Why Harm Reduction?
North American based researchers Williams and Perry (1998) documented arguments for an abstinence based approach. Essentially, these arguments state that anything other than abstinence condones illegal behaviour; that full brain maturation and therefore complex thinking does not occur until the ages of 17-21 so processing of harm reduction messages earlier than this is unlikely; that significant morbidity and mortality are associated with underage drinking; and that earlier use increases risk of alcohol dependency and abuse.
The North American dominance in published school drug education evaluations has directed school drug education towards 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 important 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. A harm reduction approach provides young people with the knowledge that no use is a valuable strategy to reduce potential harm associated with alcohol, but also provides 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 Project (SHAHRP Australia and SHAHRP Northern Ireland) study support a harm reduction approach (Publications). 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 on how to cope with alcohol use situations and 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 not influenced by 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 SHAHRP clearly show that young people are capable of making decisions on how to reduce alcohol related harm, and are able to act on these decisions (Publications: 8). Analysis shows that baseline non-drinkers and baseline unsupervised drinkers were significantly less likely to consume alcohol in a risky manner, and that more risky drinkers experienced 18.4% less alcohol related harm after participating in both phases of the program. Furthermore, SHAHRP has an ongoing effect as this difference was maintained (19.4%) 17 months after completing the program.