SHAHRP

School Health and Alcohol Harm Reduction Project

International Bulletin:

Harm Reduction versus abstinence approach to school drug education

Why abstinence?

North American based researchers Williams and Perry (1998) have documented arguments for an abstinence based approach that capture the key elements that guide thinking in this area. Essentially, they state that there is a consensus that anything other than abstinence would condone illegal behaviour; that full brain maturation and therefore complex thinking does not occur until the ages of 17-21 years and that processing of harm reduction messages earlier than this is unlikely to be possible; that adolescence has not always been a time of heavy alcohol use; that significant morbidity and mortality are associated with underage drinking; and that earlier use increases risk of alcohol dependency and abuse disorders.

The North American dominance in published evaluations about school drug education has directed school drug education toward an abstinence approach for many years. Behaviours assessed for change using this paradigm are usually limited to use only. As alcohol is the drug that causes the most harm to young people it is also sensible to assess any reduction in harm experienced by young people. It is unlikely, given alcohol's social acceptability in many societies, that young people are going to abstain for an extended period. It is more useful to provide young people with the knowledge that no use is a valuable strategy to reduce potential harm associated with alcohol, but to also provide young people who continue to drink with other relevant strategies that will reduce harm in alcohol use situations.

Why harm reduction?

Current alcohol related experiences of young people and the results of the School Health and Alcohol Harm Reduction (SHAHRP) study refute the arguments put forward by Perry et al supporting abstinence (Publications: 2, 4, 6). Although alcohol use is illegal for young people (to different degrees in different countries) a high proportion of young people continue to use alcohol. Abstinence based programs provide no advice for this group of young people, particularly as these programs are rarely successful in impacting on young people, leaving them to develop their own knowledge and skills about how to cope with alcohol use situations and related problems. That adolescent alcohol use is related to significant morbidity and mortality increases the need to develop coherent programs to assist young drinkers in reducing the harmful impact that their own and other people's use of alcohol can have. If underage drinking increases the risk of alcohol dependence and disorders then it is certainly critical to include delayed use strategies within a harm reduction approach. However, to be inclusive of all young people, particularly those who have initiated drinking at an early age and who are largely unaffected by the abstinence based programs, there is a clear need to broaden our approach to harm reduction and to test this broader approach so that all young people can benefit from participation in school based drug education programs.

The results of the SHAHRP program clearly show that young people are more than capable of making decisions on how to reduce alcohol related harm, and are well able to act on these decisions (Publications: 6). Analysis shows that baseline non-drinkers and baseline unsupervised drinkers were significantly less likely to consume alcohol in a risky manner, and that the more risky drinkers experienced 18.4% less alcohol related harm after participating in both phases of the program. Furthermore, SHAHRP has a lasting effect as this difference was maintained (19.4%) 17 months after completing the program.