Challenging Dominant Addiction Discourse:
Making Harm Reduction Work for Women with Alcohol Use Problems
Summary of Proposed Research: This study seeks to investigate the deployment of
harm reduction strategies in women centered treatment programs in Canada and explores
how women’s addiction programming tackles dominant social ideologies about addiction
in the provision of these services. Harm reduction emphasizes the needs of the individual,
focusing on minimizing all forms of harmful impact of substance use. This approach
appeals to many women centered practitioners as it departs from dominant deficit based,
abstinence focused, disease model interpretations of addiction. The focal point of this
study - women’s alcohol use problems - illuminates dominant socially constructed
discourses on addiction. Through this cross Canada study, we will examine how these
discourses are challenged or reinforced by services offered to women. How service users
choose a controlled use or abstinence approach to their alcohol treatment and the context
or determinants of this decision will be examined. We will explore potential gaps
between the service providers’ efforts at challenging addiction ideology, clients’
understanding of addiction, and how these gaps are addressed. Furthermore, this study
will investigate whether agency policy supports federal policy on harm reduction
approaches to service delivery. Exploring harm reduction across service users, providers,
directors and organizational policy at multiple sites across Canada will provide a strong
profile of the landscape of women’s programming in this area (a profile that is currently
unavailable) and illustrate potential tensions and ambivalence in the deployment of harm
reduction. Finally, based upon a critical analysis of the strengths and constraints of harm
reduction in women’s treatment settings, health education materials will be developed for
service users to assist them in their choices of treatment approach. Workshops and
publications will support service providers in offering harm reduction options, when
appropriate, in treatment centres.
Key Objectives: This study will investigate three distinct yet related questions,
questions that have not been explored to date in the literature. First, we will examine the
ideologies underlying women’s beliefs about alcohol use problems and how these beliefs
affect their choice of abstinence or controlled drinking in treatment. Second, we will
explore how organizational ideologies and practices influence treatment options in
women’s alcohol treatment programs. Third, through investigating the ideologies of
alcohol problems held by women accessing services as well as the organizations
providing them, we will ultimately explore the extent to which women’s alcohol
treatment programs challenge and/or reinforce dominant disease-based ideologies on
alcohol addiction. Through this, we will offer a profile of the landscape of women’s
programs for alcohol use problems in Canada, highlight gaps between federal health
policy and organizational policy and offer a critical analysis of the strengths of and
constraints to harm reduction in women’s treatment settings across Canada. This analysis
will advance the ongoing debate in addiction services about abstinence or controlled use,
and assist in advancing harm reduction treatment strategies in women’s alcohol use
treatment programs. Dissemination of the findings will contribute to education on harm
reduction, and will occur through workshops for service providers, a harm reduction fact
sheet for service users, and conference papers and publications.
Research Methods: Data will be collected through interviews and focus groups with
service users, interviews with service providers and program directors and through
organizational policy documents. Quantitative surveys will complement the qualitative
data, including an author designed socio-demographic and drinking frequency survey, the
IDS-42, which investigates situations that motivate heavy drinking, and the Addiction
Severity Index to measure addiction severity. Data analysis will involve thematic analysis
of women’s narratives which will be contextualized within the current policies and
practices of treatment centers across Canada, as well as within existing research on
alcohol use and harm reduction.