Harm reduction with people who use psychoactive substances: social workers’ perceptions of harm reduction work and in implementing harm reduction work in their direct clinical practice in rural Central Ontario

Abstract

Harm reduction approaches to psychoactive substance use continue to be a highly politicized and polarizing topic in today’s society, even after several decades of ongoing discourse. Many social workers work for and with organizations that include harm reduction approaches to social work direct practice with individuals who use psychoactive substances. This qualitative study of six participants explores social workers’ perceptions of harm reduction work with individuals who use psychoactive substances and the ways in which they perceive the implementation and operationalization of harm reduction approaches in their direct practice in rural Central Ontario. A semi-structured interview design was used, with the research grounded in structural social work theory, as well as critical ecological theory and a person-centered perspective. Findings indicate that stigma of individuals who use psychoactive substances and associated harm reduction work is deeply rooted and reinforced within structural systems, organizations, and within social work and harm reduction work, itself. Social workers’ perception of harm reduction and it’s implementation cite organizational culture, social work as harm reduction work, and clinical barriers to implementation as main themes in the social work direct practice role, working with individuals who use psychoactive substances. Social workers are equipped to support harm reduction work through their social work worldview, and benefit from an organizational culture that both formally and informally supports harm reduction work. An aligned organizational culture and social work worldview can more effectively advocate for greater availability and accessibility of harm reduction programming and services. Implications for research, policy, and practice are discussed.