Harm Reduction

Harm reduction is both a policy approach and used to describe a specific set of interventions. These interventions aim to reduce the harms associated with drug use. Employing a strict definition of harm reduction, evidence for the efficacy and effectiveness of alcohol, tobacco and illicit drug harm reduction interventions were reviewed. Systematic searches of the published literature were undertaken. Studies were included if they provided evaluation data (pre-post, or control group comparisons). More than 650 articles were included in the review. The majority of the literature concerned illicit drugs. For alcohol, harm reduction interventions to reduce road trauma are well-founded in evidence. Otherwise, there is limited research to support the efficacy and effectiveness of other alcohol harm reduction interventions. For tobacco, the area is controversial but promising new products that reduce the harms associated with smoking are being developed. In the area of illicit drugs there is solid efficacy, effectiveness and economic data to support needle syringe programmes and outreach programmes. There is limited published evidence to date for other harm reduction interventions such as non-injecting routes of administration, brief interventions and emerging positive evidence for supervised injecting facilities. There is sufficient evidence to support the wide-spread adoption of harm reduction interventions and to use harm reduction as an overarching policy approach in relation to illicit drugs. The same cannot be concluded for alcohol or tobacco. Research at a broad policy level is required, especially in light of the failure by many policy makers to adopt cost-effective harm reduction interventions. [Ritter A, Cameron J. A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs. Drug Alcohol Rev 2006;25:611 -624]

In 2012, the politician Todd Akin caused a firestorm by suggesting, in the context of an argument about the moral permissibility of abortion, that some forms of rape were “legitimate” (i.e., carried out with great force or violence). This seemed to imply that other forms of rape must be “illegitimate” (i.e., carried out with less force or violence). In response, several commentators emphasized that rape is a “heinous crime” and that there are “no varying degrees of rape.” While the intention of these commentators was clear, I argue that they may—inadvertently—have played into the very stereotype of rape (implicitly) endorsed by Akin. Such a response, I claim, actually obscures a range of sexual harms, including some that may not rise to the level of being a crime. I also offer some thoughts on the moral psychology behind anti-abortion arguments of the kind advanced by Akin.

The aims and purposes of nursing teaching plans are to impart creative, salient, innovative and forward looking subject matter.  The love of the subject is contagious within the classroom  or real world setting.  Taking a different path than most students do (such as diet, hypertension, smoking) is rewarding through the challenge.

What are the effects of circumcision  on sexual function and experience? And what does sex—in the sense related to gender—have to do with the ethics of circumcision? Jacobs and Arora (2015) give short shrift to the first of these questions; and they do not seem to have considered the second. In this commentary, I explore the relationship between sex (in both senses) and infant male circumcision, and draw some conclusions about the ongoing debate regarding this controversial practice.

Surgically modifying the genitals of children—female, male, and intersex—has drawn increased scrutiny in recent years. In Western societies, it is illegal to modify the healthy genitals of female children in any way or to any extent in the absence of a strict medical indication. By contrast, modifying the healthy genitals of male children and intersex children is currently permitted. In this journal in 2015, Stephen R. Munzer discussed a controversial German court case from 2012 (and its aftermath) that called into question the legal status of nontherapeutic male circumcision (NTC), particularly as it is carried out in infancy or early childhood. Whether NTC is legal before an age of consent depends partly upon abstract principles relating to the best interpretation of the relevant laws, and partly upon empirical and conceptual questions concerning the degree to which, and ways in which, such circumcision can reasonably be understood as a harm. In this article, we explore some of these latter questions in light of Professor Munzer's analysis, paying special attention to the subjective, personal, and individually and culturally variable dimensions of judgments about benefit versus harm. We also highlight some of the inconsistencies in the current legal treatment of male versus female forms of nontherapeutic childhood genital alteration, and suggest that problematically gendered assumptions about the sexual body may play a role in bringing about and sustaining such inconsistencies.

The absence of pleasure in harm reduction discourse is more and more frequently noted, but few have considered what, exactly, more attention to pleasure might do. What is the value of pleasure for harm reduction praxis? Central to such an inquiry is the question of how pleasure is grasped, conceptually and methodologically. In this paper I use Foucault’s History of Sexuality to elaborate a perspective on the use of pleasure within harm reduction. I argue that Foucault’s work suggests a distinction between therapeutic and social-pragmatic approaches to pleasure, and that such a distinction is important for harm reduction – to the extent that it seeks to maintain a critical awareness of the relation between stigma and care – in that the latter model raises the possibility of maintaining de-pathologizing modes of care. An appreciation of pleasure in terms of its social pragmatics helps to recognize practices of safety, care and risk that might otherwise go unregistered in the current punitive political environment. It provides a basis for conceiving practical measures that are in touch with given concerns and bodily
practices, and thus have more chance of being taken up. It also enables a more dynamic and responsive approach to the practice of bodies and pleasures.

Interpretation Available evidence does not strongly support an important causal relation between cannabis use by young people and psychosocial harm, but cannot exclude the possibility that such a relation exists. The lack of evidence of robust causal relations prevents the attribution of public health detriments to illicit drug use. In view of the extent of illicit drug use, better evidence is needed.

Canada continues to experience an escalating opioid overdose crisis that has claimed more than 8000 lives in the country since 2016. The presence of the synthetic opioid fentanyl and its analogues is a central contributor to the increases in preventable opioid-related deaths. However, a number of converging social-structural factors (e.g., the continued criminalisation of drug use, political changes) and political barriers are also complicating and contributing to the current crisis. We briefly outline four harm reduction interventions (i.e., injectable opioid agonist treatment, naloxone distribution programs, overdose prevention sites, and drug checking services) as emerging and rapidly expanding responses to this crisis in Canada. These examples of innovation and expansion are encouraging but also occurring at the same time that the opioid overdose crisis shows few signs of abating. To truly address the crisis, Canada needs political environments at all government levels that are responsive and foster harm reduction innovation and drug policy experimentation.

Arora and Jacobs (2016) assume that liberal societies should tolerate non-therapeutic infant male circumcision, and argue that it follows from this that they should similarly tolerate—or even encourage—what the authors regard as ‘de minimis’ forms of female genital mutilation (as defined by the World Health Organization). In this commentary, I argue that many serious problems would be likely to follow from a policy of increased tolerance for female genital mutilation, and that it may therefore be time to consider a less tolerant attitude toward non-therapeutic infant male circumcision. Ultimately, I suggest that children of whatever sex or gender should be free from having healthy parts of their most intimate sexual organs either damaged or removed, before they can understand what is at stake in such an intervention and agree to it themselves.

Le présent rapport donne un aperçu des résultats de la recherche en matière de prévention de la violence sur le plan international. La notion de violence est prise ici dans une acception large et englobe aussi bien les formes de violence qui tombent sous le coup de la loi que celles qui ne sont pas punissables, ainsi que les facteurs de risque (précoces) de violence. Le rapport se fonde, d’une part, sur une présentation d’études de synthèse internationales portant sur l’efficacité de la prévention de la violence et, d’autre part, sur une recherche consacrée à la structure actuelle de l’offre et aux évaluations déjà menées en Suisse. Ce sont, au total, 26 stratégies de prévention et d’intervention aux niveaux de l’individu, de la famille, de l’école et de l’aide aux victimes qui ont été identifiées; leur efficacité est avérée par de nombreuses études internationales. Chaque chapitre fournit aux acteurs de terrain et aux décideurs un aperçu des objectifs, des caractéristiques et de l’efficacité des différentes approches. Le rapport donne également une vue d’ensemble de la pratique en Suisse et émet des conclusions et des recommandations pour des stratégies d’approfondissement de la prévention ainsi que pour la recherche. Bien que des progrès considérables aient été réalisés ces dernières années en Suisse, la base de connaissances est encore trop mince pour émettre des recommandations précises quant à l’efficacité des programmes. En effet, la plupart de ceux qui sont proposés n’ont pas fait l’objet d’une évaluation scientifique sur ce point. Le présent rapport, telle une boussole provisoire pour les mesures à prendre, pourra servir à renforcer la dynamique amorcée vers une prévention de la violence davantage axée sur les résultats de la recherche.

High rates of violence among street-level sex workers have been described across the globe, while in cities across Canada the disappearance and victimization of drug-using women in survival sex work is ongoing. Given the pervasive levels of violence faced by sex workers over the last decades, and extensive harm reduction and HIV prevention efforts operating in Vancouver, Canada, this research aimed to explore the role of social and structural violence and power relations in shaping the HIV risk environment and prevention practices of women in survival sex work. Through a participatory-action research project, a series of focus group discussions were conceptualized and co-facilitated by sex workers, community and research partners with a total of 46 women in early 2006. Based on thematic, content and theoretical analysis, the following key factors were seen to both directly and indirectly mediate women's agency and access to resources, and ability to practice HIV prevention and harm reduction: at the micro-level, boyfriends as pimps and the 'everyday violence' of bad dates; at the meso-level, a lack of safe places to take dates, and adverse impacts of local policing; and at the macro-level, dopesickness and the need to sell sex for drugs. Analysis of the narratives and daily lived experiences of women sex workers highlight the urgent need for a renewed HIV prevention strategy that moves beyond a solely individual-level focus to structural and environmental interventions, including legal reforms, that facilitate 'enabling environments' for HIV prevention.

This paper demonstrated that laws that criminalise sex work or aspects thereof are associated with negative outcomes for sex workers’ right to health under international law. It also showed that the right to health is an underused mechanism in judicial challenges to these laws.

The objective was to analyse, at practical and judicial levels, the relationship between prohibitory prostitution laws and the right to health. International treaties were examined to establish the relevant content of the right. Studies of the health-related effects of these laws, in various jurisdictions, were reviewed. Existing research into the effects of legalising prostitution under specified circumstances, and the effects of decriminalisation, was also examined. Case law was reviewed of judicial challenges to prostitution laws, and health-related aspects of relevant cases were discussed. The reasons that each court did or did not reach a decision protecting sex workers’ right to health were also considered.

The dissertation found that prohibitory laws lead to negative consequences for sex workers’ health by increasing their risk of violence and sexually-transmitted infections; adversely affecting their mental health, through these risks and through stigmatisation; denying them occupational health and safety; and excluding them from the process by which health-affecting decisions are made. It found positive health outcomes from removal of these laws, although excessive regulation of legal prostitution can have negative effects. It also found insufficient justification for health-based arguments in favour of prohibitory laws.

It showed that only a small number of challenges to these laws have highlighted their relationship to health, and the basis of these challenges has not been the right to health itself, although a breach of a derivative right has sometimes been asserted. Health has also, at times, served as a defence to these laws.
It concluded that sex workers’ right to health can best be protected through a legal framework that decriminalises consensual commercial sex and explicitly protects their occupational health and safety rights. This must be accompanied by efforts to ameliorate stigmatisation. Judicial action can play a role, although it may require the assertion of a derivative right rather than the right to health.

This article discusses 3 different strategies for dealing with the harmful consequences of drug use and other risky behaviors: We can discourage people from engaging in the behavior (prevalence reduction), we can encourage people to reduce the frequency or extent of the behavior (quantity reduction), or we can try to reduce the harmful consequences of the behavior when it occurs (harm reduction). These strategies are not mutually exclusive; this article offers a framework for integrating them. The framework is useful for examining frequent claims that harm reduction "sends the wrong message." Opposition to harm reduction is based in part on a recognition of potential trade-offs among the strategies, but it is also fueled by several more symbolic psychological factors. Strategies for successfully integrating prevalence reduction, quantity reduction, and harm reduction are explored.

Protection orders are widely used legal interventions intended to reduce the risk of future harm by one person considered to be a threat to another. However, there has been controversy about when and whether such orders are useful. This article is a review of empirical studies of outcomes associated with protection orders and factors associated with violations of the orders. Although protection orders are not a panacea, the results support that they can serve a useful role in threat management. We describe factors to consider before implementing a protection order.

Il presente rapporto fornisce una panoramica a livello internazionale delle conoscenze scientifiche sulla prevenzione della violenza. Viene utilizzata una definizione ampia del temine «violenza», che comprende sia le forme
di violenza penalmente perseguibili sia quelle non perseguibili e i fattori di rischio precoci. Il rapporto si basa su disamine di studi internazionali sull’ef - ficacia della prevenzione della violenza nonché su una ricerca relativa alla struttura dell’offerta esistente e alle valutazioni svolte in Svizzera. Nel com - plesso, sono stati individuati 26 approcci preventivi incentrati sull’individuo,  sulla famiglia, sulla scuola e sull’aiuto alle vittime, la cui efficacia è suf - fragata dai risultati di ricerche internazionali. In ogni capitolo del rapporto gli operatori del settore e i responsabili politici possono farsi un’idea degli obiettivi, delle caratteristiche dei programmi e dell’efficacia degli approcci in  questione. È inoltre fornita una panoramica sulla prassi svizzera e vengono formulate conclusioni e raccomandazioni per possibili strategie e ricerche ulteriori. Sebbene negli ultimi anni in Svizzera siano stati compiuti notevoli progressi nell’ambito della prevenzione della violenza, le conoscenze di base in materia restano comunque troppo esigue per poter fornire raccomanda - zioni precise per programmi efficaci a livello nazionale. La maggior parte dei programmi proposti in Svizzera non è stata valutata scientificamente in termini di efficacia. Il presente rapporto intende rafforzare lteriormente il riorientamento in corso verso una prevenzione della violenza maggiormente basata su prove scientifiche e funge da punto di riferimento provvisorio per il lavoro preventivo.

Recent years have seen the emergence of a ‘global mental health’ agenda, focused on providing evidence-based interventions for mental illnesses in low and middle-income countries, as well as intense debates among anthropologists and cultural psychiatrists about the appropriateness of this agenda. In this article, we reflect upon these debates, drawing on ethnographic fieldwork on the management of substance use disorders in China, Russia and the United States. We argue that the logic of ‘treatment gaps’, which guides much research and intervention under the rubric of global mental health, partially obscures the complex assemblages of institutions, therapeutics, knowledges and actors framing and managing addiction (as well as other mental health issues) in any particular setting.

Background: In Australia, the burden of alcohol-attributable harm falls most heavily on young people. Prevention is important, and schools have long been seen as appropriate settings for pre-emptive interventions with this high risk group. This paper evaluates the effectiveness, in relation to alcohol harm prevention, of the Drug Education in Victorian Schools (DEVS) programme, nine months after implementation. This intervention dealt with both licit and illicit drugs, employed a harm minimisation approach that incorporated interactive, skill based, teaching methods and capitalised on parental influence through home activities. Methods: A cluster randomised, controlled trial of the first ten lessons of the DEVS drug education programme was conducted with year eight students, aged 13-14 years. Twenty-one secondary schools in Victoria, Australia were randomly allocated to receive the DEVS programme (14 schools, n = 1163) or the drug education usually provided by their schools (7 schools, n = 589). Self-reported changes were measured in relation to: knowledge and attitudes, communication with parents, drug education lessons remembered, proportion of drinkers, alcohol consumption (quantity multiplied by frequency), proportion of student drinkers engaging in risky consumption, and the number of harms experienced as a result of alcohol consumption. Results: In comparison to the controls, there was a significantly greater increase in the intervention students' knowledge about drugs, including alcohol (p ≤ 0.001); there was a significant change in their level of communication with parents about alcohol (p = 0.037); they recalled receiving significantly more alcohol education (p < 0.001); their alcohol consumption increased significantly less (p = 0.011); and they experienced a lesser increase in harms associated with their drinking (p ≤ 0.001). There were no significant differences between the two study groups in relation to changes in attitudes towards alcohol or in the proportion of drinkers or risky drinkers. There was, however, a notable trend of less consumption by risky drinkers in the intervention group. Conclusions: A comprehensive, harm minimisation focused school drug education programme is effective in increasing general drug knowledge, and reducing alcohol consumption and harm.

Personality dimensions such as novelty seeking (NS), harm avoidance (HA), reward dependence (RD) and persistence (PER) are said to be heritable, stable across time and dependent on genetic and neurobiological factors. Recently a better understanding of the relationship between personality traits and brain structures/systems has become possible due to advances in neuroimaging techniques. This Magnetic Resonance Imaging (MRI) study investigated if individual differences in these personality traits reflected structural variance in specific brain regions. A large sample of eighty five young adult participants completed the Three-dimensional Personality Questionnaire (TPQ) and had their brain imaged with MRI. A voxel-based correlation analysis was carried out between individuals' personality trait scores and grey matter volume values extracted from 3D brain scans. NS correlated positively with grey matter volume in frontal and posterior cingulate regions. HA showed a negative correlation with grey matter volume in orbito-frontal, occipital and parietal structures. RD was negatively correlated with grey matter volume in the caudate nucleus and in the rectal frontal gyrus. PER showed a positive correlation with grey matter volume in the precuneus, paracentral lobule and parahippocampal gyrus. These results indicate that individual differences in the main personality dimensions of NS, HA, RD and PER, may reflect structural variance in specific brain areas.

En la RIOD no somos ajenas a los debates políticos y normativos que, en los diferentes niveles, se desarrollan, pero sobre todo no somos ajenas a las demandas y necesidades de las personas y las comunidades para y con las que trabajamos; entre quienes nos genera especial inquietud aquellas personas que, por su especial situación de vulnerabilidad, no se acercan a la red, ni a los dispositivos que se establecen para dar respuesta a las situaciones de consumo de drogas. En este sentido, y cumpliendo con nuestra misión de incidir en las políticas públicas y los problemas relacionados con el consumo de drogas y adicciones, desde un enfoque de Derechos Humanos, nos estamos centrando, durante el año 2018, en el desarrollo de una estrategia para el fortalecimiento e impulso de políticas y programas de reducción de daños asociados al consumo de drogas en Iberoamérica. La estrategia se ha desarrollado a través de varias acciones, y una de ellas es la que presentaremos en este acto: la recopilación de experiencias orientadas a buenas prácticas en una guía que, además, nace con vocación de ser una herramienta que ayude a la incorporación del enfoque de reducción de daños, y el monitoreo de la calidad de la atención y evaluación del desempeño en las políticas y recursos dirigidos a personas usuarias de drogas en situaciones de alta vulnerabilidad socio-sanitaria. Esta iniciativa ha sido financiada a través de la convocatoria de 2017 para la realización de actividades de interés general, con cargo a la asignación tributaria del Impuesto sobre la Renta de las Personas Físicas, del Ministerio de Sanidad, Servicios Sociales e Igualdad.

Drug use is a popular behavior among youth. Music and lyrics are recognized as a contributing factor to the liberalization of views on legal and illegal drugs, and thus to use these substances. This study aims to identify the relationship between musical preference and views on and the use of drugs among youth. Over 2,500 students from 27 high schools in the Subcarpathian Voivodeship of Poland were surveyed. Respondents were chosen via stratified random sampling , and data was collected using a questionnaire. The results of the analysis empirical data suggest that the opinions of youths about drugs may be related to their musical preferences. The results of this study may be applied to prevention activities. They may also be a starting point for further research on the relationships between music and risky behavior.

In this digest, Cameron Duff proposes a different way of understanding the risk environment literature as it relates to the implementation of harm reduction. He argues that we need to look beyond the everyday tools of harm reduction like needle and syringe programs and peer education to 'enabling places' and 'enabling resources', areas where public policy makers and social planners can ensure the delivery of more innovative harm reduction policies and programs. Duff urges us to see harm reduction as more than just providing drug users with specific resources to reduce individual drug-related harm. Instead, he argues that we need to make use of the range of material, social and affective resources that are available across the diverse settings in which drug use occurs.

Harm reduction psychotherapy is an exciting and emerging treatment for a broad spectrum of substance use problems. This article introduces an issue of the Journal of Clinical Psychology : In Session devoted to the state of the art of harm reduction psychotherapy. We describe the harm reduction paradigm, the context for and history of the development of harm reduction psychotherapy, and its clinical principles. We then outline and frame the contributions to the issue. Our goal is that this issue will encourage psychotherapists to employ more harm reduction principles in practice and will provide many evidence-based methods to do so. &

Background: People who inject drugs have been central to the development of harm reduction initiatives. Referred to as peer workers, peer helpers, or natural helpers, people with lived experience of drug use leverage their personal knowledge and skills to deliver harm reduction services. Addressing a gap in the literature, this systematic review focuses on the roles of people who inject drugs in harm reduction initiatives, how programs are organized, and obstacles and facilitators to engaging people with lived experience in harm reduction programs, in order to inform practice and future research.

Methods: This systematic review included searches for both peer reviewed and gray literature. All titles and abstracts were screened by two reviewers. A structured data extraction tool was developed and utilized to systematically code information concerning peer roles and participation, program characteristics, obstacles, and facilitators.

Results: On the basis of specific inclusion criteria 164 documents were selected, with 127 peer-reviewed and 37 gray literature references. Data extraction identified key harm reduction program characteristics and forms of participation including 36 peer roles grouped into five categories, as well as obstacles and facilitators at systemic, organizational, and individual levels.

Conclusions: Research on harm reduction programs that involve people with lived experience can help us better understand these approaches and demonstrate their value. Current evidence provides good descriptive content but the field lacks agreed-upon approaches to documenting the ways peer workers contribute to harm reduction initiatives. Implications and ten strategies to better support peer involvement in harm reduction programs are identified.

Purpose: To compare risk and protective factors that influence youth substance use in Australia and the United States. The two countries have different policy orientations toward substance use: Australia has adopted harm-reduction policies, and the United States has adopted abstinence-focused polices.

Progressive public health authorities in high-income countries have advocated supervised consumption facilities, where people who use illicit drugs can consume them in a hygienic, supervised environment, as a way of reducing drug-related risks to both people who use drugs and communities. However, the planning of such facilities has often met with strong reactions from the local community. 'Not in my backyard' (NIMBY) type reactions are frequently encountered and public opinion polling is limited in its ability to provide detailed insights into the reasons why people support or oppose these facilities in Toronto and Ottawa. We explore perceptions of residents and business representatives to the proposed implementation of supervised consumption facilities, and examine their perceptions of risks from these facilities. We collected qualitative data from 2008-2010 using focus groups and interviews with 38 residents and 17 business representatives in these two large Canadian cities lacking supervised consumption facilities. We used thematic analysis to examine expressed benefits and risks regarding supervised consumption facilities amongst community members. These participants saw these facilities as potentially risk-reducing, but recognised that the facilities could also create risks for their communities. While community members accepted that facilities could have positive health effects, they expressed a level of concern regarding the risk of public nuisance associated with supervised consumption facilities that seemed unwarranted based on the existing evidence. Discussions on the risks involved in the establishment of supervised consumption facilities should move beyond a focus on the benefits to facility users, to exploring community-level benefits and risks, and integrate evidence regarding actual risk experiences from other locations. Similar approaches may apply to NIMBY concerns related to other contentious issues.

Book chapter

Drawing on my experience of living with HIV for over two decades, this essay discusses the forms of anxiety and concern that emerged in 1996 in the context of the introduction of HIV combination antiretroviral therapy around the use of so-called 'drug cocktails'.  It shows how these concerns reflect broader anxieties about increasing sexual activity between men at this time. This event  happens to kickstart a corresponding problematisation of gay men's use of recreational drugs–  another sort of 'drug cocktail' - on the same basis. I see the present moral panic over chemsex as the latest instalment of this discourse.

The piece demonstrates the analogous character of antiretroviral therapy and recreational substance use in gay men's practice, arguing that pleasure, self-medication, and experimentation with the conditions of life are concerns that cut across outdated distinctions between pharmaceutical drugs and illicit drugs. Meanwhile, the stigmatised and criminalised status of HIV-positive sex, gay sexuality and illicit drug use produces paranoid subjects and effectively endangers the health and wellbeing of those affected.  It must be countered. Paying attention to the collective experiments of drug users is likely to be much more generative.

I wrote this piece for a collection called Long Term, edited by Scott Herring and Lee Wallace, who invited me to write something about living with HIV.

Cultural studies has become a major source of theoretical and critical innovation at the forefront of the New Humanities over the last 50 years.  As an interdisciplinary space that draws quite liberally on the methods of established disciplines ¬– philosophy, sociology, semiotics, anthropology, history and literary criticism among them – the heterogeneity of what takes place under the sign of cultural studies makes it difficult to pin down as a coherent field.  Conceived as an attractor for yet-to-be-devised cross-fertilisations of theory and method, the field has functioned as an experimental horizon enabling innovation and movement to take place in other disciplines.  Drug and alcohol researchers have invoked cultural studies as a potential corrective to the predominance of scientific and pathologizing accounts of intoxication.  And certainly, cultural studies has levied much-needed attention to the meanings, pleasures and social contexts of drug and alcohol use; their discursive classification; and the regulatory effects of these processes. But surprisingly, drugs and alcohol rarely serve as an explicit point of focus or source of more than cursory attention in key collections of cultural studies.  Indeed, drugs function in early cultural studies as a kind of irritant that spurs articulation of some key tensions and problems confronted by the field, including questions regarding the meaning of consumption; agency and passivity; the cultural and the material; subjects and objects; and conceptions of the political. We argue that the trickiness of drugs as a cultural object might yet make them uniquely generative objects for cultural studies, and we discuss the usefulness of newly influential approaches from affect theory and science and technology studies to this effect, before considering the political ambitions of the field.  Since the project of cultural studies has always at some level been marked by an explicit discourse of social involvement, its scientific authority is occasionally subject to question within the policy field.  Against these criticisms, we argue that the ‘self-situating’ propensity of cultural studies, combined with its empirical commitment to everyday cultures, offer a scholarly repertoire that generates movement between a number of objectives that may be equally important for the drug and alcohol field today: policy application, embodied reflection, speculative inquiry and the voicing of critique.

O artigo debate o tema redução de danos (RD) com substâncias psicodélicas, tomando como base uma intervenção da Associação Psicodélica do Brasil em um festival de música eletrônica no Rio de Janeiro. Por meio da experiência da equipe e da avaliação dos usuários e usuárias presentes, foi investigada a pertinência da ação de RD no contexto recreativo, bem como a importância de características da droga, do set e do setting para a experiência. Foi observado que, entre os participantes da pesquisa, a prática do autocuidado é recorrente; houve atribuição de grande importância para o set e o setting no uso, assim como para ações de RD – acolhimento de experiências difíceis, informação partilhada e testagem de substâncias. É provável que a
modalidade de evento em que foi realizada a intervenção e a pesquisa
tenha influenciado nos resultados encontrados, pois houve grande preocupação dos organizadores com as atividades de RD, fato distante da realidade da maioria dos eventos de música eletrônica. Foram analisadas as experiências difíceis que receberam acolhimento, assim como seus pontos marcantes. Além disso, os pesquisadores identificaram a importância da testagem colorimétrica para a prática de RD, analisando seus limites e desafios.

Dieser Bericht bietet einen Überblick über die wissenschaftlichen Erkenntnisse zur Gewaltprävention auf internationaler Ebene. Dabei wurde eine breite Definition von Gewalt angewendet, die sowohl rechtlich strafbare wie nicht strafbare und (frühe) Risikofaktoren für Gewalt beinhaltet. Der Bericht stützt einerseits auf einer Darstellung von internationalen Übersichtsstudien zur Wirksamkeit von Gewaltprävention und anderseits auf einer Recherche zur aktuellen Angebotsstruktur und Evaluationen in der Schweiz. Insgesamt wurden 26 Präventionsansätze in den Bereichen Individuum, Familie, Schule und Opferhilfe identifiziert, deren Wirksamkeit durch internationale Forschungsergebnisse untermauert wird. Jedes Kapitel vermittelt Praktikerinnen und Praktikern sowie Entscheidungsträgerinnen und -trägern einen Eindruck von den Zielen, den Programmmerkmalen und der Wirksamkeit der Ansätze. Zudem wird eine Übersicht über die schweizerische Praxis gegeben und es werden Schlussfolgerungen und Empfehlungen für mögliche weiterführende Strategien und Forschung formuliert. Obwohl in den letzten Jahren in der Schweiz erhebliche Fortschritte im Bereich Gewaltprävention erzielt wurden, ist die Wissensbasis immer noch zu dünn um eindeutige Empfehlungen zu wirksamen Programmen in der Schweiz abzugeben. Die meisten in der Schweiz angebotenen Programme wurden nicht hinsichtlich ihrer Wirksamkeit wissenschaftlich evaluiert. Der vorliegende Bericht soll die begonnene Dynamik hin zu mehr erkenntnisbasierter Gewaltprävention weiter stärken und stellt ein vorläufiger Kompass für die Präventionsarbeit dar.