“Everyone Deserves Services No Matter What”: Defining Success in Harm-Reduction-Based Substance User Treatment

Abstract

This article reports qualitative interview data from a study of participant-generated outcomes of two harm reduction programs in the United States. We address the question:"What does success in harm-reduction-based substance user treatment look like?" Providers in this study understood harm reduction to adhere to notions of "any positive change," client centeredness, and low-threshold services. Participants reported changes in demarginalization, engagement in the program, quality of life, social functioning, changes in substance use, and changes in future goals and plans. The nature of these changes is difficult to articulate within traditional notions of success (i.e., abstinence, program completion, etc.). We conclude that participants in harm reduction programs experience tangible positive changes but that legitimation of these changes calls for a reconceptualization of "outcomes" and "success" in the current context of substance user treatment and research.

Harm Reduction and Tensions in Trust and Distrust in a Mental Health Service: A Qualitative Approach

“…In this regard, through an understanding of therapeutic success as nuanced, low-threshold environments and non-judgmental interactions may allow trust and dialogue to develop among providers and users. Furthermore, as suggested in other related studies, the achievement of de-marginalization, social functioning, mutually trusting relationships between PSCSU and provider, engagement in the program, changes in drug use, and articulation of future goals and plans for users can be used to measure the success of harm reduction-based mental health care [14, 45]. …”

“…Because of these benefits, the provision of a harm reduction approach has been viewed as a moral imperative for health care providers [2]. Furthermore, adopting a harm reduction perspective can build mutual trust, which is a path to achieving positive outcomes and change in users’ lives [45]. …”

Framing Failure

“…ing drug users (IJUs). 11 As a particular initiative within a much larger framework of drug-user treatment initiatives, such programs will not have wellness as their goal but much more limited goals of keeping IJUs from some of the worst physical consequences of their practices, drawing them into normal social interactions, building trust, and providing them with an environment in which they may gain better control over their lives or reflect on alternate possibilities for their future (Lee & Zerai 2010). Failure, in this context, will not be telicly related to achieving abstinence, getting a job, and returning to full social engagement-activities more closely connected to wellness, but to more limited goals that, no doubt, also have some aspirational connection with wellness but do not judge themselves solely in terms of its achievement.…”

Patient-reported outcome measures: Are they patient-generated, patient-centred or patient-valued?

“…Indeed, a non-negligible number of authors (Balian & Altenberg, 2009;Koester et al, 1999;Trujols & Pérez de los Cobos, 2005) have stressed the need to consider patient priorities in (a) rethinking what is meant by a successful MMT or any other type of intervention and/or (b) establishing the outcome dimensions and variables that should be assessed to establish the effectiveness of such interventions. That said, we should note that several evaluation models and PROMs that incorporate the patient's perspectiveto a greater or lesser degreehave already been developed (Lee & Zerai, 2010;Lozano Rojas et al, 2008;Ruefli & Rogers, 2004).…”