Controlled drinking, harm reduction and their roles in the response to alcohol-related problems

This article first distinguishes three meanings of the term ‘harm reduction’ in the literature on alcohol problems: a European sense in which a change in drinking is not necessarily required; an American sense which includes the controlled drinking (CD) goal of treatment; and a government policy sense in which it is seen as an alternative to whole population alcohol policies. The article then goes on to consider the roles of the CD goal and the harm reduction philosophy in response to three groups of people with alcohol problems or increased risk of such problems: the non-treatment-seeking population of hazardous and harmful drinkers; the population of socio-economically disadvantaged street drinkers or others who are thought unlikely to make radical changes in drinking behaviour; and the regular population of treatment-seeking problem drinkers. It is concluded, inter alia, that the equation of harm reduction and the CD goal in the American sense of harm reduction is confusing and may have had a detrimental effect of the practice of CD treatment. The CD goal should imply an aim of harm-free drinking.