Self-Determination and Alcohol Use: Exploring the Intersection of Ethics and Harm Reduction for People with Intellectual Disabilities

The closure of government-run institutions for people with intellectual disabilities (ID) has led to the advancement of equal rights, status, and community integration. As a result of increased community integration, people with ID now have more access and choice to consume substances such as alcohol. This becomes a significant concern insofar as alcohol use (AU) is on the rise in this population, and people with ID face many barriers to accessing AU/Alcohol Use Disorder (AUD) services. In this chapter, we explore concepts such as “Nothing About Us Without Us”, dignity of risk, choice, autonomy, and self-determination, and highlight their alignment with the principles of harm reduction. We argue that adopting a harm reduction approach is ethically justifiable for people with ID related to AU/AUD. It is crucial to have people with ID lead or be involved in harm reduction strategies to ensure the strategies are meaningful and accessible.