By 2019 I had grown concerned enough about the occasionally all-encompassing nature of Harm Reduction as an activist ideology (rather than the set of sound clinical practices in harm reduction I’ve literally seen and been involved in across my entire career since 1988), that I coined a term for the sake of my own clarity. That term is the “Harms of Use”.
The idea I had was to turn the idea of reducing the harm of using in the other direction. That is to say, I decided to start to examine the simple harms of simple use.
We know from decades of epidemiological data and studies examining the characteristics of clinical populations that most people who use substances never develop a substance use disorder.
And we know further, that most people with a substance use disorder get better (remission, etc.) without any clinical assistance.
So that makes me wonder, “What are the harms of use?” In other words, what harms does simple using cause?
In truth, part of my struggle leading me to coin this term and explore this topic is the idea of “Do no harm” as an ethical mandate for licensed or credentialed clinical professionals. Before I suggest something, or deliberately ignore something, I need to know the pro’s, con’s, effects, and side effects. Thus, I undertook a serious and prolonged study of this topic.
Part of my effort led me to compile a list of references. I used that list of references to develop and co-facilitate a workshop with an MD turned addiction counselor – for people working in clinical capacities within addiction treatment settings. Being able to share both the development and facilitation of that workshop with an MD/addiction counselor was a real learning opportunity for me.
Something we both noticed is that what was formerly clandestine (illicit substances) were becoming prescribed. And what were pharmaceuticals previously available only by prescription (licit substances) were moving their manufacturing and availability into clandestine spaces. I learned a lot from reading the papers in that list of references, and additional papers as well. I continue to read in that area to this very day.
Along the way, a few other papers/topics really stood out to me. Here are some of them.
- No safe level of alcohol use for brain health?
- The effects of paternal alcohol use prior to conception.
- A brain imaging study of the family members of people with alcohol use disorder.
- Healthy lifestyle and cognitive decline in middle-aged and older adults residing in 14 European countries.
- A paper examining the genome of 1,054,365 people from four ancestral groups vs. cannabis.
- The impacts of drinking: quantity vs frequency by age of drinker
- Study betel nut before you finalize your public health or harm reduction policy.
For those that might be interested, here’s the original reference list we compiled: Harms of use: a list of references.
Overall, I’m somewhat less interested in what harm I can diminish, than I am in understanding what harm I cause.
Recovery Review 