Harm reduction practices in outpatient drug-free substance abuse settings (2012)

Objective: In the United States, drug-free (non-drug substitution) substance abuse treatment practices are informed by an abstinence-only model that has been criticized as hindering service retention and utilization. The public health paradigm of harm reduction offers alternative treatment practice ideas, yet little is known about how they are viewed by front-line practitioners in these settings.
Methods: Using semi-structured interviewing, this qualitative study explored support for and use of harm reduction amongst a sample of 15 practitioners from 9 outpatient drug-free substance abuse agencies.
Results: Respondents identified personal, professional, contextual and client factors as indicating or contraindicating harm reduction. Support for specific practices (tapering plans, non-abstinence treatment goals and substance use management) was limited, although harm reduction was supported as a guiding practice philosophy and in non-substance using areas of clients' lives. Specific concerns were articulated as personal objections to harm reduction, needing to send an abstinence-based message, and inter- and intra-agency dynamics and formal and informal policies.
Conclusions: The generalizability of the study is unknown, but it provides a framework for understanding harm reduction practices in these settings. Practitioner support for harm reduction in these settings does exist but is highly qualified and nuanced.