HARM REDUCTION STRATEGIES FROM THE PERSPECTIVE OF RADICAL BEHAVIORISM:
AN INTEGRATIVE LITERATURE REVIEW
DOI:
https://doi.org/10.59099/prpub.2025.125Keywords:
Substance abuse, Damage reduction, Behavior analysis, Harm reduction strategies, Radical BehaviorismAbstract
There are several approaches and ways of providing care for people suffering from substance use disorders. In this context, harm reduction presents itself as an alternative to the usual model of punitive practices. The aim of this study was to map and analyze the proposal of harm reduction in the treatment of individuals dependent on psychoactive substances from a behavioral analysis perspective. An integrative literature review was conducted for the period from 2018 to 2024, focusing on articles describing harm reduction strategies. After analysis, the interventions were categorized into seven distinct groups: distribution of supplies, substance testing, substitution therapy, supervised consumption rooms, cognitive and behavioral techniques, various distinct strategies, and recurring aspects. The results indicate a high proportion of heterogeneous, individualized strategies tailored to specific contexts. Additionally, there is a predominance of interventions targeting opioids and a focus on supply distribution and psychoeducation.
References
Allen, S. T., O’Rourke, A., Johnson, Jessica. A., Cheatom, C., Zhang, Y., Delise, B., Watkins, K., Reich, K., Reich, R., & Lockett, C. (2022). Evaluating the impact of naloxone dispensation at public health vending machines in Clark County, Nevada. Annals of Medicine, 54(1), 2692–2700. https://doi.org/10.1080/07853890.2022.2121418 DOI: https://doi.org/10.1080/07853890.2022.2121418
Almeida, É. A. S. de, Sartes, L. M. A., & Souza, K. S. S. de. (2022). Inserção das Estratégias Cognitivo-Comportamentais no CAPS Álcool e Drogas. Psicologia: Ciência E Profissão, 42(2022), 1–13. https://doi.org/10.1590/1982-3703003239448 DOI: https://doi.org/10.1590/1982-3703003239448
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, text revision DSM-5-TR. (pp. 754–904).
Artenie, A., Perry, R., Mahaso, M., Jankie, T., McNaughton, A. L., Stone, J., ... & Scheibe, A. (2024). HIV incidence and factors associated with HIV risk among people who inject drugs engaged with harm-reduction programmes in four provinces in South Africa: a retrospective cohort study. The Lancet HIV, 11(12), e823-e832. https://doi.org/10.1016/s2352-3018(24)00263-7 DOI: https://doi.org/10.1016/S2352-3018(24)00263-7
Aureliano, L. F. G., & Borges, N. B. (2012). Operações Motivadoras. In N. B. Borges, & F. A. Cassas, Clínica analítico-comportamental: aspectos teóricos e práticos (pp. 32–39). Artmed.
Avila, J. C., Maglalang, D. D., Nollen, N. L., Lee, S. C., Suh, R., Malone, M., ... & Ahluwalia, J. S. (2024). Using pod based e-cigarettes and nicotine pouches to reduce harm for adults with low socioeconomic status who smoke: A pilot randomized controlled trial. Nicotine and Tobacco Research, 26(9), 1150-1158. https://doi.org/10.1093/ntr/ntae047 DOI: https://doi.org/10.1093/ntr/ntae047
Bailey, K., Abramovitz, D., Artamónova, I., Davidson, P. J., Stamos-Buesig, T., Vera, C. F., Patterson, T. L., Arredondo, J., Kattan, J., Bergmann, L., Sayone Thihalolipavan, Strathdee, S. A., & Annick Bórquez. (2023). Drug checking in the fentanyl era: Utilization and interest among people who inject drugs in San Diego, California. International Journal of Drug Policy, 118(2023), 104086–104086. https://doi.org/10.1016/j.drugpo.2023.104086 DOI: https://doi.org/10.1016/j.drugpo.2023.104086
Bailey, N. R., Mitchell, K. A., & Miller, T. M. (2024). Opioid Misuse Harm Reduction. Journal of Addictions Nursing, 35(1), 3-14. https://doi.org/10.1097/jan.0000000000000561 DOI: https://doi.org/10.1097/JAN.0000000000000561
Banaco, R. A. (2013). Teoria Comportamental. In N. A. Zanelatto, & R. Laranjeira (Orgs), O Tratamento da Dependência Química e as Terapias Cognitivo-Comportamentais (2ª ed., pp. 135–152). Artmed.
Banaco, R. A. (2021). Prefácio. In S.M. Oliani, R.A. Reichert, & R.A. Banaco, Análise do Comportamento e Dependência de Drogas: Teoria, Pesquisa e Intervenção (pp. 9–18). Centro Paradigma.
Bardin, L. (2011). Análise de Conteúdo. Almedina Brasil.
Bartholomew, T. S., Feaster, D. J., Patel, H., Forrest, D. W., & Tookes, H. E. (2021). Reduction in injection risk behaviors after implementation of a syringe services program, Miami, Florida. Journal of Substance Abuse Treatment, 127(2021), 108344. https://doi.org/10.1016/j.jsat.2021.108344 DOI: https://doi.org/10.1016/j.jsat.2021.108344
Bastos, F. I. P. M., Vasconcellos, M. T. L. de, Boni, R. B. de, Reis, N. B. dos, & Coutinho, C. F. S. (2017). III Levantamento Nacional sobre o uso de drogas pela população brasileira. Fundação Oswaldo Cruz. https://www.arca.fiocruz.br/handle/icict/34614
Baum, W. M., & Teresa, M. (2019). Controle de estímulos e conhecimento. In W. M. Baum, Compreender o behaviorismo: Comportamento, cultura e evolução. (3rd ed.). Artmed. (Trabalho original publicado em 1999).
Beharie, N., Urmanche, A., & Harocopos, A. (2023). A mixed-methods analysis of risk-reduction strategies adopted by syringe services program participants and non-syringe services program participants in New York City. Harm Reduction Journal, 20(1). https://doi.org/10.1186/s12954-023-00772-3 DOI: https://doi.org/10.1186/s12954-023-00772-3
Bornstein, K. J., Coye, A. E., St. Onge, J. E., Li, H., Muller, A., Bartholomew, T. S., & Tookes, H. E. (2020). Hospital admissions among people who inject opioids following syringe services program implementation. Harm Reduction Journal, 17(1). https://doi.org/10.1186/s12954-020-00376-1 DOI: https://doi.org/10.1186/s12954-020-00376-1
Bressel, P. J.-R.-D., Killcross, S., & McNally, G. P. (2018). Behavioral and neurobiological mechanisms of punishment: Implications for psychiatric disorders. Neuropsychopharmacology, 43(8), 1639–1650. https://doi.org/10.1038/s41386-018-0047-3 DOI: https://doi.org/10.1038/s41386-018-0047-3
Carneiro, H. (2018). Drogas: a história do proibicionismo. Editora Autonomia Literária LTDA - ME.
Catania, A. C. (1999). Aprendizagem: Comportamento, Linguagem e Cognição Porto Alegre: Artmed.
Clua-García, R. (2020). La gestión de placeres y daños: Estudio etnográfico sobre el consumo de drogas en vía pública, viviendas y salas de consumo higiénico. Salud Colectiva, 16(2020), e2481. https://doi.org/10.18294/sc.2020.2481 DOI: https://doi.org/10.18294/sc.2020.2481
Conselho Federal de Psicologia, Mecanismo Nacional de Prevenção e Combate à Tortura, & Procuradoria Federal dos Direitos do Cidadão. (2018). Relatório da Inspeção Nacional em Comunidades Terapêuticas (pp. 11–72). https://site.cfp.org.br/wp-content/uploads/2018/06/Relatorio-da-inspecao-nacional-em-comunidades-terapeuticas_web.pdf
Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry & research design: Choosing among five approaches (4th ed., pp. 42–69). SAGE Publications.
Day, N., Criss, J., Griffiths, B., Gujral, S. K., John-Leader, F., Johnston, J., & Pit, S. (2018). Music Festival attendees’ Illicit Drug use, Knowledge and Practices regarding Drug Content and purity: a cross-sectional Survey. Harm Reduction Journal, 15(1). https://doi.org/10.1186/s12954-017-0205-7 DOI: https://doi.org/10.1186/s12954-017-0205-7
Debenham, J., Birrell, L., Champion, K. E., & Newton, N. (2024). An on‐line school‐based substance use harm reduction programme: The Illicit Project randomized controlled trial results. Addiction, 119(4), 741-752. https://doi.org/10.1111/add.16403 DOI: https://doi.org/10.1111/add.16403
Decreto No 9.761, de 11 de abril de 2019. (2019). Aprova a Política Nacional sobre Drogas. Presidência da República. https://www.in.gov.br/web/dou/-/decreto-n-9-761-de-11-de-abril-de-2019-71137316
Domanico, A. (2019). História, conceitos e princípios de redução de danos. In Universidade Federal de São Paulo, & Universidade Virutal do Estado de São Paulo, Redução de danos: conceitos e práticas (pp. 5–15). http://www.tjmt.jus.br/intranet.arq/cms/grupopaginas/105/988/Redu%C3%A7%C3%A3o_de_danos_-_conceitos_e_pr%C3%A1ticas.pdf
Ercole, F. F., Melo, L. S. de, & Alcoforado, C. L. G. C. (2014). Integrative review versus systematic review. Reme: Revista Mineira de Enfermagem, 18(1). https://doi.org/10.5935/1415-2762.20140001 DOI: https://doi.org/10.5935/1415-2762.20140001
Escohotado, A. (2010). The general history of drugs. Graffiti Milante Press.
Farias, E. C., & Otsuka, E. (2019). Contexto social e histórico das drogas:múltiplos usos, racismo e repressão do proibicionismo do Estado. In Conselho Regional de Psicologia de São Paulo, Álcool e outras drogas: subsídios para sustentação da política antimanicomial e de redução de danos (pp. 9–19). https://www.crpsp.org/uploads/impresso/2725/bmdIHzMZ_fDEtrdfEQOgcnE5Zk3CWdHt.pdf
Fernández-Calderón, F., Díaz-Batanero, C., Barratt, M. J., & Palamar, J. J. (2018). Harm reduction strategies related to dosing and their relation to harms among festival attendees who use multiple drugs. Drug and Alcohol Review, 38(1), 57–67. https://doi.org/10.1111/dar.12868 DOI: https://doi.org/10.1111/dar.12868
Foreman-Mackey, A., Pauly, B., Ivsins, A., Urbanoski, K., Mansoor, M., & Bardwell, G. (2022). Moving towards a continuum of safer supply options for people who use drugs: A qualitative study exploring national perspectives on safer supply among professional stakeholders in Canada. Substance Abuse Treatment, Prevention, and Policy, 17(1). https://doi.org/10.1186/s13011-022-00494-y DOI: https://doi.org/10.1186/s13011-022-00494-y
Gil, A. A. C. (2010). Como elaborar projetos de pesquisa. Atlas.
Goodyear, T., Mniszak, C., Jenkins, E., Fast, D., & Knight, R. (2020). “Am I gonna get in trouble for acknowledging my will to be safe?”: Identifying the experiences of young sexual minority men and substance use in the context of an opioid overdose crisis. Harm Reduction Journal, 17(1). https://doi.org/10.1186/s12954-020-00365-4 DOI: https://doi.org/10.1186/s12954-020-00365-4
Goodman-Meza, D., Arredondo, J., Slim, S., Angulo, L., Gonzalez-Nieto, P., Loera, A., Shoptaw, S., Cambou, M. C., & Pitpitan, E. V. (2022). Behavior change after fentanyl testing at a safe consumption space for women in Northern Mexico: A pilot study. International Journal of Drug Policy, 106, 103745. https://doi.org/10.1016/j.drugpo.2022.103745 DOI: https://doi.org/10.1016/j.drugpo.2022.103745
Harper, L., Powell, J., & Pijl, E. M. (2017). An overview of forensic drug testing methods and their suitability for harm reduction point-of-care services. Harm Reduction Journal, 14(1). https://doi.org/10.1186/s12954-017-0179-5 DOI: https://doi.org/10.1186/s12954-017-0179-5
Jakubowski, A., Rath, C., Harocopos, A., Wright, M., Welch, A., Kattan, J. A., Behrends, C. N., Lopez-Castro, T., & Fox, A. D. (2022). Implementation of buprenorphine services in NYC syringe services programs: a qualitative process evaluation. Harm Reduction Journal, 19(1), 969–972. https://doi.org/10.1186/s12954-022-00654-0 DOI: https://doi.org/10.1186/s12954-022-00654-0
Jargin, S. V. (2009). On the Causes of Alcoholism in the Former Soviet Union. Alcohol and Alcoholism, 45(1), 104–105. https://doi.org/10.1093/alcalc/agp082 DOI: https://doi.org/10.1093/alcalc/agp082
Johnson, T. J., Wanta, W., Boudreau, T., Blank-Libra, J., Schaffer, K., & Turner, S. (1996). Influence Dealers: A Path Analysis Model of Agenda Building during Richard Nixon’s War on Drugs. Journalism & Mass Communication Quarterly, 73(1), 181–194. https://doi.org/10.1177/107769909607300116 DOI: https://doi.org/10.1177/107769909607300116
Karam, M. L. (2013). Direitos humanos, laço social e drogas: por uma política solidária com o sofrimento humano. Conselho Federal de Psicologia (Org.), Drogas, Direitos Humanos e Laço Social, 33-51. CFP.
Klaire, S., Janssen, R. M., Olson, K., Bridgeman, J., Korol, E. E., Chu, T., Ghafari, C., Sabeti, S., Buxton, J. A., & Lysyshyn, M. (2022). Take-home drug checking as a novel harm reduction strategy in British Columbia, Canada. International Journal of Drug Policy, 106(2022), 103741. https://doi.org/10.1016/j.drugpo.2022.103741 DOI: https://doi.org/10.1016/j.drugpo.2022.103741
Leite, F. L. (2006). Redução de Danos e Análise do Comportamento – um Modelo Teórico e uma Proposta de Intervenção Comunitária [Monografia de Graduação, Universidade de Fortaleza]. http://newpsi.bvs-psi.org.br/tcc/608.pdf
Marçal, J. V. de S. (2009). Behaviorismo radical e prática clínica. In A. K. C. R de Farias, Análise Comportamental Clínica: Aspectos Teóricos E Estudos De Caso. Artmed Editora.
Marlatt, G. A. (1996). Harm reduction: Come as you are. Addictive Behaviors, 21(6), 779–788. https://doi.org/10.1016/0306-4603(96)00042-1 DOI: https://doi.org/10.1016/0306-4603(96)00042-1
McKee, M. (1999). ALCOHOL IN RUSSIA. Alcohol and Alcoholism, 34(6), 824–829. https://doi.org/10.1093/alcalc/34.6.824 DOI: https://doi.org/10.1093/alcalc/34.6.824
Miler, J. A., Carver, H., Masterton, W., Parkes, T., Maden, M., Jones, L., & Sumnall, H. (2021). What treatment and services are effective for people who are homeless and use drugs? A systematic “review of reviews.” PLOS ONE, 16(7), e0254729. https://doi.org/10.1371/journal.pone.0254729 DOI: https://doi.org/10.1371/journal.pone.0254729
Mistler, C. B., Chandra, D. K., Copenhaver, M. M., Wickersham, J. A., & Shrestha, R. (2021). Engagement in Harm Reduction Strategies After Suspected Fentanyl Contamination Among Opioid-Dependent Individuals. Journal of Community Health, 46(2), 349–357. https://doi.org/10.1007/s10900-020-00928-3 DOI: https://doi.org/10.1007/s10900-020-00928-3
Mok, J., Milloy, M.-J. ., Grant, C., Lake, S., DeBeck, K., Hayashi, K., & Socías, M. E. (2021). Use of Cannabis for Harm Reduction Among People at High Risk for Overdose in Vancouver, Canada (2016–2018). American Journal of Public Health, 111(5), 969–972. https://doi.org/10.2105/ajph.2021.306168 DOI: https://doi.org/10.2105/AJPH.2021.306168
Moreira, M. B., & Augusto, C. (2007). Aprendizagem pelas consequências: o reforçamento. In M.B. Moreira & C. Augusto, Princípios básicos de análise do comportamento (2nd ed., pp. 46–74). Artmed.
Nações Unidas. (1971). Convenção sobre substâncias psicotrópicas. http://www.tjmt.jus.br/intranet.arq/cms/grupopaginas/105/975/convention_1971_en.pdf
National Institute on Drug Abuse. (2020). Common comorbidities with substance use disorders: Part 1: The Connection Between Substance Use Disorders and Mental Illness. https://nida.nih.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness
Nery, L. B., & Fonseca, F. N. (2017). Análises funcionais moleculares e molares: um passo a passo. In L.B. Nery, & F. N. Fonseca, Teoria e Formulação de Casos em Análise Comportamental Clínica (pp. 22–54). Artmed Editora.
Oliani, S. M., Reichert, R. A., & Banaco, R. A. (2021). Análise Comportamental do Uso e Dependência de Substâncias: Aspectos Teórico-conceituais e Possibilidades de Intervenção. In S.M. Oliani, R.A. Reichert, & R.A. Banaco, Análise do Comportamento e Dependência de Drogas: Teoria, Pesquisa e Investigação (pp. 19–32). Editora Paradigma.
Raupp, L., Amorim, L. de, Pacheco, J. C., Lomonaco, D., Lopes, F., & Schneider, D. R. (2022). Caracterização de atores e práticas de Redução de Danos na região Sul do país. Saúde E Sociedade, 31(2). https://doi.org/10.1590/s0104-12902022210264pt DOI: https://doi.org/10.1590/s0104-12902022210264pt
Raupp, L. M., & Pereira, K. R. (2020). Redução de danos em rave no Rio Grande do Sul: concepções de uma ação. Pesquisas E Práticas Psicossociais, 15(1), 1–18. http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1809-89082020000100011#:~:text=A%20a%C3%A7%C3%A3o%20ocorreu%20de%20modo,danos%20associados%20ao%20seu%20uso
Riley, D., & O´hare, P. (2000). Harm reduction: History, definition and practice. In J. A. Inciardi, & L. D. Harrison (Eds.), Harm Reduction: National and International Perspectives (pp. 1–26). SAGE Publications, Inc. DOI: https://doi.org/10.4135/9781452220680.n1
Rosen, J., Glick, J. E., Zhang, L. L., Cooper, L., Olatunde, P. F., Pelaez, D., Rouhani, S., Sue, K. L., & Park, J. H. (2022). Safety in solitude? Competing risks and drivers of solitary drug use among women who inject drugs and implications for overdose detection. Addiction , 118(5), 847–854. https://doi.org/10.1111/add.16103 DOI: https://doi.org/10.1111/add.16103
Roxburgh, A., Jauncey, M., Day, C., Bartlett, M., Cogger, S., Dietze, P., Nielsen, S., Latimer, J., & Clark, N. (2021). Adapting harm reduction services during COVID-19: lessons from the supervised injecting facilities in Australia. Harm Reduction Journal, 18(1). https://doi.org/10.1186/s12954-021-00471-x DOI: https://doi.org/10.1186/s12954-021-00471-x
Safi, F., Rioux, W., Rider, N., Fornssler, B., Jones, S., & S Monty Ghosh. (2023). Feasibility and acceptability of inserts promoting virtual overdose monitoring services (VOMS) in naloxone kits: a qualitative study. Harm Reduction Journal, 20(1), 1–8. https://doi.org/10.1186/s12954-023-00792-z DOI: https://doi.org/10.1186/s12954-023-00792-z
Schuster, C. (1994). O comportamento da busca de droga: implicações para as teorias de dependência de drogas. In C. Schuster, A natureza da dependencia de drogas (pp. 206–231). Artes Médicas.
Sidman, M. (2003a). Coerção gera coerção. In M. Sidman, Coerção e suas implicações (pp. 220–230). Livro Pleno.
Sidman, M. (2003b). Nem todo controle é coerção. In M. Sidman, Coerção e suas implicações (pp. 44–64). Livro Pleno.
Simões, V., Yamauchi, R., & Miguel, A. Q. C. (2021). Manejo de Contingências para o Tratamento dos Transtornos por Uso de Substâncias. In S.M. Oliani, R.A. Reichert, & R.A. Banaco, Análise do Comportamento e Dependência de Drogas: Teoria, Pesquisa e Intervenção (pp. 141–161). Editora Paradigma.
Skinner, B. F. (2003). Por que os organismos se comportam. In B.F. Skinner, Ciência e comportamento humano (pp. 24–45). Martins Fontes.
Souza, M. T. de, Silva, M. D. da, & Carvalho, R. de. (2010). Revisão integrativa: o que é e como fazer. Einstein (São Paulo), 8(1), 102–106. https://doi.org/10.1590/s1679-45082010rw1134 DOI: https://doi.org/10.1590/s1679-45082010rw1134
Sud, A., Chiu, K., Friedman, J., & Dupouy, J. (2023). Buprenorphine deregulation as an opioid crisis policy response - A comparative analysis between France and the United States. International Journal of Drug Policy, 120(2023), 104161. https://doi.org/10.1016/j.drugpo.2023.104161 DOI: https://doi.org/10.1016/j.drugpo.2023.104161
Surjus, L. T. de L. e S., & Silva, P. C. (2019). Redução de danos: ampliação da vida e materialização de direitos. Universidade Virtual do Estado de São Paulo. https://www.unifesp.br/campus/san7/images/E-book-Reducao-Danos-versao-final.pdf
Taffarello, R. F. (2009). Drogas: falência do proibicionismo e alternativas de política criminal [Dissertação de mestrado, Universidade de São Paulo]. https://teses.usp.br/teses/disponiveis/2/2136/tde-17112011-091652/publico/DISSERTACAO_COMPLETA_ROGERIO.pdf
Treadway, W. L. (1929). A Report of the Departmental Committee on Morphine and Heroin Addiction to the British Ministry of Health. Public Health Reports (1896-1970), 44(33), 1995–2000. https://doi.org/10.2307/4579355 DOI: https://doi.org/10.2307/4579355
Toscano, M. P., Macchione, A. C., & Leonardi, J. L. (2019). Análise funcional do comportamento . In W. V. Melo (Ed.), A prática das intervenções psicoterápicas: como tratar pacientes na vida real (pp. 84–101). Sinopsys .
World Health Organization. (2022a). Mental Health. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response
World Health Organization. (2022b). World mental health report: Transforming mental health for all.
Victor, G., Ray, B., & Watson, D. P. (2024). Use of harm reduction strategies by individuals with a history of incarceration: A short report using baseline data collected from the STAMINA clinical trial. Journal of Substance Use and Addiction Treatment, 162, 209376. https://doi.org/10.1016/j.josat.2024.209376 DOI: https://doi.org/10.1016/j.josat.2024.209376
World Health Organization, United Nations Office on Drugs and Crime, & Joint United Nations Programme on HIV and AIDS. (2004). Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention: WHO/UNODC/UNAIDS position paper.
Zinberg, N. E. (1986). Historical perspectives on controlled drug use. In N.E. Zinberg, Drug, set, and Setting: the Basis for Controlled Intoxicant Use (pp. 1-32). Yale University Press.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Pedro Henrique Gomes Pinheiro Vasconcelos, Petrus César Teixeira Loureiro, Fabiana Neiva Veloso Brasileiro, Yan Valderlon, Monique Andrade Campos

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors agree to the following terms of PLURAL - Revista de Psicologia UNESP Bauru:
Articles submitted must be original and will be published for the first time by Revista Plural, but authors will retain copyright. The work will be simultaneously licensed under the Creative Commons Attribution CC-By 4.0 International License to allow the work to be shared with acknowledgement of authorship and first publication by this journal.
Authors are allowed to enter into additional contracts separately, for example, to publish in an institutional repository or as a book chapter, as long as both the acknowledgement of authorship and initial publication in this journal are detailed and recorded.
Authors are allowed and encouraged to publish and distribute their work online in institutional repositories (preprints) or on their personal website.



