A Mixed Methods Study Clarifying Clinicians’ Definitions of Harm Reduction and Related Clinician Characteristics
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background: Harm reduction is a vital, evidence-based approach to reducing substance-related harm, yet its clinical implementation remains inconsistent. Prior research examining clinicians' attitudes toward harm reduction has ignored a foundational conceptual gap: the lack of a shared, operational definition. This mixed-methods study aimed to clarify how clinicians define harm reduction and identify the individual provider characteristics associated with these definitions. Methods: A sample of practicing clinicians (N=174; Mean age=38, SD=13; 79% White, 60% women) completed a cross-sectional online survey. Using qualitative thematic analysis, we explored clinicians' open-ended definitions of harm reduction. Concurrently, exploratory quantitative analysis assessed the breadth of specific harm reduction strategies clinicians endorsed and the provider characteristics associated with endorsement. Results: Clinicians generally conceptualized harm reduction as a personalized, broad approach to limit harm (11 subthemes identified). However, a persistent, underlying preference for abstinence that functionally constrained this broad definition also appeared. Endorsing a broader range of strategies was positively associated with years of clinical experience and reporting personal or familial experience with addiction. Endorsing a narrower range of strategies was positively associated with holding a non-doctoral degree and identifying with a more conservative political ideology. Conclusions: The operational definition of harm reduction varies significantly among clinicians, with a bias toward abstinence that may undermine harm reduction implementation fidelity. Narrower conceptualizations reflect not only clinical knowledge deficits but also ideological frameworks, professional training, and potential semantic "label aversion." Future efforts to standardize care must move beyond skills acquisition and investigate conceptually rigorous, values-based training.
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7196931587