Journal of HIV/AIDS Prevention & Education for

Adolescents & Children

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Harm Reduction

Marcia Bok & Julio Morales

To cite this article: Marcia Bok & Julio Morales (2000) Harm Reduction, Journal of HIV/AIDS
Prevention & Education for Adolescents & Children, 3:3, 87-99, DOI: 10.1300/J129v03n03_06

To link to this article: http://dx.doi.org/10.1300/J129v03n03_06

Published online: 13 Nov 2009.

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 Harm Reduction:
Dealing Differently with Adolescents
and Youth
Marcia B o k
Julio Morales
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ABSTRACT. A harm reduction perspective can be helpful in commu-

nicating with adolescents and youth around HIV prevention interven-
tions and awareness of the risks associated with using drugs. While
these risks may be related to the abuse of drugs, risks are often related
to societal prohibitions and punishments around drug use. This article
discusses the dangers of the War on Drugs and suggests that a harm
reduction approach provides guidelines for more effective drug policy
and drug intervention strategies. [Article copies available for a feefrom The
Haworth Document Delivery Service: 1-800-342-9678.E-mail address: getinfo@
haworthpressinc.com <Website: http:l/www.hawor~hpressinc.com>]

KEYWORDS. HIV risk reduction, harm reduction drug policy, harm

reduction drug intervention strategies

INTRODUCTION

Many professionals and drug users engage in harm reduction prac-

tices without realizing that they are using harm reduction principles;
and others think they are using a harm reduction approach when, in
fact, they are not. Both misconceptions reflect the status of harm

Marcia Bok is Professor Emerita, School of Social Work, University of Connecti-

cut, West Hartford, CT. Julio Morales is Professor, School of Social Work, Universi-
ty of Connecticut, West Hartford, CT.
Journal of HIVIAIDS Prevention & Education for Adolescents & Children
Vol. 3(3) 1999
O 1999 by The Haworth Press, Inc. All rights reserved.
 88 Journal of HIVIAIDS Prevention & Education for Adolescents & Children

reduction in the United States today. On the one hand, for some
people, harm reduction has become a "buzz word" for a wide variety
of vaguely defined practices, while others may be totally unaware that
harm reduction has become conceptualized into a relatively new and
popular, yet controversial, alternative approach to traditional drug
policy, advocacy, and treatment.
Watson (1991) defines harm reduction as "the philosophical and prac-
tical development of strategies so that the outcomes of drug use are as
safe as is situationally possible. It involves the provision of factual infor-
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mation, resources, education, skills and the development of attitude

change, in order that the consequences of drug use for the users, the
community and the culture have minimal negative impact" @. 14).
Harm reduction is a philosophy, an attitude, and a movement de-
signed to help the most recalcitrant drug user; that is, the individual
who is either not ready or able to totally eliminate drug use but, for
whom, current policies and practices lead to serious adverse effects. It
is not so much an outcome, such as abstinence from drug use, as a
process of change-on a societal and individual level. Not adhering to
abstinence as a major goal of drug policy and drug treatment is prob-
ably the most controversial aspect of harm reduction. But there are
other controversial principles, as well. For example, from a prevention
perspective, abstinence from sexual activity is generally considered an
unrealistic goal for most people and safer sex practices, rather than no
sex, is generally advocated (depending on the age of the individual).
Along this same line of thinking, harm reductionists generally believe
that prohibitions against drugs can be more dangerous than using
drugs (again, depending on the age of the user). Thus, HIV infection
from opposition to needle exchange programs is considered more
deadly than injected drug use; and incarceration for minor, non-violent
drug use is considered to have more serious consequences than pos-
session and use of moderate amounts of marijuana.

TRADITIONAL U.S. DRUG POLICY

Although many individuals, from libertarians to progressives, be-
lieve that the War on Drugs is unwinnable, there continues to be great
resistance in the U.S. to any change away from a zero tolerance for
drugs policy. While the White House drug policy director, Barry
McCaffrey appears to be recognizing the cost-effectiveness of drug
 Marcia Bok attd Julio Morales 89

treatment over incarceration, he has recently delivered a report to the

Congress which basically continues and intensifies current federal
drug strategies. In response to the report, President Clinton said that
"while there is some encouraging progress in the struggle against
drugs. . . the social costs of drug use continue to climb." A new five
part federal plan continues to emphasize drug control and includes
educating the nation's children on the dangers of drug use. The plan is
aimed at reducing the use and availability of drugs by 25 percent by
2002 and 50 percent by 2007. The plan includes securing the nation's
borders from drugs and reducing the supply of drugs into the country.
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A national drug-control advertising campaign is also planned.

Close to $18 billion was spent lin 1997 on the War on Drugs,
without major improvement in the drug situation in the U.S. Two-
thirds of this money was used for interdiction-stopping drugs from
entering the country-and enforcement-arresting, trying and imprison-
ing users. Although affecting the supply side of drugs has met with
little success, there appears to be little innovation or motivation to
change this federal response to the ongoing drug problem (Rosen-
baum, 1998). There is relatively little attention to increased funding
for drug treatment, reduced incarceration for minor offenses, or
changing the nature of the drug education message to youth. Most
critical of all is the lack of open and honest dialogue about the easy
availability of drugs and the affects of drug use. Continued adherence
to the unsuccessful "war on drugs,",zero tolerance drug policies and
zero tolerance for new ideas is likely to result in unchanged outcomes.
The Drug Abuse Resistance Education (DARE) program is an ex-
ample of government funding of a zero tolerance, ineffective youth
education program (Johnson, 1998). One of the most indicting find-
ings about DARE, based on a six-year study of 1,798 students con-
ducted by the University of Illinois at Chicago, was that "kids in the
suburbs who . . . , participated in DARE actually had significantly
higher levels of drug use than suburban kids who did not get the
DARE program." Even traditional institutions, like The National In-
stitute of Drug Abuse (NIDA), do not endorse DARE.

LIMITATIONS OF THE.WAR ON DRUGS:

SUPPLY AND DEMAND
The National Center on Addiction and Substance Abuse's 1997
"Back to School Survey" found that 76 percent of high school and 46
 90 Journal of HWIAIDS Prevention & Education for Adolescents & Children

percent of middle school students report that drugs are kept, used, or
sold on their school grounds. The slogan of "drug free schools zones"
appears to have about as much credibility with young people as "just
say no to drugs." Nevertheless, punishment and isolation of drug
users, rather than innovative harm reduction programs, continue to
prevail. Congress has approved legislation that would ban financial
aid to a student in higher education "who has been convicted of any
offenses under ~ e d e r aor
l State law involving the possession or sale of
a controlled substance" (Network News, Sept. 1998). This, of course,
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would overly penalize poor and minority students who are more likely
than white, middle-class student to be arrested and convicted of a drug
offense. It may also deny future financial aid to students who may
need it most. Other Congressional proposals include "random suspi-
cionless drug testing of students in grades 7-12," drug testing for all
teenagers who apply for a drivers license and a grant program to
promote drug testing programs in small businesses. The "Drug-Free
Workplace Act" also asks states to reject the legalization of drugs
through legislation and ballot initiatives. These proposals and actions
provide a pretty clear view of the government's continued stance on
drug policy. The government's emphasis on punishment and incar-
ceration for drug use, as a major prevention strategy, is particularly
opposed by the harm reduction perspective.
Some of the current facts about drug use among adolescents and
young adults may help to understand to scope and magnitude of the
problem. According to the annual National Household Survey on
Drug Abuse (NHSDA), released August 21, 1998, the number of
Americans using illicit drugs remained flat in 1997, with an estimated
13.9 million Americans (6.4 percent of the U.S. population age 12 and
older) indicating they had used an illicit drug in the month prior to
being interviewed. However, young people age 12-17 reported an
increase in 1997 use of drugs after a slight decrease in 1996. Marijua-
na made up the bulk of the increase (Network News, Sept. 1998).
According to the NHSDA, marijuana continues to be the most fre-
quently used illicit drug; about 60 percent of all illicit drug users
reported only using marijuana. However, the survey also revealed that
an estimated 111 million persons age 1 3 and over were current alcohol
users (51 percent of the population) and of these, about 31.9 million
persons (15.3 percent) engaged in binge drinking. While alcohol is not
illegal for adults, underage drinking is a major societal concern; again
 Marcia Bok and Julio Morales 91

reflecting the inadequacy of a prohibition policy for controlling sub-

stance use among adolescents and young adults.
An August, 1998 reaction to the NHSDA report from the Washing-
ton, D.C. based Drug Policy Foundation (DPF) states that "today's
teenagers have received the most intensive anti-drug programming of
any in America's history, yet youth drug use continues to climb. Fur-
thermore, young people have consistently reported that illegal drugs
like marijuana are readily available." DPF indicts the seek-arrest-im-
prison strategy that characterizes current U.S. drug policy. The gov-
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ernment continues to spend valuable resources on the criminal justice

system instead of on effective education, even as HlV infection among
young people continues to increase.
A report from the Centers of Disease Control and Prevention on
1997 national youth risk behavior found that 33.4 percent of youth in
grades 9-12 recently engaged in heavy drinking and 50.8 percent had
drunk alcohol in the past 30 days. In addition, 36.4 percent of high
school students had smoked cigarettes more than once in the 30 days
preceding the survey and 26.2 percent reported having used marijuana
in the previous 30 days. Nationwide, 79.1 percent of high school
students reported having had at least one drink of alcohol during their
lifetime and 79.2 percent said they had tried cigarette smoking. By
contrast, 47.1 percent of students reported having used marijuana
during their lifetime, 8.2 percent used some form of cocaine, 3.1
percent used illegal steroids, and 17 percent had used other illegal
drugs. Approximately one in fifty (2.1 percent) reported having in-
jected drugs. Hispanic students (although variations among Hispanic
groups are not noted) were significantly more likely than white or
black students to have ever used cocaine; and white students were
significantly more likely than black students to have done so. Black
male students were significantly more likely than white male students
to have ever used marijuana. Hispanic and white students were signifi-
cantly more likely than black students to have had at least one drink of
alcohol during their lifetime.
Despite different patterns of drug use, African Americans continue
to be the predominate casualities of the drug war. All too familiar
statistics (that continue to cry out for attention) are that African Amer-
icans, only 12.6 percent of the population and 11 percent of drug
users, constitute almost 37 percent of those arrested for drug viola-
tions, over 42 percent of those in federal prisons for drug violations,
 92 Journal of HIVIAIDS Prevention & Education for Adolescents & Children

and almost 60 percent of those in state prisons for drug felonies. One in
three African American men between the ages of 20 and 29 years old is
under correctional supervision or control (Network News, 1998).
It appears that our efforts to reduce the demand for drugs have fared
no better than our efforts to reduce the supply of drugs. Current drug
use prevention education programs have not decreased drug using
behaviors. Most of these programs focus on the dangers of marijuana.
But half of American teenagers try marijuana anyway, find that most
of the dire warnings are not true and begin to mistrust everything
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about drugs that adults tell them (Rosenbaum, 1999). On the other
hand, heroin can be much more dangerous than marijuana. Sharing
needles with an infected person can cause hepatitis or HIV. Repeated
heroin use will cause physical dependence on the drug and will result
in withdrawal symptoms when the individual tries to stop using. Even
the occasional heroin user, while not necessarily addicted, can experi-
ence a fatal overdose if the potency of a batch of heroin in not known.
Thus, it is very important to be knowledgeable and cautious when
using heroin. This is the kind of information and warnings that should
be given to teenagers! But the effects of marijuana and heroin are
rarely differentiated in the "scare" messages that are delivered. "Zero
tolerance," which focuses on fear and prohibition, is applied to all
drugs. However, this strategy can cause teenagers to distrust adults,
deny their drug use and prevent them from talking to their parents or
seeking other kinds of adult help.

SEXUAL BEHAVIOR AND HNIAIDS

On the issue of.sexual behavior, it appears that prevention messages
may be having some impact on sexual activity among some young
people. A report released by the Alan Guttmacher Institute in 1998
reveals that after two decades of steady increase, the proportion of
American high school students who say they have had sexual inter-
course fell 10 percentage points during the 1990s. The study also
shows that young people are more likely to use condoms and less
likely to have multiple sex partners. Additional data indicate that the
rate of teenage pregnancies in the U.S. has dropped to its lowest rate in
two decades and there is a decline in births among teens in every part
of the U.S. (Lewin, 1998; Vobejda, 1998). In fact, according to the
National Center for Health Statistics, the teen-age birth rate, which has
 Marcia Bok and Julio Morales 93

been dropping steadily for six years, has dipped so sharply that it has
helped to push the nation's overall birth rate to the lowest level since
the government began keeping records in 1909 (Stolberg, 1999). De-
laying sex until they are older, having sex less frequently and using
birth control more often are behavior changes that appear to be signifi-
cantly related to the decreased birth rate. The data indicate that about
20 percent of the decrease since the late 1980s is because of decreased
sexual activity and 80 percent of the decrease is because of more
effective contraceptive practices (Stolberg, 1999). These figures are
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important because they reflect the relative impact of abstinence and

birth control messages on teenagers.
On the other hand, however, teen pregnancy still remains much
more common in this country than in other industrialized nations, with
one million teens becoming pregnant each year. In addition, each year
in the U.S. about three million teenagers acquire a sexually transmitted
disease; and HIV infection continues to grow among young people.
According to the U.S. Centers for Disease Control (CDC), between
1990 and 1992, the number of reported AIDS cases in 13-21 year olds
increased 62 percent-a jump from 5,560 to 9,000 cases. Currently,
one-fifth of the people diagnosed with AIDS are in their 20s, and most
were infected as teenagers. In addition, AIDS cases among teenage
women increased more than 13 times between June, 1989 and Decem-
ber, 1996 (Center for Women Policy Studies, 1998). A CDC report in
1998 indicates that the rate of HIV infection among women 16 to 21 is
much higher than that of men in the same age group. The highest rates
of infection among youth are among black women, with five out of
every 1,000 infected with HIV. While African Americans make up
12.5 percent of the U.S. population; they now account for 57 percent
of all new HIV infections. Among individuals aged 14-24, blacks
account for 63 percent of all new infections; while the national death
rate from AIDS has dropped, the disease has become the leading killer
of African Americans, aged 25 to 44 (Stolberg, 1998).
In 1997, World AIDS day focused on the children infected and
affected by HIV. Carol Bellamy, of the United Nations Children's
Fund, noted that HIV will be a major killer of children within little
more than a decade, and that the majority of deaths will be in those
countries that are least able to absorb the loss of so many young
people. By 2000, health officials estimate, 10 to 15 million children
worldwide, will be orphaned by AIDS. At the 12th World AIDS
 94 Jourttal of HNIAIDS Prevention & Education for Adolescents & Children

Conference in Geneva in June (1998) it was reported that more than 10

million people had become infected with HIV since the last AIDS
conference in Vancouver in 1996. About half were under age 25 (Alt-
man, 1998).

A HARM REDUCTION APPROACH TO SEX AND DRUGS

All of these data strongly point to the need for multi-level and
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targeted education efforts to a diverse group of adolescents and young

adults. Marsha Rosenbaum, Director of the Lindesmith Center in San
Fransisco (1999; 1996) points to some of the problems inherent in
current drug prevention messages and some of the corrections that
need to occur to deliver drug education that is truly effective:
1. Adults have to convince teenagers that the information they pro-
vide is accurate. A restoration of trust in adults is needed.
2. Zero tolerance for drug use can prevent teenagers from asking
for help. Young people will often suffer in silence in order to
avoid the wrath of their parents. If a teenager is using drugs, he/
she should not fear rejection by significant adults.
3. Rather than totally prohibiting drugs, which may be unrealistic,
we should focus on the reduction of the harm related to drug use.
Accurate and timely education on the effects of different drugs is
critical.
4. Related to prohibition is the emphasis on abstinence as a preven-
tion strategy. Abstinence is a form of denial, by adults, about the
actual behaviors of teenagers and young adults. This kind of de-
nial encourages other forms of denial by youth.
5. Theory and research into behavior change show that while some
drug education programs may influence attitudes toward drugs,
these programs may produce little behavioral change. Similarly,
perceived risk or personal susceptibility around specific drug-re-
lated behaviors will not automatically translate into behavioral
change. Skill building and feelings of competency around
change are also needed.
6. The pharmacology of the drug, set and setting are three of the
most powerful concepts associated with drugs and the effects of
drug use (Zinberg, 1984). Set (i.e., expectations around the phys-
iological, psychological, and social effects of drug use) and set-
 Marcia Bok and Julio Morales 95

ting (i.e., the context in which drug use occurs) help to under-
stand the influence of peers on teenage behaviors. If teens are
using drugs and this behavior is positively reinforced by peers
and the effects of drug use are perceived as positive, it will be
difficult to change these behaviors. On the other hand, disap-
proval by peers and lack of enjoyment or negative effects around
drug use can enhance behavior change. Just as knowledge alone
is not sufficient to change behavior, it is difficult to change be-
havior that is socially approved by peers and is pleasurable.
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Harm reduction, by focusing on the harm, without denying the

pleasure, provides a different kind of drug use prevention mes-
sage. Thus, the positive, as well as the negative, aspects of drug
use are acknowledged and the costs and benefits of drug use
have to be discussed.
7. The notion that using marijuana is a "gateway" to more danger-
ous drugs is not substantiated in research. If it were true you
would have many more young people using more dangerous
drugs. However, excessive use of some drugs is associated with
more relaxed sexual behavior possibly leading to unprotected
sex.
8. Abuse and use of drugs are often undifferentiated; but, in fact, it
is possible to use and not abuse drugs. Lack of differentiation en-
genders fear of all drugs. The outcomes of marijuana and heroin
use are likely to be quite different. When prevention is dis-
cussed, most of the concern should be about drug abuse and ad-
diction.
9. It is fear of young people using drugs that generates much of the
hysteria around drug policy. Adults are skeptical about teenagers
making appropriate decisions around drugs. However, if proper-
ly informed and properly motivated, young people are capable of
making responsible decisions around serious drug use.
According to Rosenbaum (1996) a harm reduction approach con-
tains four basic assumptions:
1. The designation of a drug as legal or illegal is political and not
pharmaceutical. What is legal or illegal today can change at any
time, with the' prohibition of alcohol and cigarettes as prime ex-
amples of this phenomenon. However, if a drug is illegal, an ef-
fective drug education program must acknowledge this status as
 96 Journal of HIVAIDS Prevention & Education for Adolescents & Children

a risk factor in itself. For example, becoming involved in the

criminal justice system usually has devastating effects beyond
the physical effects of drug use. It is important to educate youth
about the nature of all psychoactive substances, legal and illegal.
2. Total abstinence from drugs is probably not realistic for all
youth. We routinely alter our states of consciousness through al-
cohol, tobacco, caffeine, over-the-counter and prescription
drugs. We should take a pragmatic, rather than a moralistic, view
toward drug use in efforts to minimize its negative effects.
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Instead of punishing and ostracizing drug users, we need to es-

tablish criteria regarding the harm related to substance use. We
need to ask ourselves, for example, if an individual's drug use is
harmful to himself or herself, to his or her family, or to the com-
munity in which the individual lives.
3. Millions of people use a variety of drugs and go to work every-
day. Eighty to ninety percent of drug users are not controlled by
their drugs, but instead they control their drug use. Drug educa-
tion should include discussion of moderate and responsible drug
use, as well as abstinence as a possible option.
4. As mentioned earlier, the context of use (the pharmacology of
the drug, the set or psychological state of the user, and the setting
or the total situation of the individual) makes the difference be-
tween use and abuse (Zinberg, 1984).

Rosenbaum (1996) also discusses translating these assumptions

into educational programs. This would include, for example, the con-
cept of the "designated driver" which minimizes the danger of driv-
ing while intoxicated. Like needle exchange, however, critics of safe
rides programs emphasize that this approach encourages illegal drug
and alcohol use (Homer-Bouthiette, 1999). On the other side, individ-
uals like Katz (1999) argue that safe rides is not about providing a taxi
service for students to facilitate their drinking. Rather, it is about
addressing the ever-growing issue of teenage drinking and driving.
Second, Rosenbaum empasizes the importance of knowing the physi-
ological effects of drugs, as well as their risks and benefits. What are
the costs and benefits of drug use? Third, we should incorporate chil-
dren's experience, expertise and intelligence in a drug eduation curric-
ulum. "Peer education" programs have been shown to be particularly
effective with teenagers. Fourth, positive role models should educate
 Marcia Bok and Julio Morales 97

children about drug use. These are individuals who are moderate and
responsible drug users who can convey harm reduction messages such
as not driving while intoxicated and never using drugs at work or
school.
Unfortunately, most school curricula in the U.S.use a moralistic
and judgmental message and do not incorporate most of the more
controversial principles of harm reduction. A drug education ap-
proach, used (in a limited way) in the United Kingdom, incorporates
peer support and respects the rights of young people to make their own
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informed decisions on drug use. That curriculum includes facts about

drugs; personal drug use and risk-taking; stereotypes about drug use;
drug, set, and setting factors; laws, rules, and legal rights; skills in
giving and receiving help; community action locally and nationally;
and a parents and community workshop (Cohen, 1993).
An Oregon program founded in 1982, Mothers Against Misuse and
Abuse (MAMA) emphasizes helping parents and children make re-
sponsible decisions in a drug-filled world. The program provides hon-
est information about both legal and illegal drugs and provides a
comprehensive, non-judgmental, yet cautionary perspective on drug
education. (MAMA, no date).
While the War on Drugs is supposed to protect our society, and
especially young people, from drugs, this has not happened. On the
contrary, the War on Drugs has resulted in thousands of Prisoners of
War-i.e., Prisoners of the Drug War. Mandatory minimum sentencing
has resulted in incarceration of thousands of young people for long
periods of time for minor offenses. Theprivatization of prisons has fed
the growth of the prison system in a major way and the profit motive
affects criminal justice in the U.S. from racial inequity to cruel and
unhumane treatment in prisons.
Parents and other family members whose relatives are incarcerated
or whose children have died from drug overdoses are often ashamed
and isolated in their grief. Youth who have observed a peer experienc-
ing a potentially deadly drug reaction are often afraid to call 911 for
help. It is unlikely that the schools will take a proactive role in effec-
tive drug prevention education in the short run. Thus, one of the keys
to effective drug education and policy change is the enlistment of
parents in the struggle. Adults must be convinced that current policies
and rhetoric are not effective and they must transmit their beliefs and
knowledge to their children. They need to be helped to overcome the
 98 Journal ofHNIAIDS Prevention & Education for Adolescents & Children

fear that discussing drugs and sex will encourage promiscuity and
drug abuse among young people.
In conclusion, sometimes when social workers and other human
service providers receive harm reduction training they feel that it
reinforces what they already do and believe: start where the client is,
maintain an accepting and non-judgmental attitude, and let the client
set his or her own goals for treatment. This is a good start. But it is not
the whole story. The War on Drugs is a political battle and thus drug
policies are mired in a battlefield. A harm reduction approach is cur-
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rently miles away from zero tolerance for drugs. While total absti-
nence from substance use may be desirable, it is most often not realis-
tic. Ignoring other approaches to avoid harm associated with substance
use may inadvertently create more harm than expected. As is true so
often, a different approach to drugs and drugs use is likely to occur
incrementally. But we must keep up the pressure to achieve systems
change.

REFERENCES
Altman, Lawrence K.At AIDS Conference, a call to arms against "Runaway Epi-
demic," NY Times, June 29,1998.
Cohen, J. Achieving a reduction in drug-related harm through education, in Heather,
N., Wodak, A., Nadelmann, E., and O'Hare, P., eds. Psychoactive Drugs and
Harm Reduction: From Faith to Science, 1993.
Homer-Bouthiette, Dawn. Do safe-ride programs encourage students to drink? Yes.
They skirt the real issue. TheHartford Courant, March 13,1999.
Johnson, Dirk, Second Thoughts on Cops in the Class NY Times, September 27,
1998.
Katz, Deborah. Do safe-ride programs encourage students to drink? No. They save
lives, The Hartford Courant, March 13, 1999.
Lewin, Tamar. Youth pregnancy rate falls, report says, NYTimes, October 15, 1998.
Mothers Against Misuse and Abuse. Using Alcohol Responsibly. Mosier, Oregon,
MAMA, no date.
Network News, A monthly publication for the drug policy foundation's advocacy
network, Washington, D.C., September, 1998.
Rosenbaum, M. The best policy against drugs? The Hartford Courant, February 22,
1999.
Rosenbaum, M. Kids, drugs, and drug education: A harm reduction approach, Na-
tional Council on Crime and Delinquency, August, 1996.
Stolberg, Sheryl Gay. Eyes shut, Black America is being ravaged by AIDS. NY
Times, June 29, 1998.
Stolberg, Sheryl Gay. Birth rate at new low as teen-age pregnancy declines. NY
Times, April 29, 1999.
 Marcia Bok and Julio Morales 99

Obejda, Barbara. Fewer high school students having sex, study finds. The Harvord
Courant, September 18, 1998.
Watson, M. Harm reduction: Why do it? International Journal of D r u a Policv. 5.
13-15,199i.
Zinberg, N.. Drug, set, and setting. New Haven: Yale U. Press. 1984.
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