Abstract
Harm reduction is a controversial model for treating drug users, with little formal research available on its operation and effectiveness. In order to advance the field, we first conducted participatory research of harm reduction with 120 clients using nominal-group technique to develop culturally relevant outcomes to measure progress. Second, we conducted focus group interviews with a different group of clients to help validate the outcomes. Third, we used the outcomes in an evaluation of the largest harm reduction program in New York City, which involved a representative sample of 261 and entailed baseline, post, and six follow-up assessments. The participatory research resulted in outcomes of 10 life areas important to drug users. Evaluation results showed that program participants made positive improvements across most outcomes, with the most substantial progress made in how clients dealt with drug-use problems. Along with their participation in the program, progress in some outcomes was also associated with clients' type of drug use (i.e., stable vs. chaotic), where more stable drug use was associated with better ways of making an income and types of housing. Surprisingly, progress was not associated with the kinds or numbers of services received or the length of time in the program. This was attributed to the service delivery model of harm reduction, in which clients are less inclined to associate their success with a single staff person or with a single service or intervention received than with the program as a whole.
Highlights
Harm reduction programs operate with the assumption that some people who engage in high-risk behaviors are unwilling or unable to abstain
Research on harm reduction programs has been limited largely to demonstrating their success with reducing the transmission of HIV/AIDS among drug users as a result of
Clients participated in groups that allowed them to identify areas of life functioning that people like themselves deemed important and meaningful to work on in the harm reduction program – income, housing, food, family relations, self-improvement; connectedness to services/benefits/programs, dealing with negative feelings, health problems, and legal and drug-use problems
Summary
Harm reduction programs operate with the assumption that some people who engage in high-risk behaviors are unwilling or unable to abstain. Using a "low-threshold approach," they do not require that clients abstain from drug use to gain access to services, nor expect adherence to one service to be eligible for another. Rather than having abstinence goals set for them, clients in such programs take part in a goal-setting process, an approach that has been shown to correlate consistently with retention and success [1,10]. Research on harm reduction programs has been limited largely to demonstrating their success with reducing the transmission of HIV/AIDS among drug users as a result of (page number not for citation purposes) Behavior change is regarded as incremental and based on the premise that people are more likely to initiate and maintain behavior changes if they have the power both to shape behavioral goals and enact them.
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