Damage reduction as endpoint in the management of substance addiction

Objectives
The treatment of addiction is very complex and results from the integration of pharmacological and psychological techniques whose end-point is generally to obtain and maintain total abstention from substances of abuse for the individual patient; however, this goal in clinical practice is often very difficult to achieve given the high psycho-behavioral dependence on many substances, the frequent psychiatric and poly-abuse comorbidity and the low motivation of many patients, at least at the beginning, to stop completely and definitively with one or more substances that often accompany them for many years or decades. Thus in recent times it has appeared as an idea the implementation, generally more realistic, of methods that imply the reduction and change of consumption, and consequently also of the physical damage, associated with psychoactive substances. In this article we will deal with the methods that lead to this result, with practical examples where this is already applied and with possible ideas for the future management of some situations of frequent clinical confirmation.
Materials and methods
The work was carried out by searching on sites of scientific articles such as PubMed, Researchgate and Google Scholar, by typing in keywords such as “addiction”, “harm reduction”, “addiction drug therapy”, as well as in paper manuals of psychiatry and psychopharmacology.
Results and conclusions
We have found many articles, both recent and past years, of studies and data that testify that harm reduction is, for many subjects, a more realistic and easily achievable endpoint, both as an intermediate step towards complete abstention and as an objective primary, especially in the case of significant psychiatric comorbidity, poly-abuse or unfavorable socio-economic conditions and in some cases, such as for tobacco smoking or intravenous drug use, it also allows to reduce physical complications and public health expenditure, going for the benefit not only of practitioners working in mental health centers but of all branches of medicine, including general medical care