| In the United States, drug-free substance abuse treatment programs generally operate under an abstinence-only, disease model based service orientation. Citing several reasons, critics suggest disease model approaches hinder client utilization and retention within such services. The framework of harm reduction offers an alternative approach to substance abuse treatment services and may have potential for improving utilization and retention outcomes. Yet little is known about how harm reduction is perceived by practitioners in drug-free substance abuse treatment settings, and the circumstances in which harm reduction may or may not be accepted. In addition, despite a body of narrative literature suggesting harm reduction is consistent with professional social work, there is scant empirical work considering whether social workers differ from non-social workers in their beliefs and practices of harm reduction.;Using semi-structured, in-person interviews with 15 front-line practitioner respondents employed in nine different outpatient drug-free substance abuse treatment settings, this qualitative study examined respondent beliefs toward harm reduction and the relevant factors cited as indicating or contraindicating harm reduction practices. To elucidate any possible differences related to professional identity, these belief and attitudinal findings were also compared in terms of respondents identifying as either a social worker (eight of 15) or a non-social worker (seven of 15).;Results indicate practitioner beliefs about harm reduction are often dictated more by personal and professional work dynamics, and less as a consideration of the clinical aspects of a given client. Beliefs about harm reduction were often dissonant from its depiction in existing professional literature, while some respondents reported having little formal knowledge of it. Although support for specific harm reduction practices identified in the literature review (gradual tapering, non-abstinence treatment goals, and substance use management) was generally limited, respondents did support harm reduction as a guiding philosophy for their clinical work. Social workers and non-social workers showed much more similarity than difference in beliefs and practices, and possible explanations for this may lie with the role of agency and collegial dynamics in discouraging open support for harm reduction or seeing it as viable.;The generalizability of these results for practitioners throughout the United States is unknown, but they provide a framework for understanding harm reduction in such settings, and are largely unique to current research. Implications for the utility of harm reduction within these settings are discussed, as are specific implications for practitioners, and directions for subsequent research. |
