“Everyone Deserves Services No Matter What”: Defining Success in Harm-Reduction-Based Substance User Treatment

Abstract

This article reports qualitative interview data from a study of participant-generated outcomes of two harm reduction programs in the United States. We address the question:“What does success in harm-reduction-based substance user treatment look like?” Providers in this study understood harm reduction to adhere to notions of “any positive change,” client centeredness, and low-threshold services. Participants reported changes in demarginalization, engagement in the program, quality of life, social functioning, changes in substance use, and changes in future goals and plans. The nature of these changes is difficult to articulate within traditional notions of success (i.e., abstinence, program completion, etc.). We conclude that participants in harm reduction programs experience tangible positive changes but that legitimation of these changes calls for a reconceptualization of “outcomes” and “success” in the current context of substance user treatment and research.

RÉSUMÉ

“Tout le monde mérite des services, quelle que soit la situation”: définir le succès des traitements basés sur la réduction des risques chez les usagers de drogues.

Cet article présente des résultats d’entretiens qualitatifs, provenant d’une étude aux résultats déterminés par les participants, sur deux programmes de réduction des risques aux Etats-Unis. Nous posons la question suivante: «A quoi ressemble le succès dans un traitement basé sur la réduction des risques chez les usagers de drogues?»

Dans cette étude, les prestataires de services comprenaient réduction des risques comme adhérant aux notions telles que “tout changement positif”, services centrés sur le client, et services a bas seuil. Les participants ont rendu compte de changements en terme de démarginalisation, engagement dans le programme, qualité de vie, fonctionnement social, changements dans l’usage de drogues et changement dans les but et plans futures. La nature de ces changements est difficile à articuler à l’intérieur des notions traditionnelles de succès (par exemple abstinence, achèvement du programme, etc.). Nous concluons que les participants aux programmes de réduction des risques connaissent des changements positifs tangibles mais que la légitimation de ces changements nécessite une reconceptualisation de “résultats” et “succès” dans le contexte actuel du traitement des toxicomanes ainsi que de la recherche.

Mots Clés: démarginalisation, légitimation

RESUMEN

“No importa la razón, todos merecen servicios”: definiendo al éxito en tratamientos de usadores de sustancias basados en la reducción de daño

Este artículo reporta datos cualitativos de entrevista de un estudio donde los resultados fueron generados por participantes de dos programas de reducción de daño en los Estados Unidos. Respondemos a la pregunta:“¿En que manera vemos éxito en el tratamiento de usadores de sustancias basado en la reducción de daño?” Los proveedores en este estudio entendieron que la reducción de daño se adhiere a las nociones de “cualquier tipo de cambio positivo,” estar centrado en el cliente y servicios de baja tolerancia. Los participantes reportaron cambios en desmargenalización, interés en el programa, calidad de vida, funcionamiento social, cambios en uso de sustancias y cambios en metas y planes para el futuro. La naturaleza de estos cambios es difícil de articular dentro de las nociones tradicionales de éxito, como por ejemplo abstinencia, completar el programa, etc. Concluimos que participantes en programas de reducción de daño experimentan cambios tangibles y positivos pero que la legitimación de estos cambios llama para una reconceptualización de “resultados” y“éxito” en el contexto actual de tratamiento e investigación de usadores de sustancias.

Palabras claves: desmargenalización, legitimación

Keywords :

• demarginalization
• harm reduction
• legitimation
• low-threshold services
• quality of life

THE AUTHORS

Heather Sophia Lee, Ph.D., is a social worker in training and a qualitative researcher. She is currently a Center for Disease Control and Prevention fellow in the School of Public Health at the University of Illinois at Chicago and is simultaneously pursuing a master's degree in clinical social work at the University of Chicago. She received her Ph.D. in educational policy studies at the University of Illinois at Urbana-Champaign in 2006, where she conducted dissertation research on harm reduction in substance user treatment. From there she went on to be a National Institute on Drug Abuse postdoctoral fellow at the University of California at San Francisco from 2006 to 2008. Her research has focused mostly on qualitative understandings of access to and engagement in substance user treatment with a particular interest in the homeless population. Her next research project is a phenomenological study of retrospective understandings of early parental loss.

Assata Zerai, Ph.D, is an Associate Professor and the Director of Graduate Studies of the Sociology Department at the University of Illinois at Urbana-Champaign. She received her Ph.D. in sociology in 1993 from the University of Chicago. Her scholarship focuses on the ways that race, class, and gender as interlocking spheres are reflected in maternal and child health and antiwar activism. She is currently working on a project titled “An Africana Feminist Analysis of Maternal and Child Health in South Africa and Zimbabwe.” Her recent publications include Dehumanizing Discourse, Anti-Drug Law and Policy in America: A “Crack Mother’s” Nightmare, co-authored with Rae Banks (2002);“A Black Feminist Critique of American Religious Anti-War (Dis)engagements” (forthcoming);”A Black Feminist Analysis of Responses to War, Racism, and Repression” (with Zakia Salime, 2006) in Critical Sociology;“Health Seeking Behavior in Times of Economic Crisis in Nigeria” (2004); and“ ‘Tell No Lies; Claim No Easy Victories’: A Critical Analysis of the BRC Congress 2003” in Socialism and Democracy, co-authored with Horace Campbell (2004). She co-edited an issue of Social Science and Medicine that was published in 2007, entitled “HIV/AIDS in Africa: Gender, Agency and Empowerment,” with Ezekiel Kalipeni.

Notes

1 Treatment can be briefly and usefully defined as a planned, goal-directed, temporally structured change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (by culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help-based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—that aren't also used with nonsubstance users. In the West, with the relatively new ideology of “harm reduction” and the even newer “quality of life” treatment-driven model there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor's note.

2 The reader can consider and explore the dimensions of and the relationships between “success” and “improvement.” Editor's note