Reducing Harm, Saving Lives: A Teaching Guide
Bishop Drewery - [email protected]
PSYCH 305
Section AD - Homework #2, due March 6th, 2026Learning Objectives:
By the end of this project, learners will be able to:
1. Explain Substance Use Disorder (SUD) as defined in the DSM-5-TR.
2. Discuss the history of harm reduction and its role in SUD interventions.
3. Identify different harm reduction strategies and describe the evidence supporting each.
4. Critically evaluate common misconceptions about harm reduction and SUD.This project is designed to educate a general audience with limited prior knowledge of Substance Use Disorder and/or harm reduction. The website consists of eight content pages as well as a references page with my sources. The content pages are presented in a sequential order, but there will always be a link to return here if you want to hop to another page.Accessibility was a priority when designing this project. Considerations include high-contrast text, alternative text on images (although the format of a Carrd website makes it difficult to include images, so I opted not to), high-legibility fonts, minimal visual noise, and consistent navigation. The font I choose, Atkinson Hyperlegible, was developed by the Braille Institute of America in collaboration with Applied Design Works to support readers with visual impairments and cognitive accessibiltity needs.If you have any feedback, questions, or want to ask me about disability advocacy & accessibility, feel free to contact me via email at anytime.
What Is Substance Use Disorder?
Diagnosis
Substance Use Disorder (SUD) is defined by the DSM-5-TR as: "a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems" (American Psychiatric Association, 2022, p. 546). To diagnose a Substance Use Disorder, there are four different groupings of symptom criteria.SUD has four different categories of symptoms (listed in the table, citing pages 545 and 546 of the DSM-5-TR) that are used to diagnose different disorders underneath the Substance Use Disorder umbrella. There are varying levels of severity: 2-3 symptoms is a mild SUD, 4-5 is a moderate SUD, and 6+ is a severe SUD (p. 547). These symptoms must have occurred within the last 12 months.
| Impaired Control | Social Impairment | Risky Use | Pharmacological Criteria |
|---|---|---|---|
| Criterion 1: Takes the substance in larger amounts or over a longer period than was originally intended. | Criterion 5: Continues substance use despite having persistent social or interpersonal problems caused/exacerbated by the substance's effects. | Criterion 8: Takes the substance in situations where it is physically hazardous. | Criterion 10: Tolerance, meaning that the person requires an increased dose of the substance to achieve the desired effect (or a reduced effect when the usual dose is consumed). |
| Criterion 2: Expresses a desire to cut down or regulate substance use, or reports unsucessful efforts to decrease/discontinue use. | Criterion 6: Gives up or reduces important activities/obligations because of substance use. | Criterion 9: Continues using the substance despite knowledge of having a persistent physical or psychological problem due to substance use. | Criterion 11: Withdrawal symptoms after going without the substance. |
| Criterion 3: Virtually all of the individual's daily activities revolve around the substance. | Criterion 7: Withdraws from family activities and/or hobbies to use the substance. | ||
| Criterion 4: Cravings, meaning an intense desire or urge for the drug (especially in an environment where the drug was previously obtained/used). |
SUD Umbrella
Whenever possible, clinitians try to specify the substance being taken (ex: Ketamine Use Disorder). To aid them in diagnosing and treating individuals with a substance use disorder, there are many addicted substances listed by the DSM-5-TR that include:
Alcohol Use Disorder
Cannibus Use Disorder
Phencyclidine Use Disorder ("angel dust")
Other Hallucinogen Use Disorder, which involves any hallucinogenic drug that isn't phencyclidine. This includes: LSD, psilocybin/"magic mushrooms," mescaline/peyote, dimethyltryptamine/DMT, phencyclidine/PCP, ketamine/"special K", salvia divinorum, MDMA/"ecstasy," etc (Talcherkar, 2025).
Inhalent Use Disorder, which involves any hydrocarbon-based inhalant (glue, paint thinner, gasoline, etc.)
Opioid Use Disorder
Sedative, Hypnotic, or Anxiolytic Use Disorder (grouped together; includes most perscription sleeping/anxiety medications) (American Psychiatric Disorder, 2022, p.620-622).
Tobacco Use Disorder
Stimulant Use Disorder, which involves amphetamines such as cocaine or meth. This also includes stimulants such as caffeine, nicotine, and MDMA (which can overlap with other use disorders described above).
Other (or Unknown) Substance Use Disorder, which is diagnosed when a substance taken can't be classified.
History of Harm Reduction
Harm reduction was defined by David Purchase as "more of an attitude than a fixed set of rules or regulations" (Marlatt et al., 2012, p. 17). What he means is that there is not one single approach to substance use (quitting), but that communities and healthcare providers should help treat substance use disorders at every step of the way. Harm reduction prioritizes reducing the negative consequences of drug use, particularly when abstinence is not an immediate goal (or is not a goal at all).Harm reduction as a term and movement emerged in response to the HIV/AIDS epidemic of the 1980s. Intravenous drug use was one of the primary ways that AIDS was contracted, so grassroots efforts advocated for drug users to have access to sterile needles while they strove to gradually quit (Wurth et al, 2024). Allowing people to have safe places to use drugs protects them from diseases like HIV or hepatitis and grants them access to trreatment resources that they may not have sought out otherwise.The principles to harm reduction have been laid out by Hawk et al (2017), summarized in the table below.
| Principle | Definition | Approaches |
|---|---|---|
| Humanism | Providers respect patients as individuals, and recognize that people do things for a reason. | Do not make moral judgements against patients. Services should be user-friendly, and providers ought to respect patients' choices. |
| Pragmatism | Behaviors and the ability to change them are influenced by social norms and a patients' past experiences/traumas/etc. | Abstinence isn't assumed to be the patient's goal, and messages to patients should be about actual harms rather than moral standards. |
| Individualism | Every human being as their own needs and strengths. There is a wide spectrum of SUD which requires a wide spectrum of intervention options. | Don't make assumptions! There isn't a universal application of drug use intervention, so care should be tailored for the individual patient. |
| Autonomy | Individuals ultimately make their own choices about what treatments and medications they utilize. | Providers must respect the autonomy of their patients. |
| Incrementalism | Any positive change is an important step, and treatment can take years. | Providers should understand that relapse is a part of recovery. They can help patients celebrate any positive change. |
| Accountability | Patients are responsible for their own choices and behaviors. They have the right to make harmful health choices, but are still entitled to see treatment. | Patients are not "fired" for not achieving goals according to a provider's standards. |
Harm Reduction Strategies
| Strategy | Definition | Benefits | Limitations |
|---|---|---|---|
| Naloxone Distribution Programs | Naloxone, also known as Narcan, is distributed in-person or by mail for free to those at risk of overdose and/or their loved ones. | Narcan blocks opioid receptors and is approved by the FDA to reverse respiratory depression in the case of an overdose (Yang et al). If community members have a way to reverse an overdose, they can feel empowered to help rather than being forced to just be bystanders. | Many people aren't trained in recognizing what an overdose looks like, or how to use Narcan, and distribution programs require funding. (This applies to distribution of other supplies like fentanyl test strips, condoms, safe injection equipment, etc.) |
| Needle Exchange Programs | Outreach programs provide sterile injection supplies as well as a safe place to dispose of them. | Disesase/infection transmission is reduced, needles don't end up littered in public spaces, and people struggling with substance abuse can be referred to treatment. | Beliefs that these places are just 'helping addicts do drugs' creates stigma. |
| Methadone Clinics | Drugs like metadone and buprenorphine reduces cravings and can be provided in a supervised clinic for those aiming to quit opioids. For alcohol use disorder, disulfiram is a medication that causes unplesant side effects when drinking alcohol (Cleveland Clinic, 2022). | Methadone can help people quit using opioids entirely! When people do use opioids while on methadone, they may not feel the euphoric feelings of the drug, which empoers them to cut back without fearing cravings. | Like any medication, methadone has side effects, including: drowsiness, lightheadedness or dizziness, nausea, etc (Mosel, 2025). There's also a public stigma about replacing one addiction (opiods) with another (methadone); |
| Drug Checks | Test strips, mass spectrometry (MS), and fourier transform infrared (FTIR) spectroscopy can test for fentanyl (which is a common cause of drug-related deaths). | There may be opioids such as fentanyl laced in drugs that users don't know about, so testing drugs can save lives. | It may be difficult to access testing technology because of transportation and accessibility problems. Other patients may not be willing to get testing strips because of stigma and/or fear of surveillance (Rose et al). |
| Public Education | Education programs that aim to teach people about substance use, overdose prevention, and harm reduction (like this website!). | Being educated about SUD can reduce stigma, which empowers patients to seek care. If communities know about harm reduction strategies, people can be prepared if someone they know needs resources or if they see someone actively overdose. | Education depends on accuracy, and it's possible for certain groups to spread misinformation about harm reduction resources. It also can't address structural barriers like limited healthcare access. |
| Good Samaritan Laws/Legality Laws | People who call emergency services for an overdose or administer Narcan are protected from legal consequences. Certain drugs such as cannabis have been legalized as well in many states. | Legalization allows for regulation of cannabis to protect from lacing, underage use, etc. Good Samaritan Laws encourage people to act during emergencies. | Protections & access to legalized substances vary by state, city, or county. Legalization doesn't get rid of health risks or misuse. |
| Safe Injection Sites (SISs) | Places where patients can use drugs while being supervised by healthcare professionals, using clean needles, and with access to naloxone in-case of an overdose (Kaplan, 2018, p. 13). Patients can also access treatment through these sites. | SISs keep drug use off the street and provides education on substance use disorder. In Vancouver, the implementation of a SIS reduced drug-related deaths by 35% within a 500 meter radius of the facility (Kaplan, 2018, p. 13). | Similarly to needle exchange programs, these sites are controversial and come with a lot of stigma. Skepticism and judgement of people suffering from addiction leads to legal restrictions against SISs. |
Common Misconceptions
Myth: "Harm reduction normalizes, encourages or “enables” risky behavior."
This isn't true! By providing a safer way to do drugs, providers can empower people to make less risky choices (as in sharing needles, doing drugs intravenously in unsanitary conditions, etc). They can then make informed decisions about their health and access the resources to cut back or quit their drug use.
Myth: "Harm reduction is anti-abstinence."
Harm reduction, by nature, meets every individual where they're at. Abstinence from drugs is the ideal, but it's not attainable for some people. The goal is to provide support to everyone, if they are ready and able to quit entirely or not.
Myth: "Harm reduction encourages criminal activity."
In a Swiss study, heroin addicts who utilized treatment programs reported lowered criminal behavior; from 69% reporting income from illegal sources to 10% (Strang et al, 2012, p. 37).
Myth: "Drug addicts don't want help."
Stigma about harm reduction is a huge barrier! Weiger et al. (2024) interviewed sixteen people who use drugs (PWID) about stigma, and they reported not seeking safer ways to use (such as syringe exchange centers or naloxone) because of internalized shame about their use as well as fear of being judged at harm reduction centers (p. 2871). If harm reduction resources was more normalized and supported by the public, law enforcement, and healthcare workers, more PWID would seek access to these resources.
Conclusions
My project set out to explain what Substance Use Disorder (SUD) is, the roots of harm reduction, and the strategies used in communities across the world. Harm reduction can't be limited to a single program; it is an evidence-based framework rooted in respect and compassion for people struggling with addiction. These interventions save lives and empower people to recover as well as create communities of people who use substances, their loved ones, and their healthcare providers.Misconceptions about SUD and harm reduction are often caused by moral panic and fear. But research has always showed that when people are given unconditional support without judgement, they are more likely to seek treatment and make positive changes in their lives.By exploring this website, I hope you've been able to understand harm reduction and challenge stigma against those seeking treatment. To test your knowledge of this site, head to the next page! If you'd like to learn more about the research, you can visit the references page.
Test Your Knowledge!
Click on the blacked-out text to reveal the answer!
Question 1: According to the DSM-5-TR, what defines a Substance Use Disorder?
A. Physical Health
B. Risky Use
C. Impaired Control
D. Social Impairment
A. That behaviors are influenced by a person's past experiences.
B. That people struggling with SUD are usually incarcerated because punishment is the most effective deterrent.
C. That any positive change is beneficial.
D. That everyone is responsible for their own choices and behaviors.
A. Raises awareness
B. Reduces stigma
C. Empowers people to act in the case of an overdose
D. All of the above
Substance Use/Addiction Resources
NHRC: The National Harm Reduction Coalition. This organization promotes harm reduction practices across the nation! They advocate for policy reforms at the local, state, and national level, provide clean syringes, and more.
NASEN: The North American Syringe Exchange Network. They help connect people struggling with substance use disorder with healthcare, safe ways to use drugs, resources to quit, and community.
Next Distro: A naloxone & sterile syringe mailing program.
ASAM: The American Society for Addiction Medicine. This page has resources on finding physicians who specialize in addiction care, addiction treatment guides for patients, support groups, and more.
AAC: American Addiction Centers, which has information on rehab centers and outpatient care.
Life Ring: Offers online and local meetings for all kinds of substance use recovery. They don't use prayer or religion to respect those of all faiths.
WFS: Women for Sobriety, which helps women get connected to addiction resources, sobriety meetings, etc.
SAMHSA: Substance Use and Mental Health Services Administration. This page includes a database of all opioid treatment programs and helplines in the United States.
Sober Apps: Get Smart About Drugs has a page full of apps anyone can install on their phone to support their sobriety journey.
SMART: Offers resources and information on SMART recovery meetings in the United States.
NA: Narcotics Anonymous.
AA: Alcoholics Anonymous.
DPP: The Dave Purchase Project! This organization provides supplies to NASEN and harm reduction services to Tacoma, Washington.
References
American Psychiatric Association. (2022). Substance-related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).Cleveland Clinic. (2022, June 3). What is harm reduction and how does it work? https://health.clevelandclinic.org/what-is-the-harm-reduction-modelHawk, M., Coulter, R.W.S., Egan, J.E., Fisk, S., Friedman., M.R., Tula, M., & Kinsky, S. (2017). Harm reduction principles for healthcare settings. Harm Reduction Journal, Vol. 14. DOI: 10.1186/s12954-017-0196-4.Marlatt, G.A., Larimer, E.M., & Witkiewitz, K. (2012). Harm reduction: Pragmatic strategies for managing high-risk behaviors. The Guilford Press. ISBN: 9781462502660.Mosel, S. (2025, Dec 16). Opioid rehabilitation: How does a methadone clinic work? American Addiction Centers. https://americanaddictioncenters.org/rehab-guide/methadone-clinics.Rose, C.G., Pickard, A.S., Kulbokas, V., Hoferka, S., Friedman, K., Epstein, J., & Lee, T.A. (2023). A qualitative assessment of key considerations for drug checking service implementation. Harm Reduction Journal, Vol. 20, pp. 1-11. DOI: 10.1186/s12954-023-00882-y.Strang, J., Groshkova, T., & Metrebian, N. (2012). Insights: New heroin-assisted treatment. European Monitoring Centre for Drugs and Drug Addiction. DOI: 10.2810/50141.Wurth, A., Bolick, M., & Yates, T. (2024). Evolution of the science and perception of harm reduction. Policy Forum: Invited Commentaries & Sidebars, Vol. 85(issue 5). DOI: 10.18043/001c.12325.Weger, R., Weinstock, N., Jawa, R., & Wilson, J.D. (2024). "We're not gonna aid you in shooting up": Stigma's relationship to harm reduction in people who inject drugs. Journal of General Internal Medicine, Vol. 40, pp. 2870-2878. DOI: 10.1007/s11606-024-09129-3.Yang, C., Favaro, J., & Meacham, M.C. (2021). NEXT harm reduction: An online, mail-based naloxone distribution and harm-reduction program. American Journal of Public Health, Vol. 11(No. 4), pp. 667-671.
Formatting notice: Hanging indents were impossible on Carrd.