Harm reduction in a Norwegian housing first project: a qualitative study of the treatment providers’ practice

Abstract

Purpose Little is known about how harm reduction is practiced in Norwegian housing first (HF) projects. The purpose of this paper is to explore, describe, and interpret how providers apply a harm reduction approach within a housing project focused on individuals who are homeless with co-morbid substance use and mental health problems. Design/methodology/approach This qualitative study was part of a larger evaluation study of a three-year HF project in a Norwegian municipality. Data were collected using four multi-stage focus groups with five providers working in the HF project. Focus group interviews were transcribed verbatim and analyzed using thematic analysis. Findings Analysis resulted in three main themes: “Letting the service user sit in the driver’s seat,” “We don’t follow service provision contracts, we do everything,” and “Collaborating with the local community.” Research limitations/implications There is a need to develop increased knowledge about service users’ experiences within the harm reduction approach. Practical implications To practice effective harm reduction, treatment providers must have open authorizations and the opportunity to exercise professional judgment. Harm reduction practice must also focus on social, political, and economic factors influencing users’ everyday lives. Originality/value The paper contributes to the knowledge base on harm reduction within HF practice that differs from a traditional model wherein clients are expected to abstain from substance use. It highlights important preconditions for challenges practitioners might encounter at both individual and service system levels.

‘It maybe doesn’t seem much, but to me it’s my kingdom’: staff and client experiences of Housing First in Scotland

“…Similary, both Baxter et al (2019) and Beaudoin (2016) found that HF resulted in no clear differences in substance use when compared with treatment as usual. Qualitative research from a Norwegian HF program suggested that trusting relationships can contribute to clients talking openly about substance use and/or mental health problems (Andvig et al, 2018). While our study involved a small sample which limits the conclusions that can be drawn, our data lends some support to the idea that substance use in HF programs tends to stabilize rather than increase or decrease.…”

Warriors against the ‘War on Drugs’: Lay experts in Norwegian drug policy

“…In Norway, syringe distribution was introduced in the 1980s, OSPs since the 1990s, and in 2005, an injecting room opened in the capital, Oslo (Andvig et al, 2018). Recently, the government decided to establish a heroin substitution project (Norwegian Government, 2020).…”

Harm reduction: Philosophical drivers of conceptual tensions and ways forward

“…An example of harm reduction as a social practice is Housing First programming, where abstinence from drug use is not a condition for the provision of housing (Gaetz, Scott, & Gulliver, ), and where service providers invite PWUD to talk about their own understanding of their circumstances. Service providers also help the person attain financial stability and ensure access to entitled services (Andvig, Sælør, & Ogundipe, ). Conceptualizing harm reduction as a social practice also means the necessary engagement of PWUD in the design and implementation of interventions with the goal of ensuring relevance and acceptability (Harris).…”