“Everyone deserves services no matter what”: Defining success in harm-reduction-based substance user treatment
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“Everyone deserves services no matter what”: Defining success in harm-reduction-based substance user treatment.

Lea H.S., Zerai A.
Substance Use and Misuse: 2010, 45(14), p. 1–17.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Lea at hsophialee@gmail.com.

A study exploring the challenges of defining and measuring ‘outcomes’ and ‘success’ in substance use treatment environments, from the perspective of staff and participants in two different US harm-reduction counselling programmes.

Summary In this paper, the authors ask what ‘success’ means to providers and participants in two harm reduction-based substance use treatment programmes in the United States. This is part of a larger study in which 18 staff members and 32 participants were interviewed about the perceived impact of harm reduction programmes. Of the two programmes investigated, the first provided drop-in services including case management, counselling, and meals to homeless people using drugs and alcohol; and the second provided counselling for individuals and couples able to pay for services.

Both staff and participants defined success broadly as ‘any positive change’. There was also agreement that it was important for staff and participants to develop relationships with each other based on mutual trust. Staff perceived their role in facilitating success was primarily about providing client-centred, low-threshold services. Measures of success from the perspective of participants included demarginalisation, engagement in the programme, quality of life, social functioning, changes in substance use, and changes in future goals and plans. These differ from traditional notions of success in substance use treatment, for example, abstinence and programme completion.

The article suggests that defining and measuring success can be problematic. If we neglect to define what success means in substance use treatment environments, we miss the opportunity to recognise positive changes. Yet if we standardise measures of success, we risk neglecting people’s individual lived experiences.

The authors conclude that participants in harm reduction programmes do experience tangible positive changes, and these can be represented as ‘outcomes’ and ‘success’, providing those involved are sensitive to the challenges discussed above.

Last revised 27 October 2015. First uploaded 27 October 2015

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