Harm-reduction for unwanted pregnancies and unwanted addictions: an instructive analogy

Addiction treatment aims to reduce the harm that addiction causes to individuals and society. However, many clinics, especially in the private sector, have ideological objections to using medico-pharmacological treatments and are often critical of other services that do offer pharmacological treatments. This situation contrasts sharply with the attitude of family planning (FP) clinics, even though they too aim to reduce harm. Ironically, the most anti-pharmacological clinics are often those which proclaim most loudly that addiction is a 'disease', while avoiding unwanted pregnancy, which is not usually seen as a disease, is widely and effectively achieved with medical techniques. FP clinics typically consider widely varying patterns of sexual behaviour, social contexts and patient attitudes in devising individual treatment plans, while addiction clinics commonly have a one-size-fits-all, take-it-or-leave- it approach. Addiction services could learn some useful clinical and ideological lessons from FP clinics.