Harm reduction as a treatment model for alcohol use disorder: A concept analysis

Alcohol use disorder (AUD), the most prevalent substance use disorder globally, remains underdiagnosed and undertreated, highlighting the urgent need for expanded access to evidence-based prevention, treatment, and harm reduction strategies. Harm reduction has gained recognition as a viable alternative to abstinence-based treatment models. However, its application in the treatment of AUD remains ambiguous and is often subject to misconceptions.

The purpose of this concept analysis is to provide clarification on the concept of harm reduction within the context of AUD treatment.

This concept analysis was conducted using the Walker and Avant (2019) analytic model. We identified the defining attributes, antecedents, consequences, and empirical referents of harm reduction as a treatment model for AUD. Model, borderline, and illegitimate cases were also constructed to further clarify the concept. The 29 articles included in this analysis were selected from CINAHL, PubMed, and PsycINFO databases, with no temporal limits.

Research findings suggest that harm reduction has four defining attributes, three antecedents, four consequences, and three empirical referents. Key attributes include flexible treatment goals, patient-centered approach, risk reduction strategies, and a supportive and nonjudgmental environment.

Based on our analysis, we conclude by defining harm reduction for AUD in the context of individual-level treatment as a patient-centered approach with the overall goal of reducing alcohol-related harms rather than abstinence only, using flexible treatment goals, risk reduction strategies, and a supportive, non-judgmental environment.