Alcohol supply,demand, and harm reduction: What is the strongest cocktail? |
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| Institution: | 1. British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada;2. Department of Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;3. Canadian Institute for Substance Use Research, Health and Wellness Building Room 273, University of Victoria, Victoria, BC V8P 5C2, Canada;4. Canadian Association of People Who Use Drugs, 102-68 Highfield Park Drive, Dartmouth, NS B3A 1X4, Canada;5. Ottawa Inner City Health, 5 Myrand Ave, Ottawa, ON K1N 5N7, Canada;6. Department of Medicine, Dalhousie University, Suite 442 Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada;7. Vancouver Coastal Health Authority, 801-601 West Broadway, Vancouver, BC V5Z 4C2, Canada;9. PHS Community Services Society, 350 Columbia Street, Vancouver, BC V6A 4J1 Canada;10. Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada;11. Faculty of Medicine, Institute of Medical Science, Departments of Psychiatry, Family and Community Medicine, and Pharmacology and Toxicology, University of Toronto, 250 Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8, Canada;12. Schulich School of Medicine, Western University, Clinical Skills Building, London, ON V6A 5C1, Canada;13. Department of Family Medicine, Université de Montréal, 2900 Edouard Montpetit Boulevard, QC H3T 1J4, Canada;14. Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Medical Sciences Building, Room 3157, Toronto, ON V5S 1A8, Canada;15. Canadian Drug Policy Coalition, Simon Fraser University, 2400 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada;1. University of Liverpool, Liverpool, United Kingdom & RMIT University, Victoria, Australia;2. Durham University, United Kingdom |
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| Abstract: | The concept of harm reduction emerged from the drug field in the 1980s in response to the urgent need to reduce the risk and spread of blood-borne viruses in people who continued to inject illicit drugs. The concept has since become increasingly influential in the alcohol and even tobacco fields. While there are many different applications of the term today, the distinction used by the International Harm Reduction Association (IHRA) between strategies relying on ‘use reduction’ and those that primarily strive for harm reduction without necessarily requiring reduction in consumption is used here. The evidence base for the effectiveness of harm reduction strategies on the one hand, and efforts that require a degree of use reduction via demand or supply reduction on the other hand, is summarised based on a comprehensive review funded by the Australian government. In the alcohol field, the concept of harm reduction has sometimes been proposed as an alternative to the view that alcohol-related harm will only be reduced via a reduction of the total population consumption of alcohol. This paper will present evidence to suggest that, in order to be most effective, a comprehensive policy to reduce alcohol-related harm needs also to include interventions to reduce the quantity of alcohol consumed per occasion. Furthermore, it is highly unlikely in most modern drinking societies that significant reductions in alcohol-related harm can occur without also a significant drop in total population consumption. Nonetheless, harm reduction is an important and influential principle in alcohol policy that can be incorporated alongside such effective strategies as controls on the physical and economic availability of alcohol and the routine delivery of brief interventions in primary health care settings. |
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