For most of the Twentieth Century the dominant approach to problems of addiction, and to any use of those drugs that were labeled as being addictive, has been prohibition, a demand for total abstention, and the threat of punishment for any possession or use.
Early in the 1970's, a number of treatment practitioners in America, Britain, and the Netherlands began to take an alternate approach that has become known as "harm reduction" or "harm minimization." An early source of this approach was the treatment of persons whose use of the then popular drug "LSD" (Lysergine, or lysergic acid diethylamide) had resulted in a fearful or powerfully disorienting experience known as a "bad trip."
Physicians faced with patients experiencing a "bad trip" on LSD or other hallucinogenic drugs had, at first, treated them with major tranquilizers, seeking to terminate the drug experience. Results of this approach proved to be most unacceptable. A few patients died from the combination of the neuroleptics with other drugs in their systems. Many reported that the treatment increased rather than relieved their distress despite making them quieter and more easily managed by the nursing sisters. Worse still, the likelihood of traumatic aftereffects seemed to be increased by these attempts to terminate the experience. Young people learned that it was best to avoid Causalty Department care for their "bad tripping" friends and developed their own approach to these crises. There seem to have been pioneering uses of this approach simultaneously in Amsterdam, New York City, San Francisco and elsewhere. The approach was usually called "talking down" and it involved capitalizing on the suggestibility that is characteristic of persons under the influence of LSD. The lay helper would use that suggestibility to guide the person's drug experience in the direction of more positive affect. Instead of trying to suppress the drug effects this approach tried to enhance the user's comfort with those effects. Instead of trying to pull the person back into contact with reality, the "talk down" sought to shape the false reality along less frightening lines.
One of America's early practitioners of this approach was Dr. David Duncan of Houston, Texas, USA. Despite, or perhaps as a consequence of, starting his career as a police officer and later a prison warder, he rejected the ideas of treating addicts as criminals or of outlawing the non-medical use of certain drugs (such as heroin, ganja or LSD) while permitting the use of other drugs (such as alcohol, caffeine or nicotine). The approach to both treatment and prevention at the drug abuse treatment center he directed in Houston was one that attempted to cure the addiction without necessarily ending use of the drug, an approach that proved highly successful despite contradicting virtually every current theory of addiction and its treatment. He also became an early advocate of methadone maintenance treatment, which eliminated the damage done to the addict or society by heroin addicts without eliminating the addiction itself. Harm reduction flourished in Texas under his leadership a dozen years before it was given its popular name in Britain in 1984.
The worldwide threat of acquired immune deficiency syndrome (AIDS) contributed to the growth of the harm reduction syndrome when it was learned that a major means of spread of this serious bloodborne illness was the sharing of hypodermic syringes or needles by addicts. Such sharing resulted in some nations from a limited supply of injection devices but in Europe, North America and some other places it resulted solely from laws prohibiting non-medical sales or possession of such devices. The first exchange program aimed at providing addicts with sterile syringes in order to prevent the spread of AIDS was established by a group of heroin addicts in Amsterdam. Such exchanges now operate in many cities around the world and have been proven effective in slowing the spread of AIDS among addicts and to their non-addicted sex partners.
The public health authorities in Liverpool, England became leaders in promoting harm reduction approaches such as syringe exchange and the methods pioneered by Duncan in America. In 1984, as a result of their efforts, the British Home Office's Advisory Council on Misuse of Drugs recommended that government funds for prevention programs should be available for two different types of programs, those with a goal of use reduction and those with a goal of harm reduction. The approach had thus gained a name -- harm reduction -- and had been clearly separated from efforts to stop or discourage people's use of illegal drugs.