The document discusses the tensions between harm reduction and abstinence approaches for addressing drug problems within the criminal justice system. It notes that criminal justice systems themselves can cause harm through actions like arrests, fines and imprisonment. It also notes the contradiction between acknowledging continuing drug use under harm reduction while criminal systems are obligated to prohibit drug possession. The document examines issues like how criminal systems negotiate the level of harm they are willing to inflict, and the difficulties of acknowledging ongoing drug use while enforcing abstinence policies.

1. Harm Reduction or Abstinence
Julian Buchanan
julianbuchanan@gmail.com

2. Harm Reduction: Conflicts
with CJS
‘Contradictions that hinder the effort to reduce harm through the criminal
justice system. The first is the fact that criminal justice systems themselves
produce harms. …arrests, fines, community penalties, imprisonment and
parole all infringe on individual freedoms and pleasures.
Countries do not use prison as a direct, rational measure to reduce
crime. Rather, they choose — through a complex process of ideological,
moral, political and juridical negotiation — the level of pain that they are
willing to inflict on their citizens (Christie 1982). If we choose the level of
harm that we inflict, we can also choose to reduce it.’ (p.380)
Stevens A., Stover, H. & Brentari, C. (2010) Criminal justice Approaches to
Harm Reduction in Europe, pp379-402 in EMCDDA, Harm reduction:
evidence, impacts and challenges EMCDDA, Lisbon, April 2010
On Blackboard

3. Issues with Treatment in the CJS
 The second contradiction in pursuing harm reduction in the criminal
justice system is that between the pursuit of abstinence and the
acknowledgement of continuing drug use. Countries are obliged,
through the UN drug conventions, to prohibit and to penalise the
possession of certain substances.
 The criminal justice system is the process that puts these obligations
into practice. It is very difficult for the same system to
acknowledge that the people under its control continue to defy
the law. (p.380)
Stevens A., Stover, H. & Brentari, C. 2010 Criminal justice Approaches to Harm Reduction in Europe, pp379-402 in
EMCDDA, Harm reduction: evidence, impacts and challenges EMCDDA, Lisbon, April 2010

4. Coercive Benefits
 Both drug courts and ‘coerced abstinence’ interventions deploy frequent
monitoring and chemical tests with the threat of graduated penal sanctions to
deter re-initiating drug use and to reduce the probability of more serious offending
and subsequent criminal sanctions.
 Other enforcement measures may also have promise. Stricter controls on
precursor chemicals appear to have at least short-term effects on
methamphetamine consumption (Cunningham & Liu 2003). Work-place testing is
argued by some to have led to reductions in adult drug use, by threatening job
loss (Frenchet al. 2004). Evaluations of school testing programs provide hints that
these, too, might reduce adolescent substance use.
(p.351) [my emphasis]
Addiction: 101 341-347 (March 2006)
How much can treatment reduce national drug Problems? Peter Reuter & Harold Pollack School of Public Policy,
University of Maryland and the RAND Corporation, CA, USA and School of Social Service Administration, University of
Chicago, IL, USA

5. Abstinence
Model
 Addicts typically lie, hide, manipulate and hurt themselves
and others they need confronting
 Addicts need to hit rock bottom to see sense
 People need to become clean – we can drug test them
 Drug Free is the only way to be
 Any level of use is unacceptable they have a lifelong
disease and should never use again
 People are either addicts or ex-addicts

6. ABSTINENCE
Eradicate drugs
Criminalisation
Stigmatisation
Separation
Homogenous view
Cure
Deny & deter
All use problematic

7. Counselling principles lost in
enforcing abstinence
 Listen
 Respect the person – unconditional positive regard
 Go at the clients pace
 Be non judgmental
 Empathy/care
 Understand
 No hidden agenda
 Client led and owned
Based upon Ghodse, H. (2002) Drugs and Addictive Behaviour: A Guide to
Treatment (3rd edn). Cambridge: Cambridge University Press

8. Abstinence Approach:
RUSSIA
http://uculr.com/2012/04/05/solving-the-russian-hiv-crisis-with-harm-reduction-strategies%EF%BB%BF-2/
http://newsbeastlabs.thedailybeast.com/projects/death-by-indifference/

10. Harm Reduction -
Risk Reduction
1. Pragmatic
2. Humane
3. Realistic
4. Engages

11. But doesn’t….
Harm Reduction condone drug
use, encourages risk taking
and removes the harsh
realities of dangerous
behaviour which people who
do drugs should suffer?

12. Do seat belts encourage speeding
and dangerous driving
Should they be allowed?

14. My experience of pushing abstinence as
a Probation Officer
1. Writing Court Reports pushing abstinence
2. Supervision – Emphasise evidence and dangers of
drugs
3. Push every chance to become drug free
4. Arrange Detox
5. Take the person to Rehab
6. Relapse, return to old ways –guilt –broken
relationships – breach of court
7. Time for me to rethink abstinence.

15. My journey from abstinence
to risk reduction mid 1980s
‘an abstentionist viewpoint - the expectation to
give up is pressed from the outset of contact, the
client succumbs to that pressure of expectation
and attempts abstinence through either ’cold
turkey’, ’detoxification programme’ or ’rehabilitation
unit’.
Unfortunately the degree of success achieved is
minimal with by far the majority failing and
returning to the drug scene, increasing officer
family and self frustration and feelings of
failure. …
We have come to believe that a different
philosophy should be adopted which
incorporates both apparently irreconcilable
views [abstinence vs maintenance] onto a scale
or ladder of achievable targets. This philosophy
begins with the pragmatic statement that:

16. From abstinence to risk reduction
’If it is, at a particular moment in time, impossible to cure a
drug ‘addict’, one can at least try to create an environment
for harm reduction.’
The implications of such a statement are that first one must
identify those drug abusers who are dependent and
differentiate from those who are experimental or recreational
users.
One must also seek to ascertain what clients themselves wish
to do, for whilst we might see their drug abuse as problematic,
they may see it as the answer to a problem or may not wish to
change their abuse for a variety of reasons. If one begins with
the stance of ’Risk Reduction’, many more doors are open to
engage with the client and discover ways of helping them.’ (pp.
123-124)
Buchanan, J. & Wyke, G. (1987) ‘Drug Abuse, Probation Practice and the Specialist Worker’, Probation
Journal Vol. 34 No. 4 pp. 123-126

17. HARM REDUCTION
Live with drugs
Decriminalisation
Normalisation
Integration
Heterogenous view
Minimise harm
Freedom & responsibility
Some use problematic

18. Engaging &
helping people
Harm reduction water level
Abstinence water level
People
with drug
problems

19. ABSTINENCE
Eradicate drugs
Criminalisation
Stigmatisation
Separation
Homogenous view
Cure
Deny & deter
All use problematic
HARM REDUCTION
Live with drugs
Decriminalisation
Normalisation
Integration
Heterogenous view
Minimise harm
Freedom & responsibility
Some use problematic
Based upon
Goldberg, T. 1999,
Demystifying
drugs: A
psychosocial
perspective,
Macmillan Press,
London

20. Needle Park Zurich
 http://dotsub.com/view/7119acc7-8ea0-4041-ba5d-ec5169bf08ae

21.  66%
swiss
supported
roll out

22. Learning from Switzerland
http://www.youtube.com/watch?v=Cco4BT-KDK8

23. Swiss HAT
The Impact of Heroin Prescription on Heroin Markets in Switzerland by Martin Kiillias and
Marcelo F . Aebi Crime Prevention Studies, volume 11, pp. 83-99 (2000)
http://www.popcenter.org/library/crimeprevention/volume_11/
The Swiss heroin prescription program was targeted at hard-core drug users
with very well established heroin habits. These people were heavily
engaged in both drug dealing and other forms of crime.
• It substantially reduced the consumption among the heaviest
users, and this reduction in demand affected the viability of
the market.
• It reduced levels of other criminal activity associated with the
market.
• By removing local addicts and dealers, Swiss casual users
found it difficult to make contact with sellers.

24. Swiss programme

25. Heroin Assisted Treatment –
systematic review
http://www.emcdda.europa.eu/publications/insights/heroin-assisted-treatment

26. http://www.youtube.com/watch?feature=player_embedded&v=3KxldfcQlQE#t=8
0
Watch to 4:06

27. Importance of harm reduction
 ‘given the frequent contact between drug users and
criminal justice systems, and ongoing epidemics of
blood-borne viruses linked to problem drug use, there
is an urgent need for harm reduction services to be
scaled-up’
 EMCDDA 2010 (p.394) Harm reduction: evidence, impacts and challenges
Chapter 14 by Alex Stevens, Heino Stöver and Cinzia Brentari ‘Criminal justice approaches to harm
reduction in Europe’ see
http://www.academia.edu/2835065/Criminal_justice_approaches_to_harm_reduction_in_Europe

28. A review of the evidence-base for harm reduction
approaches to drug use by Neil Hunt
 In essence, harm reduction refers to policies and
programmes that aim to reduce the harms associated
with the use of drugs.
 A defining feature is their focus on the prevention of drug-
related harm rather than the prevention of drug use per
se. One widely-cited conception of harm reduction
distinguishes harm at different levels – individual,
community and societal - and of different types - health,
social and economic (Newcombe 1992).
 These distinctions give a good indication of the breadth of
focus and concern within harm reduction.
Document URL: http://www.forward-thinking-on-drugs.org/review2-print.html

29. Harm Reduction Approach:
MALAYSIA
http://www.aljazeera.com/video/asia-
pacific/2011/11/201111308512277302.html

30. Harm Reduction
complemented by
Motivational Interviewing
and the Cycle of Change
an effective approach for
any habit or learnt
behaviour

31. Harm Reduction
utilising Millar & Rollnicks
Motivational Interviewing
and Prochaska & Di Clemente’s
Cycle of Change

32. Cycle of Change Prochaska, Di Clemente & Norcross (1992)
32
Maintenance
Pre
Contemplation
Termination
Action Preparation
ContemplationRELAPSE

33. Motivational Interviewing
 ‘directive and client controlled’. (Rollnick and Miller
1995)
 Aims to elicit behaviour change by ‘helping clients to
explore and resolve ambivalence’ (Peterson and Mc
Bride, 2002).
 ‘Is only a prelude to treatment; it creates openness to
change, which paves the way for further important
therapeutic work’ (Goodman, 2007)
33

35. Goldberg, T. 1999,
Demystifying drugs: A
psychosocial perspective,
Macmillan Press, London

36. Harm Reduction Case Study
 Katie is young single parent mother aged 22 years old who
has two children aged 18 months and 4 years old.
 Afraid of losing her children she keeps her 4 years drug
habit a secret.
 She currently injects street drugs using needles she gets
from a friend after she’s used them. After she has used her
needles she hides them carefully in a bag which she puts in
the bin.
 She finances her habit mainly by shoplifting and sex work,
but she is increasingly in debt. She says she uses mainly at
night when the kids are in bed.
 She also worried because she thinks she might be
pregnant.
What can be done to reduce harm

37. Harm Reduction Matrix
A = Severe; B= Moderate; C = Low
Newcombe, R. (1992) The reduction of drug related harm: a conceptual framework for theory,
practice and research. In, O.Hare et al (Eds.) The reduction of drug related harm. London
Routledge.

38. Harm Reduction: Conflicts
with CJS
‘Contradictions that hinder the effort to reduce harm through the criminal
justice system. The first is the fact that criminal justice systems
themselves produce harms. …arrests, fines, community penalties,
imprisonment and parole all infringe on individual freedoms and
pleasures.
Countries do not use prison as a direct, rational measure to reduce
crime. Rather, they choose — through a complex process of ideological,
moral, political and juridical negotiation — the level of pain that they are
willing to inflict on their citizens (Christie 1982). If we choose the level of
harm that we inflict, we can also choose to reduce it.’ (p.380)
Stevens A., Stover, H. & Brentari, C. (2010) Criminal justice
Approaches to Harm Reduction in Europe, pp379-402 in EMCDDA,
Harm reduction: evidence, impacts and challenges EMCDDA,
Lisbon, April 2010
On Blackboard

39. Issues with Treatment in the CJS
 The second contradiction in pursuing harm reduction in the criminal
justice system is that between the pursuit of abstinence and the
acknowledgement of continuing drug use. Countries are obliged,
through the UN drug conventions, to prohibit and to penalise the
possession of certain substances.
 The criminal justice system is the process that puts these obligations
into practice. It is very difficult for the same system to
acknowledge that the people under its control continue to defy
the law. (p.380)
Stevens A., Stover, H. & Brentari, C. 2010 Criminal justice Approaches to Harm Reduction in Europe, pp379-402 in
EMCDDA, Harm reduction: evidence, impacts and challenges EMCDDA, Lisbon, April 2010

40. thanks
julianbuchanan@gmail.com