The Journal of Behavioral Health Services & Research

, Volume 41, Issue 1, pp 80–89

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


    • School of Social WorkUniversity of Southern California
  • Deborah K. Padgett
    • Silver School of Social WorkNew York University
  • Emmy Tiderington
    • Silver School of Social WorkNew York University

DOI: 10.1007/s11414-013-9318-2

Cite this article as:
Henwood, B.F., Padgett, D.K. & Tiderington, E. J Behav Health Serv Res (2014) 41: 80. doi:10.1007/s11414-013-9318-2


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 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 different approaches to homeless services: the traditional or “treatment first” approach that requires abstinence, and the more recent housing first 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 harm reduction versus abstinence approaches. Themes included the following: (a) harm reduction as a welcomed alternative, (b) working with ambiguity, and (c) accommodating abstinence. Drawing on recovery principles, the authors consider the broader implications of the findings for behavioral health care with this population.

Copyright information

© National Council for Community Behavioral Healthcare 2013