Harm Reduction:A Model for Social Work Practice with AdolescentsKatherine van WormerTHE SOCIAL POLICY JOURNAL 3 (2), 2004, 19-37.ABSTRACT. A practical antidote to the war on drugs, the harm reduc-tion approach seeks to meet clients where they are, establish rapport andhelp them modify or give up their risk-taking behavior. This article pre-sents the case for harm reduction techniques for work with youth whoserisk-taking behavior is problematic. Emphasis is on drinking, drug use,and high-risk sexual activity.KEYWORDS. Harm reduction approach, client-centered approach,strengths perspective, adolescents, high-risk adolescent behaviorINTRODUCTION“Meet the client where the client is,” the popular slogan of socialwork practice, sums up harm reduction philosophy in a nutshell. Fromits origins as a way of addressing the negative consequences of druguse, the harm reduction concept has grown considerably in recent years(Hill, 1998). An international public health movement, harm reductionjoins client and therapist in the realistic pursuit of reducing the harm inKatherine van Wormer, MSSW,PhD, Professorof SocialWork, Universityof North-ern Iowa, Cedar Falls, Iowa 50614 (E-mail: email@example.com).The Social Policy Journal, Vol. 3(2) 2004http://www.haworthpress.com/web/SPJ2004 by The Haworth Press, Inc. All rights reserved.
Digital Object Identifier: 10.1300/J185v03n02_0319Page 2one’s life. Typical strategies include: helping clients substitute a lessharmfuldrug for alifethreateningdrug;recruitmentof clientsintometha-done maintenance and needle exchange programs; giving women re-turning to their battering husbands a safety plan for self protection; andan after-school program to help gays and lesbians “talk through” prob-lems of internalized homophobia that might otherwise seek self-de-structive channels of expression.Although social work and the harm reduction approach are a naturalfit and widely integrated in Europe (see van Wormer, 1999), the U.S.social work literature is remiss in terms of describing the utilization ofthis practice/policy perspective. A search of Social Work Abstracts on-line as of August, 2003 reveals ten listings for harm reduction, only fourof which are in American social work journals–from Health and SocialWork are articles by Brocato and Wagner, (2003); Reid (2002); andMacMaster, Vail, and Neff (2002); and from Social Work Research anarticle by Burke and Clapp, (1999). (Actually, this is a big improvementover one year earlier when only one article from a U.S. journal of socialwork was listed.) For point of comparison, PsycInfo lists 388 at the timeof this writing. In substance abuse texts written by American socialworkers, as well, the harm reduction model is relatively absent. Excep-tions are Abbott (2000) and van Wormer and Davis (2002). Abbott pro-vides a two page description of the model and includes a chapter byDunn (2000) that utilizes the stages of change model consistent withharm reduction and strengths-based principles. The van Wormer andDavis volume, similarly, is strengths-based and utilizes a harm reduc-tion conceptualization throughout. One can expect to hear much moreabout harm reduction and its practice counterpart, motivational inter-