Harm reduction: Set, Setting, Drug

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This resource has undergone expert review.





Harm reduction

Reducing the harms of alcohol and other drug use is a complex undertaking that involves considering all the factors that may cause harm in the first place. In addition to alcohol and other drugs being consumed, some additional factors to consider that may contribute to drug-related harms include those relating to the individual consuming the drug and the environment the drug is consumed in.

One harm reduction framework that considers all of these factors is known as the ‘Set, Setting & Drug’ framework. 

Set, Setting, Drug

The ‘Set, Setting & Drug’ framework can be applied to any situation where alcohol and other drug use occurs to help you assess and reduce potential risks. According to this framework, the relationship between an individual’s set, the setting, and the drug shapes the risk of harm experienced by the individual taking a drug. The Set, Setting, & Drug framework is detailed below and examples are provided.

SET: this refers to all factors related to the individual consuming the drug. Such factors may include an individual’s mental and physical state, genetic predispositions, gender, sleep, physique, nutrition, and any medications the individual is currently taking.

SETTING: this refers to all factors related to the environment a drug is consumed in. Such factors may include the people or friends around you, the weather, presence of law enforcement, and dangerous environmental hazards.

DRUG: this refers to all factors related to the drug consumed. Such factors may include the quantity consumed, the potency, the purity, the way the drug is taken, and whether other drugs are consumed at the same time.

Let’s apply the ‘Set, Setting & Drug’ framework to different situations and practice harm reduction for alcohol, MDMA, and cannabis use.

Situation 1: A young person drinking alcohol

Set: The brain is still developing up until the age of 25 years, so to reduce harm, it is important to avoid, delay, and reduce risky drinking during this period.

Setting: We tend to make more risky decisions in the company of friends, and consequently, often high-risk drinking occurs at social events. To reduce harm, it can help to plan whether you’re going to drink at all, determine how much you want to drink, and decide on a reasonable time to stop drinking, before arriving at the event.

Drug: Alcohol can interact with other drugs in a dangerous or even fatal way. It is important to avoid polysubstance use (taking other drugs at the same time) when consuming alcohol, and particularly avoid consuming other central nervous system depressants, such as opioids, GHB, and benzodiazepines.

Situation 2: A young person taking an MDMA cap of unknown potency

Set: Many people experience a physical and/or mental ‘come down’ after taking MDMA. This can lead to anxious and/or depressive thoughts, which can be particularly dangerous if you are susceptible to low moods.

Setting: MDMA is often taken in hot, overcrowded environments, where there is heightened social and physical stimulation, which can lead to dangerous overheating. It’s important to avoid hot environments, drink water, take frequent breaks, and cool down as much as possible to avoid overheating. These setting factors are important because overheating is a common side effect of MDMA.

Drug: Every MDMA cap has a different dose of MDMA (from 0% - 99% purity) and higher doses are more likely to cause neurotoxicity (harm to the brain). It is important to be aware of signs of overdose and allergic reactions and be aware of the location of the closest medical facilities. For more information on helping someone, see how to help someone who has taken a drug.

Situation 3: A young person smoking cannabis

Set: Cannabis effects everybody differently. If you have a history of mental illness in your family, then using cannabis can increase your risk for psychiatric disorders. It is important to investigate the presence of mental disorders in your family tree.

Setting: Cannabis impairs judgement, coordination, and reflex speed. Never drive or get in the car with someone who has recently smoked cannabis.

Drug: Some strains of cannabis have higher concentrations of the psychoactive ingredient, THC, than other strains. These higher potency strains are linked to increased learning and memory deficits and risk of psychiatric disorders, avoid using strong strains of cannabis and minimise regular ongoing use.

Evidence Base

This factsheet was developed following expert review by researchers at the Matilda Centre for Research in Mental Health and Substance Use at the University of Sydney.

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