FOR DRUG ADDICTION AND ALCOHOLISM
23th year: 2000 no 3 (selection of the articles in English )
"GUIDELINES ON HARM REDUCTION"
with illegal narcotic drugs, it is possible in the case of alcohol to imagine a
process that, based on the personal condition of individuals, helps them to
shift from a massive use of substances to a more moderate use, and hence to
reduce the respective harmful effects produced. Harm reduction interventions do
not therefore focus on the profound reasons and causes behind alcohol
dependence, but aim to achieve three closely related objectives: identification
of the risks and organization of related information and awareness activities;
implementation of environmental and social conditioning and control
interventions; reduction of the harm already produced. Another objective of
alcohol-related harm reduction strategies is to carry out primary prevention
that favors informed choices and the adoption of healthy lifestyles, by proving
that alcohol is a psychoactive substance.
Alcohol-related harm reduction
the matter according to fields of cultural interest, known as areas:
sensitization, intervention in the users’ social life, driving and safety,
availability and administration of alcoholic drinks, treatment, marginalization,
strengthening policies, support to non-profit organizations.
A drug used
to treat opiate addiction; it is a partial agonist of the m receptors and an
antagonist of the K receptors, to which it is very similar.
a weaker opiate effect than pure agonists, such as morphine and methadone. It is
effective both in detoxification and maintenance programs.
has scarce abuse potential, produces little physical dependence, presents
negligible risks of overdose, and is easy to use.
important experience based on the use of this medication was carried out in
Alpha2-agonist drug was originally developed as an antihypertensive medicine,
and is used in opiate detoxification programs. Its commercial name is Catapresan.
first care centers that are easy to access since there is no need to follow any
care or rehabilitation program in order to be accepted. Their main aim is to
provide information and guidelines, and to respond to the basic needs of those
referring to them.
generation home made drug that comprises various stimulating substances. A
specific harm reduction intervention has been designed to prevent its use, and
involves directly contacting youths in the places in which it is used.
Evaluation of the (harm reduction) interventions
that should be carried out every day, since interventions with a strong
self-reference component of scarce or dubious efficacy should never be
threshold services that provides informative material on at risk behavior,
distributes syringes, condoms, sterile material and – in some cases –
provides counseling, and medical and legal advice. In practice, it offers the
services that are typically offered in mobile units but within a fixed
or advice regarding work. These are prepared by experts and take into account
the legal and historical contexts of the work setting. They naturally evolve
over time, and represent a partial balance between scientific knowledge and the
context without pretending to provide exhaustive information on the issues.
Harm limitation (see Harm reduction)
harm limitation, risk minimization, risk reduction
reduction is a social policy that gives priority to diminishing the negative
effects caused by drug use. It has its roots in a scientific public health
protection model based on a humanitarian culture, does not give priority to
interventions aimed at decreasing the drug use (abstinence model), but envisages
various intermediate objectives as an alternative to the final aim of complete
abstinence. These objectives include limiting the harm produced even before the
user decides or attempts to stop using drugs (see main objectives of harm
Harm reduction and HIV
One of the
objectives of harm reduction is to reduce the spreading of HIV infection among
injecting drug users. Other objectives include discouraging shared syringes,
passing from injecting to oral drug use, reducing the quantity of drugs used,
disinfecting the tools used, reducing the numbers of contact persons, and
passing from illegal to medically prescribed drugs.
Harm reduction and intervention strategies
intervention tools that can be used by services include: street units, above all
for metropolitan out-patient structures, treatment with substitute drugs,
distribution of condoms, exchange of syringes, serological screening for the
main pathologies, health education, drop-in day centers, centers that provide an
alternative to streets and squares, crisis centers, residential and
semi-residential centers with very low entrance thresholds, social and care
interventions that focus on providing the essential services for persons in
particularly serious conditions (food vouchers, beds, work grants, legal advice,
etc.), strict collaboration with the penal administration and with the law
enforcement, preventing the causes of death.
Harm reduction and penal justice
reduction includes the following four objectives: containing the number of new
users, encouraging users to undertake early release processes, limiting the
negative aspects of the repressive strategies by substituting arrest with other
alternative forms of detention, minimizing the harm produced on the entire
community by reducing the drug-related offences.
Harm reduction (main objectives of)
the damage and risks, diminishing deaths due to overdose, reducing HIV
transmission, improving the health conditions of drug addicts, limiting the
criminalization processes, helping drug addicts to deal with their condition.
Heroin (drug experiment)
to utilize heroin as a “medication” in detoxification programs, based on
experiences in other countries.
threshold programs tend to encourage maximum access to services, even for people
that are not normally willing to undergo therapy. These programs, which only
require a few requisites for admission, comprise mobile units and drop-in
Low threshold care centers (LTCC)
intermediate structures that offer the same services provided by fixed units.
Both the day and residential LTCCs allow drug users to pass some time in them,
and provide counseling, medical advice, health care and legal advice.
medication that was synthesized for the first time in Germany during the 40s. It
is a competitive agonist of the opiate receptors. The aim of methadone treatment
is to reduce the use of opiates, and hence of criminal activities, death,
illnesses, etc. that are often connected with their use. Long term methadone
treatment seems more effective in reducing harm, since it is more effective in
modifying at-risk behavior and in stabilizing states of dependency, thus
allowing the patients to live more dignified lives.
Minimization of harm (see harm reduction)
Mobile street unit
street unit naturally extends harm reduction interventions to outside of the
services. Its task is to establish forms of contact with the target population
represented by social groups, especially those comprising young people, that are
already involved with the drug problem. The basic strategy is not to remove the
substance, but to help the person by promoting a vital contact that will
continue over time and therefore will be more effective. Numerous services are
offered (see harm reduction and intervention tools)
drug sold over the counter, does not produce side effects when injected in
persons that are not taking opiates.
A drug that
was synthesized by Blumberg in 1965; it is a competitive agonist of the opiate
receptors and progressively inhibits sensitivity to opiates. It was
commercialized in 1987 when it was successively used for treating drug addiction
relapses and as part of detoxification programs based on substitute and/or
symptomatic drugs. It can cause violent withdrawal effects in persons addicted
to narcotic drugs and therefore protocols using naltrexone must only be used
7-10 days after the drug addict has abstained from using opiates. It has proved
to be a valid alternative in treatment based on agonists for patients that are
motivated to stop using opiates and agonists on a daily basis. It is also
reduces alcohol craving. Commercial names: Antaxone; Nalorex.
addiction is a complex and multi-faceted problem that cannot be treated with
simple therapy. In order to obtain concrete results, the available resources
must be rationalized and optimized. Furthermore, the various services should be
differentiated, i.e. better services should be provided that avoid overlap and
activities, which commenced in Italy at the beginning of the 90s, regard the
concrete interventions carried out in the field by the street units. These
interventions, which were first implemented in order to prevent HIV infection,
have extended their activities to reestablishing contacts with those drug
addicts that refuse to refer to the formal health structures. They also attempt
to reach youths using synthetic drugs and male and females involved in the sex
trade. Attempts are made to modify the choices of the users, who are not
evaluated, although all requests for assistance are accepted.
percentage of overdoses occur among abstinent drug addicts that are in contact
with therapeutic structures but have sudden relapses. Various specific types of
advice are envisaged as part of harm reduction activities.
many drug addicts pass through a prison some time during their life, the
peculiar characteristics of prisons that could be utilized for evaluating the
addicts and providing them with appropriate treatment are rarely taken advantage
Risk reduction (see harm reduction)
which people take drugs, including personality, acquaintances, attitudes and
states of mind in given moments.
of the context in which drugs are used in determining risks relating to the use
of the substance: for example, it is safer to inhale drugs outdoors rather than
injecting rooms: these are places in which drug addicts can inject themselves in
controlled hygienic conditions. They are part of an experimental program being
carried in some European countries.