Reducing the harm of "harm reduction".

The article in this issue by Alan Leshner tackles one of the most contentious issues in drug use policy today and argues that we should dispense with "harm reduction" altogether--not the programs, policies, and interventions to which this term refers but the term itself. He makes the case that the initial clarity and simplicity of the phrase "harm reduction" have evolved into an emotion-laden designation that is interfering with the implementation and evaluation of public health programs.

Evaluation of the Drug Evaluation and Classification program: a critical review of the evidence.

Objective: A critical review of the existing evaluation studies on the Drug Evaluation and Classification (DEC) program was conducted to determine the validity and accuracy of the technique for identifying drivers under the influence of drugs.

Methods: Studies were divided into two categories--laboratory studies and field (i.e.

Estimating the costs of substance abuse: implications to the estimation of the costs and benefits of gambling.

This presentation describes a recently developed set of guidelines for estimating the economic costs of substance abuse, summarizes the findings from a Canadian study that utilized these guidelines, and discusses the implications to the potential development of guidelines for estimating the costs and benefits of gambling. The guidelines for estimating the costs of substance abuse present a general framework of costs to be included and discuss methodological issues such as the definition of abuse; determination of causality; comparison of the demographic and human capital approaches; the treatment of private costs; the treatment of nonworkforce mortality and morbidity; the treatment of research, education, law enforcement costs, the estimation of avoidable costs and budgetary impact of substance abuse, and the significance of intangible costs. Utilizing these guidelines, a study was undertaken to estimate the economic costs of alcohol, tobacco, and illicit drugs to Canadian society in 1992.

The relative risks and etiologic fractions of different causes of death and disease attributable to alcohol, tobacco and illicit drug use in Canada.

Background: In 1996 the number of deaths and admissions to hospital in Canada that could be attributed to the use of alcohol, tobacco and illicit drugs were estimated from 1992 data. In this paper we update these estimates to the year 1995.

Methods: On the basis of pooled estimates of relative risk, etiologic fractions were calculated by age, sex and province for 90 causes of disease or death attributable to alcohol, tobacco or illicit drugs; the etiologic fractions were then applied to national mortality and morbidity data for 1995 to estimate the number of deaths and admissions to hospital attributable to substance abuse.

Morbidity and mortality attributable to alcohol, tobacco, and illicit drug use in Canada.

Objectives: This study estimated morbidity and mortality attributable to substance abuse in Canada.

Methods: Pooled estimates of relative risk were used to calculate etiologic fractions by age, gender, and province for 91 causes of disease or death attributable to alcohol, tobacco, or illicit drugs.

Results: There were 33,498 deaths and 208,095 hospitalizations attributed to tobacco, 6701 deaths and 86,076 hospitalizations due to alcohol, and 732 deaths and 7095 hospitalizations due to illicit drugs in 1992.

The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992.

Unlabelled: AIMS, DESIGN AND SETTING: The economic costs of alcohol, tobacco and illicit drugs in Canadian society in 1992 are estimated utilizing a cost-of-illness framework and recently developed international guidelines.

Measurements: For causes of disease or death (using ICD-9 categories), pooled relative risk estimates from meta-analyses are combined with prevalence data by age, gender and province to derive the proportion attributable to alcohol, tobacco and/or illicit drugs. The resulting estimates of attributable deaths and hospitalizations are used to calculate associated health care, law enforcement, productivity and other costs.

Harm Reduction as an Alcohol-Prevention Strategy.

Harm-reduction programs, first developed in an attempt to mitigate the adverse consequences of illicit drug use, can be applied to alcohol-prevention programs as well. In fact, the movement toward harm reduction in illicit drug prevention may be closely paralleled by a similar trend in the alcohol-prevention field. Harm-reduction approaches to alcohol aim to diminish the negative consequences of intoxication (e.

The 1993 General Social Survey II: alcohol problems in Canada.

Rates and correlates of problems associated with the use of alcohol are reported from the 1993 General Social Survey in Canada. Approximately 1 in 11 drinkers (9.2%) reported that drinking has had an adverse effect on his or her social life, physical health, happiness, home life or marriage, work, or finances in the past year.

The 1993 General Social Survey I: alcohol use in Canada.

Rates and correlates of alcohol use are reported from the 1993 General Social Survey, a household telephone survey of 10,385 Canadians carried out by Statistics Canada. Continuing a recent trend, alcohol use has declined. The portrait of the Canadian who is most likely to drink and drink heavily is that of a young adult male who is not married, relatively well-off, and rarely or never attends religious services.

Defining harm reduction.

Harm reduction attempts to reduce the adverse consequences of drug use among persons who continue to use drugs. It developed in response to the excesses of a "zero tolerance approach". Harm reduction emphasizes practical rather than idealized goals.

A comparison of alternative measures of alcohol consumption in the Canadian National Survey of alcohol and drug use.

Based on the results of the 1989 National Alcohol and Drug Survey in Canada, this paper compares alternative measures of alcohol consumption. Utilizing questions developed by Walter Clark, the volume of drinking in a variety of social situations is described. The results are presented in terms of aggregate consumption and the proportion of total consumption which occurs in different situations.

Drinking in various settings as it relates to demographic variables and level of consumption: findings from a national survey in Canada.

Based on a large-scale 1989 national survey in Canada, the extent of drinking in different social settings is estimated. Home consumption accounts for the greatest share of total drinking. while drinking in licensed establishments accounts for approximately one-fourth of consumption.

The interaction between policy and research in the implementation of server training.

This paper describes the relationship between research and policy in the development of server training policy in Ontario. With the emergence of civil liability for the conduct of intoxicated patrons, there has been a growing movement toward the training of managers and servers in licensed establishment in the responsible service of alcohol. As part of a major government reform of alcohol regulations which has led to a new Liquor Licence Act, all persons who serve alcohol in licensed establishments in Ontario will be required to attend a server training course.

Recent developments in alcoholism:public drinking.

Drinking in bars and other public establishments has been a relatively neglected subject of research, despite its epidemiological significance. This chapter briefly summarizes the findings of observational studies in bars and taverns, as well as general population surveys on the correlates of tavern patronage. Recent developments in the control of public drinking are described.

Legislating responsible alcohol service: an inside view of the new Liquor Licence Act of Ontario.

The Ontario Government has recently passed a new Liquor Licence Act, based on the recommendations of a special advisory committee. This paper describes how the advisory committee framed the issues and arrived at a lengthy document detailing 73 recommendations on issues such as licence classification, the control of special permit functions, days and hours of operation, legal drinking age, alcohol advertising, the civil liabilities of alcohol providers and server training. The key actors and considerations are discussed, as well as the subsequent Cabinet action on the report and the implementation process currently underway.