Harm Reduction – Ideals and Paradoxes

Abstract

Aim The aim of the article is to critically reflect on the harm reduction approach used in Danish substance abuse treatment. Data The article is based on qualitative interviews with staff at treatment institutions in Copenhagen. Themes and Conclusions Three themes are addressed. First, our data indicate that low-threshold methadone treatment is difficult to combine with a long-term goal of abstinence. In fact, many harm reduction proponents among staff are directly opposed to treatment models in which abstinence is a goal. Second, we illustrate how the development of harm reduction measures is embedded in a socio-political trend focusing on a combined “autonomization/responsibilization” of social clients. This focus on clients as autonomous and responsible subjects clashes with another central conception among staff: the idea that heroin addicts are slaves to their substance use and hence cannot be treated as fully rational human beings. Third, the article analyses the relationship between harm reduction and social integration. Although social integration of substance abusers is part of the rationale behind harm reduction measures, this goal is difficult to reach with a group of clients as marginalized as the ones in focus.