Harm reduction

Section title

Harm reduction

Brief definition of policy approach

Approaches which do not necessarily seek to prevent or reduce young people’s participation in addictive behaviours per se, but whose primary aim can be seen as the reduction of harms resulting from young people’s own or others’ participation in addictive behaviours.

Description of policy approaches

Approaches which do not necessarily seek to prevent or reduce young people’s participation in addictive behaviours per se, but whose primary aim can be seen as the reduction of harms resulting from young people’s own or others’ participation in addictive behaviours. This includes approaches addressing parental/familial smoking, prevention of alcohol related violence and injury (including specific road safety measures), disease and overdose prevention and treatment (particularly in relation to illegal drugs), as well as measures to prevent gambling-related debt.

Typical measures included under this approach

  1. General harm reduction measures
    • Multiple behaviours – outreach programmes; low threshold services
  2. Approaches addressing parental/familial participation in addictive behaviours
    • Multiple behaviours – Health promotion interventions targeted at women of childbearing age which aim to identify and modify risk factors before pregnancy
    • Alcohol – Psychosocial interventions to address alcohol use in pregnancy or following child birth; interventions for children and youth with foetal alcohol spectrum disorders (FASD); support for children of alcohol dependent people
    • Tobacco – Psychosocial interventions to address tobacco use in pregnancy or following child birth; pharmacological treatment to address tobacco use in pregnancy; approaches to reduce children’s exposure to environmental tobacco smoke
    • Illegal drugs – Psychosocial interventions to address drug use in pregnancy or following child birth; pharmacological treatment to address drug use in pregnancy; interventions for opiate exposed newborns; support for young people whose parents use illegal drugs
    • Gambling – No approaches identified
  3. Road safety measures
    • Alcohol – Drink driving laws and enforcement techniques; maximum limit for BAC-level; different BAC limits based on age and driving experience; graduated driver licensing; information campaigns; behavioural counselling; community mobilisation; designated driver and safe-ride programmes; coordination of public transport and venue closing times; court-mandated treatment for recidivist drink-drivers
    • Tobacco – No approaches identified
    • Illegal drugs – Drug driving laws and enforcement techniques
    • Gambling – No approaches identified
  4. Violence and injury prevention
    • Alcohol – Restrictions on retail of alcoholic beverages to the intoxicated; alcohol server liability for damages caused by actions of patrons; late-night lockouts of licensed premises; safer drinking environments; safe glassware (polycarbonate glassware); safety-orientated design of premises; bar policies for preventing intoxication; trained security staff in bars; specific delivery structures and quality assurance measures
    • Tobacco – No approaches identified
    • Illegal drugs – No approaches identified
    • Gambling – No approaches identified
  5. Disease and overdose prevention
    • Multiple behaviours – Public education about the care of intoxicated persons at risk of fatal overdose
    • Alcohol – Thiamine fortification of drinks and flour
    • Tobacco – No approaches identified
    • Illegal drugs – Needle and syringe programmes; provision of injecting equipment; regulations on paraphernalia for injecting drug use; Hepatitis B vaccinations; HIV prevention/education; HIV/Hepatitis testing; supervised drug consumption rooms; overdose prevention; substitution treatment; prison harm reduction; treatment for psychiatric comorbidities
    • Gambling – No approaches identified
  6. Other approaches
    • Alcohol – No approaches identified
    • Tobacco – No approaches identified
    • Illegal drugs – Civil penalties (e.g., fines, community service, loss of benefits) to reduce harms arising from criminal penalties
    • Gambling – Financial participation limitations; compulsory ‘deposit limit setting’ by customers; minimum waiting time for increasing deposit limits; Restrictions on cash machine location and withdrawal limits; cash machines equipped with programmes to block access to cash advances; restrictions on the use of credit; restrictions on cheque cashing and cash payment of prizes; debt-related or money-management counselling

Summary of available evidence for interventions and policies

  1. Beneficial
    • Server liability laws in reducing all-cause motor vehicle fatalities among underage drinkers
    • Graduated driving licensing in reducing the rates of crashes among young drivers, including alcohol-related crashes
    • Tobacco cessation, excluding nicotine replacement therapy in mothers on child health outcomes
  2. Likely to be beneficial
    • No evidence identified
  3. Mixed evidence
    • Nicotine replacement therapy in mothers on child health outcomes
    • Interventions designed to establish smoke-free homes in early infancy
    • Home visitation in producing better developmental outcomes in children of substance users
    • Pre-pregnancy health promotion to improve neonatal outcomes such as birth weight in children of substance users
    • Pharmacological treatment for amphetamine psychosis
  4. Unknown effectiveness
    • Psychological, psychosocial, educational, or pharmacological interventions with pregnant women who use alcohol in order to improve child health
    • Interventions for children and youth with FASD
    • Behavioural counselling interventions targeting alcohol-impaired driving or riding
    • Activities to reduce child exposure to environmental tobacco smoke in order to improve child health
    • Psychosocial interventions and methadone treatment in pregnant women receiving illicit drug treatment programmes on birth and neonatal outcomes
    • Naloxone or opiate treatment in exposed infants of mothers who had used a prescribed or non-prescribed opiates during pregnancy
  5. Ineffective
    • No evidence identified

Key Reviews

Whitworth & Dowswell, 2009; Turnbull and Osborn, 2012; Stade et al., 2009; Lui et al., 2008; Smith et al., 2009; Premji et al., 2006; Peadon et al., 2009; Lumley et al., 2009; Terplan & Lui, 2007; Minozzi et al., 2008; McGuire and Fowlie, 2002; Williams et al., 2007; Rammohan et al., 2011; Shoptaw et al., 2009Full set of evidence tables (PDF)