By Alberto Alemanno1, Jean Monnet Professor of EU Law and Risk Regulation, HEC Paris

Drawing on the findings of behavioural science, ‘nudge’ theory offers a positive way forward for harm reduction policy, argues Professor Alemanno. Replacing rigid rules and regulations with a more nuanced approach, ‘nudge’ can help move the debate away from a morals-led, abstinence-only approach to a more scientific, pragmatic solution.

At a time when policy-makers want to change the behaviour of citizens to tackle a broad range of social problems, such as excessive drinking, obesity and crime, as well as climate change, a promising new policy approach has appeared that seems capable of escaping the liberal reservations typically associated with all forms of regulatory action.

By Andy Stonard, CEO, Esprit du Bois; Former CEO Rugby House – Drug & Alcohol Treatment Services; Author: A Glass Half Full: Drinking - Reducing the Harm

Alcohol is a major cause of harm on a global basis. But health policy and treatment responses have been inconsistent and ineffective, says Mr. Stonard. What is needed, he argues, is a complete overhaul in our thinking and a move away from the moral and economic approach which has dominated in the past. It is time, he says, to go much further in applying the increasing understanding that science is giving us.

Alcohol is a drug. Available - legally or illegally - in 90% of the world, it is produced and distributed via an industry network that includes farming, production, distribution, retail, entertainment and leisure, advertising and sponsorship. According to the World Health Organisation (WHO) and the International Centre for Alcohol Policy, between 30% and 50% of the world’s alcohol output is privately produced and consumed. As a global phenomenon, alcohol requires interventions that are flexible and appropriate to widely differing regions and countries.

By Dr Wilson Compton, Director, Division of Epidemiology, Services & Prevention Research, US National Institute on Drug Abuse (NIDA)

The development of an effective, evidence-based public health approach to drug abuse must be built on three key pillars, argues Dr. Compton. The first is an understanding of how drug use affects, and is affected by, developmental brain-behaviour interactions. The second is a clear understanding of patterns in drug abuse. Finally, it is important to understand how policies can be implemented differently in different areas – with differing effects.

Drug abuse is a subject that is often overshadowed by irrational bias, stigma and discrimination. A public health perspective on drug abuse, however, needs to rely on an evidence-based approach if it is to maximise population benefit and minimise population morbidity.

By Dr. Delon Human, President & CEO, Health Diplomats, Adviser to the UN Secretary General and former Secretary General of the World Medical Association; Author: Wise Nicotine

Dr. Human argues for a more evidence-based approach to harm reduction and a move away from the morals-based discussions of the past. Evidence for the benefits of harm reduction will need to be produced for harm reduction efforts to be sustainable, but these benefits cannot be ignored – as the binary ‘quit or die’ approach demands.

Unfortunately, harm reduction has engendered some debate and controversy. The majority of the public health community still advocates abstinence as the only defendable goal, paramount to a ‘control or ban’ approach. The underlying philosophy is, for example, that we should all work for a drug-free or tobacco-free world. If we accept any kind of drug use to help reduce harm, it would be tantamount to accepting drugs into mainstream society. There are also concerns that these harm reduction techniques might lead to increased initiation of use, decrease in the cessation of harmful substance abuse, relapses for former addicts and the “normalisation” of drugs in society. For many, asking them to agree to free methadone clinics is akin to asking them to legislate for drug consumption. But it is vital that the global science community fully embraces harm reduction.