The Utility of a Harm Reduction Approach in Treating Substance Use Disorders

Substance use, like poverty, is often looked upon as a moral issue in the United States. Who deserves help? Under what conditions? What kind of help should they get? And, most importantly, who should pay for it? As a clinician who practices a harm reduction approach, I believe that these are the wrong questions. When we shift our thinking to recognize that we can help reduce the harmful effects of drug use rather than completely eradicate it, we free up energy (and funds) to support people with addiction and improve society with a different approach.

Defining Harm Reduction in the Context of Substance Abuse

Harm reduction encompasses a set of interventions whose goal is to reduce problematic behaviors¹. When applied to substance abuse, it allows the person who uses drugs to lead decision making about changing their behavior. When applied to treating addiction, in contrast with abstinence only approaches that center the goal of completely stopping use, harm reduction focuses on moving people from behaviors that are most harmful to least harmful, even if it means continuing their use to some degree. It is an approach that aims to neutralize substance abuse through reducing shame and empowering people to guide the steps they are taking towards change. Harm reduction can be practiced in a variety of settings and to varying degrees, from needle exchange programs and safe injection sites to outpatient settings (more details on each below) where people may be in recovery from using harsher street drugs but may continue to smoke cigarettes and/or use cannabis, a population I often see in my private practice work.

Viewing Harm Reduction with a Public Health Lens

When we operate under the assumption that substance use is ubiquitous and that the ‘war on drugs’ was a failure², we can shift our thinking towards understanding substance use from a public health perspective. Needle exchange programs help stem the spread of diseases like Hepatitis C and HIV/AIDS by encouraging people who use drugs to utilize clean needles rather than sharing with one another. Additionally, supervised injection sites allow people who use drugs to be surrounded by trained professionals that can monitor their use in real time and step in should they appear in crisis. These sites also provide an opportunity to assist people who use drugs with other needed services, including STD/HIV testing, primary care services, and mental health support.

Therapeutic Interventions Used in Harm Reduction

• Motivational Interviewing
  • A therapeutic ‘style’ focused on strategies the help clients identify reasons for change and resolve ambivalence³
• Harm Reduction Therapy
  • Limits barriers to treatment, considers any reduction in use a success

Settings Where Harm Reduction Work Takes Place

• Needle exchange programs
• Safe injection sites
• College campuses
• Supportive housing sites
• Outpatient settings
• Trainings on overdose prevention and use of Naloxone

  Policy Issues

We cannot divorce harm reduction from its policy context, a context which is consistently shaped by whomever is in political power at a given moment in our history. Recent changes to harm reduction policy⁴ under the Trump administration have severely limited the Substance Abuse and Mental Health Services Administration (SAMHSA) from providing funding for interventions that focus on harm reduction, such as safe injection sites. This is direct opposition to evidence that suggests that such interventions are in fact successful in reducing use-based harm⁵. Additionally, the current drug scheduling classification system, developed as part of The Controlled Substances Act, classifies drugs based upon potential for abuse and medical use⁶. As it stands, despite the fact that many states have legalized cannabis, either recreationally medically, or both, it continues to be classified as a Schedule I drug, meaning that it is considered to have no medical use and a high abuse potential, limiting researchers ability to study it and states’ ability to better regulate its use.

  Ethical Considerations

Clinicians employing harm reduction interventions should consider factors such as a client’s complex trauma, access to resources, agency policy, individual liability and their own areas of expertise and training. Because of the lack of support for interventions at a federal level, clinicians should be aware of the legal constraints in states where they practice and encourage clients to do their own research, including vet anyone that calls themselves a psychedelic ‘guide’. Clear boundaries with clients on the expectations for sessions (for example, not coming under the influence) are important within any modality to establish a relationship of trust and mutual respect for the work.

Room for Improvement in Harm Reduction Interventions

There are racial disparities in access to harm reduction interventions that must be addressed in order to ensure equitable access to treatment. For example, Black and Latinx individuals who use drugs are less likely to receive Naloxone or overdose prevention training as compared to Whites⁷. This demonstrates that it is nearly impossible to untangle substance abuse from a complex web of other social inequalities and the policies that sustain them. Indeed, research into harm reduction interventions often studies individual level interventions rather than including community and systemic levels factors as well, reflecting current US policy on substance abuse as an individual behavior issues rather than one that is multifaceted⁵.

Summary

Harm reduction, when properly funded and equitably provided, has the potential to change the public health landscape for the better. Individuals who abuse substances deserve a chance at treatment and have a right to enter treatment at whatever point they are at in their recovery process. The sooner we engage in interventions that encourage rehabilitation over incarceration, the closer we can come to improving how people live.

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References:

1. Logan, D. E., & Marlatt, G. A. (2010). Harm reduction therapy: A practice‐friendly review of research. Journal of clinical psychology, 66(2), 201-214.

2. The National Harm Reduction Coalition. Principles of harm reduction. Retrieved on January 23rd ,2026 at https://harmreduction.org/about-us/principles-of-harm-reduction/

3. Miller, W.& Rollnick, S. (2002). Motivational Interviewing: Preparing people for change. New York: Guilford Press.

4. National Alliance to End Homelessness. Understanding Trump’s Executive Order on Homelessness: Rejecting Harm Reduction Services. Retrieved on January 23^rd, 2026 at https://endhomelessness.org/understanding-trumps-executive-order-on-homelessness-rejecting-harm-reduction/

5. McCormick, K. A., Samora, J., Claborn, K. R., Holleran Steiker, L. K., & DiNitto, D. M. (2025). A systematic review of macro-, meso-, and micro-level harm reduction interventions addressing the US opioid overdose epidemic. Drugs: Education, Prevention and Policy, 32(1), 1-14.

6. Wallack, G., & Hudak, J. (2016). Marijuana Rescheduling: A Partial Prescription for Policy Change. Ohio St. J. Crim. L., 14, 207.

7. Hughes, M., Suhail-Sindhu, S., Namirembe, S., Jordan, A., Medlock, M., Tookes, H. E., ... & Gonzalez-Zuniga, P. (2022). The crucial role of black, latinx, and indigenous leadership in harm reduction and addiction treatment. American journal of public health, 112(S2), S136-S139.