Substance Users’ Perspectives on Harm Reduction Strategies in Housing First Programs

Abstract

The social problem of housing instability for individuals with substance use issues is well known. Researchers have found that 50% of homeless individuals have a substance use disorder with a reduction in life expectancy compared to the general population. With 1% of the U.S. population experiencing homelessness, Housing First with its core component of harm reduction has been embraced by U.S. policymakers as a strategic solution towards ending homelessness through low-barrier permanent supportive housing. This generic qualitative study explored the perspectives of individuals with substance use experience about harm reduction strategies accessed that helped them to overcome system related barriers. The systems theoretical framework was used to allow the conceptualization of multiple systems (e.g., individuals, providers, housing services) and a diversity of stakeholders working together towards a shared goal of housing stability by using the principles of Housing First. Data were collected from 10 participants through in-depth semistructured interviews and analyzed using a reflective thematic analysis. Six themes emerged from the data: housing preference and affordability, assertive case management and supportive services, readily available behavioral health sessions and groups, ontological security, family and community engagement, and outside self-help groups. The study’s findings indicate that housing stability for participants was achieved through the accessibility of useful harm reduction strategies. The findings may provide government and community entities with a better understanding of the system barriers associated with housing individuals with substance use issues and the way harm reduction approaches are useful in achieving housing stability.