Strategies for implementation of harm reduction in treatment settings.

Harm reduction is a set of strategies that we all use everyday to protect us from the harms of living in a complex world. Central to the principles of harm reduction is the need to respect the client's autonomy and develop a relationship of mutual collaboration with the goal of reducing drug- and alcohol-related harm. Additional principles stress the need to develop a hierarchy of client needs, a list that includes all other services, with the importance for each set by the client. Harm reduction implementation includes a range of interventions including abstinence. Some interventions are controversial, including needle exchange, but most are traditional health promotion activities such as videos, health fairs, and drug education. Essential to implementing harm reduction is a recognition that, even for those who wish to become abstinent, this goal is difficult to achieve and maintain. We must acknowledge this and stop the practice of imposing punitive sanctions on clients who use drugs while in treatment. Exclusion or expulsion from treatment settings does nothing to reduce drug use and greatly increases the harm to the client. In conclusion, just as we need to respect diversity among our clients, staff must find a way to respect each others' ideas and concerns as we develop new ways to implement harm reduction in our work.