Henwood Benjamin F, Padgett Deborah K, Tiderington Emmy
School of Social Work, University of Southern California, 1150 S. Olive Street, T320, Los Angeles, CA, 90015, USA,
J Behav Health Serv Res. 2014 Jan;41(1):80-9. doi: 10.1007/s11414-013-9318-2.
Harm reduction is considered by many to be a legitimate alternative to abstinence-based services for dually diagnosed individuals, yet there is limited understanding of how varying approaches affect front-line practice within services for homeless adults. This paper examines how front-line providers working with individuals who have experienced homelessness, serious mental illness, and addiction view policies of harm reduction versus abstinence within two different approaches to homeless services: the traditional or "treatment first" approach that requires abstinence, and the more recent housing first approach that incorporates harm reduction. As part of a federally funded qualitative study, 129 in-depth interviews conducted with 41 providers were thematically analyzed to understand how providers view harm reduction versus abstinence approaches. Themes included the following: (a) harm reduction as a welcomed alternative, (b) working with ambiguity, and (c) accommodating abstinence. Drawing on recovery principles, the authors consider the broader implications of the findings for behavioral health care with this population.
许多人认为，减少伤害是为双重诊断患者提供的基于禁欲服务的合理替代方案，但对于不同方法如何影响为无家可归成年人提供的服务中的一线实践，人们的了解有限。本文探讨了在两种不同的无家可归者服务方法中，与经历过无家可归、严重精神疾病和成瘾问题的个人打交道的一线服务提供者如何看待减少伤害政策与禁欲政策：一种是要求禁欲的传统或“先治疗”方法，另一种是纳入减少伤害的较新的“先住房”方法。作为一项由联邦政府资助的定性研究的一部分，对41名提供者进行了129次深入访谈，并进行了主题分析，以了解提供者如何看待减少伤害与禁欲方法。主题包括：(a) 减少伤害是受欢迎的替代方案；(b) 应对不确定性；(c) 接纳禁欲。作者借鉴康复原则，考虑了这些发现对该人群行为健康护理的更广泛影响。
