Drugs & Communities

Harm reduction is for all of us

A recent article in the International Journal of Drug Policy provides us with a framework for addressing homelessness that may require a shift in our collective thinking and actions. Recognizing the complex relationship between homelessness and drug use, the authors argue harm reduction must be more fully embraced in our communities in order for us to reach our common goal of ending homelessness.

The authors (most of whom are associated with CARBC) begin by examining a current example of the integration of housing and harm reduction—Housing First, a strategy that puts the basic human need for shelter before our capacity to think about and make positive long-term changes to our substance use. Adopted in many North American cities, the strategy focuses on housing people regardless of their current patterns of substance use before offering to help them change their use, and even then only if, when and how they want and are able to change.

An abundance of evidence shows that housing a person is in itself a way to reduce harm from substance use (since being homeless automatically puts a person at higher risk of blood-borne infections, stigma, overdose and death). Yet many agencies and individuals in our society still seem unable to wrap their heads around the reality that meaningful change in any human’s choices and behaviours comes only when we live somewhere, feel we belong, and know we can trust others. As a result, the harm reduction foundation of Housing First is often ignored or resisted by service providers and other professionals who do not truly understand or share its vision and core values. In rejecting harm reduction, we have in fact lost opportunities to reduce homelessness.

What our agencies and organizations can do

To get back on track, the authors suggest our communities embrace policies based on an established risk environment framework and current evidence of Housing First and harm reduction. These include:

1.       Social inclusion policies

Like mainstream society, people who are homeless and have other problems need to be part of the discussions that affect their lives. Their experiences and opinions offer necessary insight into how to understand and address homelessness and reduce related substance use issues. What is more, working together helps to break down “us and them” barriers and reduce stigma against vulnerable populations.

2.       Adequate and appropriate supply of housing

Like mainstream society, the homeless population is diverse, with varying needs. Therefore, a range of options may be necessary to meaningfully accommodate those in need in a community. Regulated group facilities may be preferable to some individuals, but others may have better chances at success in private dwellings or another option. Offering a variety of options also helps communities reabsorb the homeless population in a more natural, seamless manner, provoking fewer negative responses from “concerned citizens” in different neighbourhoods.

3.       On-demand harm reduction services and supports

Like people with homes, people without homes have the right to make choices about how and when they make significant changes in their lives. Research shows that when help is available but not forced upon a person with a problem, they are more likely to trust and reach out to service workers on their own.

4.       Systemic and organizational infrastructure

To guarantee harm reduction is practised and maintained, a service organization’s policies, staff training and public education materials must constantly reflect and reinforce a commitment to harm reduction principles. In language and structure, the underlying message must always be respectful and supportive of people’s right and ability to chart their own path in life, including making their own choices to use—or not use—alcohol or other substances.

How individuals play a role in reducing harm

Having a home—a place to sleep, feel safe, belong—is so fundamental to the human experience that most of us find it almost impossible to imagine being without one. We even have trouble imagining other people being homeless, which is partly why we get uncomfortable when confronted by the faces and stories of people who try to talk to us on the street. It seems easier to ignore, blame or stigmatize them as too far gone with alcohol or other drugs than it is to empathize or talk with them. Otherwise, we might feel compelled to do something to help, a task most of us are not prepared to take on when we’re crossing the street on the way to work in the morning or picnicking in the park with our kids on the weekend.

Instead, we have tended to hide behind our hope that there are agencies and organizations out there working to help homeless people fix their problems so they can have a home again, and so we don’t have to be reminded or disturbed by things that seem “wrong” or out of step with the spirit of our culture. And even though intuitively we may know we are more likely to move forward in life if we have a home to stand up in first, we have not done very much to challenge policies and procedures for homeless people that work in reverse order.

It seems we must all work harder to change how we think about homeless people and substance use—indeed, all people and substance use—and the human path toward change.

Sources:

Pauly, B. et al (2013). Housing and harm reduction: What is the role of harm reduction in addressing homelessness? International Journal of Drug Policy.