The measurement of harm reduction goals and outcomes for substance use: Current state and future directions

Traditionally, substance use treatment and research have prioritized abstinence as the primary goal or outcome while overlooking the broader spectrum of harm reduction goals and outcomes. However, emerging evidence suggests that substance use itself is not necessarily the only nor the best indicator of treatment success, and other harm reduction goals and outcomes are increasingly accepted in treatment and research. This paper reviews existing harm reduction-oriented measures and identifies gaps in current assessment approaches. Key measures discussed include those assessing substance-related harms (e.g., Alcohol Use Disorder Identification Test, Drug Abuse Screening Test), consumption-based metrics (e.g., Timeline Follow-Back), and quality of life indicators. We also highlight measures of protective behavioral strategies, harm reduction motives, harm reduction self-efficacy, and goal attainment scaling as important but underutilized approaches to assessing harm reduction outcomes. Given that harm reduction goals vary by individual and may evolve over time, we argue for the development of more reliable and valid measures that capture diverse treatment outcomes. Additionally, we emphasize the need to involve people with lived experience in all stages of the measure development process to ensure their relevance and applicability. Future research should focus on refining existing measures, expanding definitions of success in substance use treatment, and more thoroughly integrating harm reduction into clinical and research settings. By shifting the focus beyond abstinence alone, researchers and clinicians can better align treatment goals with patients' needs and goals, enhance intervention effectiveness, and promote more inclusive and individualized pathways to recovery.