Discriminant analysis of factors differentiating among substance abuse treatment units in their provision of HIV/AIDS harm reduction services

Given the association between HIV/AIDS and drug use, substance abuse treatment organizations must play a prominent role in the prevention of HIV/AIDS. Effective HIV/AIDS prevention efforts targeting intravenous drug users require the use of harm reduction strategies. Current substance abuse treatment approaches stress abstinence from drug use as the primary desired treatment outcome, which might be perceived to contradict harm reduction strategies. Using data from the national Drug Abuse Treatment System Survey, this article explores the effect of ideological beliefs held by substance abuse treatment personnel on the delivery of harm reduction services to clients in outpatient substance abuse treatment (OSAT) units. Results of a discriminant analysis suggest that both abstinence-based ideologies of care and harm reduction ideologies of care distinguish between OSAT organizations engaged in harm reduction activities and organizations not engaged in such activities. Keywords: AIDS/HIV; harm reduction; ideology; substance abuse Given the association between HIV/AIDS and drug use (Centers for Disease Control, 1993), substance abuse treatment organizations have a vital role to play in the prevention of HIV infection (Friedman, Des Jarlais, & Goldsmith, 1989). However, there may be disparity between HIV/AIDS prevention ideologies and current substance abuse treatment ideologies (Des Jarlais, 1995). For instance, effective HIV/ AIDS prevention efforts targeting intravenous drug users (IDUs) may require the use of harm reduction strategies (Des Jarlais, 1995), whereas current substance abuse treatment approaches stress abstinence from drug use as the primary desired treatment outcome (Price et al., 1991). Harm reduction strategies acknowledge that some drug users initially are unwilling or unable to stop using drugs, and these strategies place greater priority on minimizing harm to the health of the drug user and the general public than on abstinence (Des Jarlais, 1995; Newcombe, 1992). Controversial interventions such as needle exchange programs often are associated with the harm reduction approach. Conflicts between substance abuse treatment and HIV/AIDS prevention ideologies have the potential to impede responsiveness by substance abuse treatment organizations to the HIV/AIDS epidemic. Proponents of institutional theory note that organizations' responsiveness to demands from the external environment is integral to their survival and essential for organizations to secure and maintain legitimacy (DiMaggio & Powell, 1983). Adopting policies and practices consistent with government regulations, accreditation requirements, or formal agreements such as contracts is one of the primary ways in which organizations achieve legitimacy. In addition, professional and peer organizations also may exert influence on organizational practices, as can public opinion. Evidence suggests, however, that it is not uncommon for human services organizations (HSOs) to be confronted by competing ideological demands in an external environment marked by fragmentation and change (Hasenfeld, 1992a, 1992b). Not surprisingly, when confronted by competing and even conflicting ideological demands, organizations often must search for a compromise (Oliver, 1991). The potential ideological conflict may be especially significant in substance abuse treatment settings, given the distinct nature of such HSOs. According to Hasenfeld, in human services settings where definitive information about the relationship between intervention technology and outcomes often is lacking, ideology can have substantial influence on the type of practices adopted by HSOs. These include practices reflected in the full range of administrative and clinical decisions made in HSOs, such as staffing, client eligibility determination, treatment planning, and services provision and termination. Thus research into the nature of the relationship between ideologies of care in substance abuse treatment settings and HIV/AIDS prevention has the potential for providing further evidence about the role that ideology plays in HSOs and to determine whether ideological factors enhance or inhibit the provision of such services in substance abuse settings. …