High and low threshold service provision in drug-free settings: Practitioner views

Background: In the United States, drug-free (non-drug substitution) treatment programmes are informed by an abstinence-only, disease model. Some critics believe this model hinders treatment service utilization and retention. An alternative public health model of harm reduction suggests that drug services should have a "low-threshold" for entry and retention such that they are offered with few or no conditions, such as abstinence from drug use. Methods: Using semi-structured qualitative interviews with 15 practitioners from 9 outpatient drug-free agencies, this study examined beliefs about low threshold service provisions. Results: Respondents identified certain conditions for drug services as clinically and programmatically appropriate and necessary to ensure safety. Factors relevant to outpatient services, drug use and client dynamics were also cited. Respondents tended to support service conditions to inform treatment planning and practices. Conclusions: Practitioners in these settings accept and support some threshold of imposed service conditions as useful in treatment and service planning. When outpatient services are terminated clinically appropriate services are offered instead. Concerns for service accessibility should focus on the availability of medically intensive services.