Rethinking Alcohol Harm Reduction.

Abstract

Alcohol harm reduction (AHR) includes a pragmatic set of strategies to reduce the acute harms of alcohol consumption without necessarily reducing use, such as managed alcohol plans and intoxication management facilities. While well established in illicit drug research, harm reduction's application to alcohol remains less explicitly examined, both conceptually and in terms of policy articulation. In contrast to population-level consumption-reduction strategies - many of which are effective at preventing harm - AHR often places greater emphasis on acute and immediate harms and may require consumers to take an active role, a feature that has raised concerns about industry mobilising 'responsible drinking' narratives. AHR also tends to be subsumed within other alcohol policies and has a less consolidated evidence base. However, drawing on international and Australian evidence, this article outlines practical and ethical reasons for a more explicit focus on AHR, including the substantial burden alcohol places on frontline health systems, its disproportionate impacts on socially disadvantaged populations and its frequent involvement in polydrug use and overdose. AHR can also facilitate cross-sectoral collaboration and lateral policymaking, and contribute to the ethical obligation of policymakers to redress the harms of alcohol commercialisation. Beyond formal policy, AHR already occurs in clinical, educational and nightlife settings. Recognising this, future research and policy efforts should focus on clarifying how harm reduction can be more explicitly integrated within alcohol policy frameworks to complement population-level approaches.