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Duncanian Studies

Harm Reduction
Use vs. Misuse
Policy Options
Harm Reduction
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     One of the earliest instances of the harm reduction approach was an educational program implemened by Dr. Duncan and his colleagues in 1971 in Houston, Texas, USA, in response to an epidemic of solvent "huffing." Young adolescents were emptying cans of spray paint into plastic bags then inhaling the resulting fumes in order to get high. Two deaths had occurred locally when boy's suffocated in the plastic bags after passing out. Another boy had inhaled enough of the paint itself to coat the interior of part of his lungs resulting in severe edema, shock and brain damage. Yet another boy had passed out near a space heater that ignited his "huffing bag" causing a fire in which he was fatally burned. Against the background of these incidents, Dr. Duncan decided to place his priority on preventing deaths. Educational presentations to youth groups continued to deal with the hazards of "huffing" or "sniffing" solvents, but each presentation ended with a description of ways to reduce the risks associated with huffing -- such as using paper bags instead of plastic bags or using a toilet paper roll with a tissue paper filter as a "carburetor" for huffing. In no way was huffing encouraged or endorsed, but the message was, "if you must huff, at least do it in a way that won't kill you." No further deaths occurred after this program went into effect and crisis calls related to huffing declined sharply, but there is no way to definitely attribute that outcome to the program.

     The earliest formal statement of this strategy, which also dealt with the problem of solvent huffing, was the "casualty-reduction" approach to glue sniffing adopted by the Institute for the Study of Drug Dependence in 1980. Another early statement of this approach was the proposal by Duncan and Gold (1983) for "cultivating drug use" -- using the word cultivation in the sense of promoting healthy and productive development, while "weeding out" tendencies toward abuse.

     In 1984, the strategy was given its most popular name in a Home Office report which described two alternate goals for drug abuse prevention programs -- either use reduction or "harm reduction." Both were recognized as acceptable goals for prevention programs. The first International Conference on the Reduction of Drug-Related Harm was held in Liverpool in 1990, with further conferences held biennially since then in other venues.  

a harm reduction outreach team in Romania

Whatever it is called, the essence of this strategy is the recognition that preventing drug abuse is a different task from preventing drug use and may be both a more justifiable and a more achievable goal. Mugford (1991) says that the harm reduction approach takes the line that people will continue to use drugs no matter what and asks how they can do so most safely. Such a strategy is consistent with human experience. Historically, every human culture has included drug consumption and all attempts at drug prohibition have failed.

     Marion Watson, Director of the Drug Research and Information Centre in Canberra, Australia, defines harm reduction as,

the philosophical and practical developmant of strategies so that the outcomes of drug use are as safe as is situationally possible. It involves the provision of factual information, resources, education, skills and the developmant of attitude change, in order, that the consequences of drug use for the users, the community and the culture have minimal hegative impact (1991, p. 14).

exchanging syringes in New York City
Such a harm-reduction strategy may involve a wide variety of different tactics. Harm reduction may involve increasing the availability, accessibility, or acceptability of treatment services to drug abusers. It may attempt to change drug use behavior through education or through the provision of services or supplies, such as safe injection rooms or syringe exchanges. It may also strive to change public perceptions of drugs and drug users or to change laws that optimise the harms associated with drug use. 
harm reduction program in Thailand


Clements, I., Cohen, J., & Kay, J. (1991). Taking Drugs Seriously: A Manual of Harm Reduction Education on Drugs. Healthwise, Liverpool.

Cohen, J., & Kay, J. (undated). Dont Panic: Responding to Incidents of Young Peoples Drug Use. Healthwise, Liverpool.

Duncan, D. F. (1992). Drug abuse prevention in post-legalization America: What could it be like? Journal of Primary Prevention, 12, pp. 317-322.

Duncan, D. F. (1994). Editorial: Rethinking drug policy options -- Getting beyond prohibition versus legalization. Substance Abuse, 15, pp. 197-198.

Duncan, D. F (1995). A new direction for drug education -- Harm reduction. The Catalyst, 22(2), pp. 8-9.

Duncan, D. F., & Gold, R. S. (1983). Cultivating drug use: A strategy for the Eighties. Bulletin of the Society of Psychologists in Addictive Behaviors, 2(3), pp. 143-147.

Duncan, D.F., & Nicholson, T. (1997). Dutch drug policy: A model for America? Journal of Health and Social Policy, 8(3), pp. 1-15.

Duncan, D. F., Nicholson, T., Clifford, P., Hawkins, W., & Petosa, R. (1994). Harm reduction: An emerging new paradigm for drug education. Journal of Drug Education, 24, pp. 281-290.

Heather, N., Wodak, A., Nadelman, E. A., & O'Hare, P. (1993). Psychoactive Drugs and Harm Reduction: From Faith to Science. Whurr, London.

Home Office (1984). Prevention: Report of the Advisory Council on the Misuse of Drugs. Her Majesty's Stationery Office, London.

Institute for the Study of Drug Dependence (1980). Teaching about a volatile situation. Institute for the Study of Drug Dependence, London.

Lewis, D. C., Duncan, D. F., & Clifford, P. R. (1997). Reconceptualizing the analysis of drug policy. Journal of Primary Prevention, 17(3), pp.

Moore, D., & Saunders, B. (1991). Youth drug use and the prevention of problems. International Journal on Drug Policy, 2(5), pp. 3-5.

Mugford, S. (Nov 12, 1991). Panel discussion on the topic, "Should public health adopt a harm reduction drug control strategy?" at the annual meeting of the American Public Health Association, Atlanta, Georgia.

Rosenbaum, M. (1996). Kids, Drugs and Drug Education: A Harm Reduction Approach. National Council on Crime and Delinquency, San Francisco.

Rosenbaum, M. (1999). Safety First: A Reality-Based Approach to Teens, Drugs, and Drug Education. The Lindesmith Center, New York.

Watson, M. (1991). Harm reduction -- Why do it? International Journal on Drug Policy, 2(5), pp. 13-15.


Related Links

Centre for Harm Reduction (Australia)

Harm Reduction: An Emerging Strategy

Mitigating the Consequences