D. Bigg, Substance use management: A harm reduction-principled approach to assisting the relief of drug-related problems, J PSYCH DR, 33(1), 2001, pp. 33-38
Disease (particularly HIV) has increased our motivation to reconsider how t
he current help system deals with drug-related problems. A more concrete fo
cus on disease prevention as an additional goal has, for many, lead to a re
evaluation of the goals of drug help work. Such a critical examination show
s how much there is to improve within the system even in the absence of blo
od borne disease. Integrating the heart of harm reduction-respecting work o
n any positive change as a person defines it for his/herself-into treatment
fashions a health sensitive alternative to the predominant practice of abs
tinence-only assistance for the relief of drug problems. This new approach
is called substance use management (SUM), as it no longer requires abstinen
ce but instead focuses on a range of options for improvements while still i
ncluding abstinence among the possible self-selected outcomes. SUM is sugge
sted as a framework for change within the treatment system that would maxim
ize treatment's constructive impact, cost-effectiveness and maturation as a
distinct discipline that can appropriately attract support and gain statur
e for making society healthier. This article describes a formalized system
for applying some of the main principles of harm reduction within the treat
ment system. Viable options for a SUM treatment focus are suggested herein
as well as a critical process, based on respect and collaboration, for use
with these options.