Provider Views of Harm Reduction Versus Abstinence Policies Within Homeless Services for Dually Diagnosed Adults

Abstract

Harm reduction is considered by many to be a legitimate alternative to abstinence-based services for dually diagnosed individuals, yet there is limited understanding of how varying approaches affect front-line practice within supportive housing services for homeless adults. This paper examines how front-line providers working with individuals who have experienced homelessness, serious mental illness, and addiction view policies of harm reduction versus abstinence within two distinctly different approaches to homeless services: the traditional or ‘treatment first’ (TF) approach that requires abstinence and the more recent Housing First (HF) approach that incorporates harm reduction. As part of a federally-funded qualitative study, 129 in-depth interviews conducted with 41 providers were thematically analyzed to understand how providers view a harm reduction versus abstinence approach. Themes included: (a) harm reduction as a welcomed alternative; (b) working with ambiguity; and (c) accommodating abstinence. Drawing on recovery principles, we consider the broader implications of the findings for behavioral health care with this population.

Case Manager Perspectives on the Role of Treatment in Supportive Housing for People with Severe Mental Illness

“…The study setting was a supportive-housing organization that participated in a larger National Institute of Mental Health-funded qualitative study examining recovery among people with severe mental illnesses and histories of homelessness (Henwood, Padgett, & Tiderington, 2014; Tran Smith, Padgett, Choy-Brown, & Henwood, 2015). The primary intent of the study was to understand mental health recovery for the population of those with severe mental illness living in supportive housing.…”

“…The setting provided supportive-housing services based on a residential-continuum model (Henwood et al, 2014). Case managers worked in two programs in a supportive-housing continuum: One program provided transitional housing, and the other provided permanent housing.…”

Starting Where the Client Is: Harm Reduction Guidelines for Clinical Social Work Practice

“…These articles range from position pieces promoting harm reduction philosophy as something aligned with our values (Bigler 2005;Brocato and Wagner 2003;Lushin and Anastas 2011;Macmaster 2004;Reid 2002;Seiger 2003;Straussner 2012;van Wormer 2004) to empirical outcome studies of the approach in various settings (Davis et al 2014;Karoll 2010;Mancini et al 2008;Witkiewitz 2005). In addition, social workers have published articles relating to harm reduction in other professional journals (Henwood et al 2014;Lee et al 2011;Little 2006, Little andFranskoviak 2010;Little et al 2008).…”

The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder

“…Childhood traumatic experiences, posttraumatic stress disorder and adult exposure to other traumatic experiences can also influence substance use [8]. Despite the substantial unmet care needs of this population, people struggling with both substance use and homelessness experience overlapping barriers to accessing care, including stigma related to care itself [9], and abstinence-based treatment first housing services [10,11]. Together, these barriers increase perceived loss of control over one's life, contribute to mistrust of the health system, and perpetuate lower access and adherence to care and treatment [12][13][14].…”