16.1 Introduction to Harm Reduction

The origins of the harm reduction movement are rooted primarily in community-based international drug policy and the healthcare industry. Over time, its scope has expanded to include various health-harming or self-harming activities, such as sexual practices, nutrition, gambling, and injury-prevention behaviors. The harm reduction framework within counseling emphasizes a person’s right to autonomy and self-determination (Fry et al., 2008). Counselors operating from this perspective aim to deliver compassionate and respectful services to individuals, even when their actions carry significant health risks. However, self-determination is not value-neutral, and clinicians often face challenges in balancing their responsibility to promote health with respecting their clients’ autonomy to engage in potentially harmful behaviors.

In this chapter, we explore the foundational principles of harm reduction, its ethical implications, and practical strategies for navigating complex dilemmas in substance use and mental health counseling.