Date of Award

January 2025

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Trace Kershaw

Abstract

Amidst the ongoing opioid epidemic and rising overdose deaths, substance use disorder (SUD) treatment has historically prioritized abstinence over harm reduction, creating gaps in patient safety. This qualitative study explores harm reduction integration in formal treatment settings and participant perceptions through 48 semi-structured interviews with individuals enrolled in Project RENEW, a larger cohort study examining factors influencing people in treatment for alcohol use across Connecticut and Georgia. Participants (79% inpatient, 51% court-mandated) described their experiences with harm reduction methods and safety strategies while in treatment. Thematic analysis revealed four key findings: 1) inconsistent access to resources like naloxone and fentanyl test strips, often without education; 2) tension between abstinence-focused programs and participants’ needs for relapse safety planning; 3) emotional and social dimensions of harm reduction; and 4) misinformation about harm reduction practices and missed opportunities for providers to give overdose prevention education. While some programs provided practical training such as naloxone administration, most prioritized religious or abstinence-only frameworks, leaving some participants feeling unprepared for post-treatment risks. Findings from this study highlight the urgent need to merge SUD care with evidence-based harm reduction principles, dissolving antiquated views that it is one or the other. By centering participant voices, this study underscores how integrating harm reduction into formal treatment programs could reduce overdose risk and better support individuals who use substances in their journeys.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/16/2026

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