2.5. Harm Reduction

Harm reduction is based on the idea that ending problematic drug and alcohol use can be a complex process and that services requiring abstinence, or detoxification, do not work well for many homeless people. Harm reduction is mainstream practice in some Northern European countries, such as Finland or the UK and is longstanding practice in France((Dr. Claude Olivenstein was influential in introducing the concept of harm reduction in France in the 1970s.)), but it is not universally employed throughout Europe. There is extensive evidence that harm reduction is more effective with homeless people with high and complex needs than abstinence-based or detoxification services((Pleace, N. (2008) Effective Services for Substance Misuse and Homelessness in Scotland: Evidence from an International Review Edinburgh: Scottish Government http://www.gov.scot/Resource/Doc/233172/0063910.pdf)). 

Harm reduction views problem drug or alcohol use as resulting from other support needs and also as having the potential to complicate and increase other support needs. For example, drug use cannot be treated or dealt with in isolation; it has to be understood in relation to a person’s other support needs, characteristics and behaviour.

A holistic (whole person) approach that seeks to address all the causes and consequences of drug and alcohol use is central to the harm reduction philosophy. Equally, harm reduction seeks to persuade and support people to modify drug and alcohol use that causes them harm. Harm reduction offers support, help and treatment, but does not require abstinence from drugs and alcohol.

Harm reduction is persuasive in approach((Pleace, N. (2008) Effective Services for Substance Misuse and Homelessness in Scotland: Evidence from an International Review Edinburgh: Scottish Government http://www.gov.scot/Resource/Doc/233172/0063910.pdf)). The goal is not necessarily to stop all drug and alcohol use, but to reduce the harm that someone experiences, helping them to reduce and manage their use. If someone wants to be abstinent, a harm reduction approach can enable this to happen, but a harm reduction approach will also engage with an active user, working with them to encourage reductions in their drug and alcohol use.

Harm reduction plays an integral role in Housing First. Housing First could not emphasise housing as a human right, promote service user choice or offer the separation of housing and treatment, if it did not use harm reduction. If abstinence were required, housing could not be offered to, or retained by, anyone who refused to stop drinking or taking drugs.