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

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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 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.

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Acknowledgments

This research was supported by grants from the National Institute of Mental Health (R01 69865 and 5F31MH083372). A version of this paper was presented at Integrating Services, Integrating Research for Co-Occurring Conditions: A Need for New Views and Action, Bethesda, MD, 2009.

Conflict of Interests

The authors have no conflicts of interest to report.

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Authors and Affiliations

  1. School of Social Work, University of Southern California, 1150 S. Olive Street, T320, Los Angeles, CA, 90015, USA

    Benjamin F. Henwood PhD, MSW

  2. Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003-6654, USA

    Deborah K. Padgett PhD, MPH & Emmy Tiderington MSW

Authors
  1. Benjamin F. Henwood PhD, MSW
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  2. Deborah K. Padgett PhD, MPH
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  3. Emmy Tiderington MSW
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Correspondence to Benjamin F. Henwood PhD, MSW.

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Henwood, B.F., Padgett, D.K. & Tiderington, E. Provider Views of Harm Reduction Versus Abstinence Policies Within Homeless Services for Dually Diagnosed Adults. J Behav Health Serv Res 41, 80–89 (2014). https://doi.org/10.1007/s11414-013-9318-2

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  • DOI: https://doi.org/10.1007/s11414-013-9318-2

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