, and Practice at a Crucial Public Health Juncture
Read, J. P. (2025) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.25-00174

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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