Substance Use and Social Justice: Promoting Harm Reduction through Social Work Education

Overview: The authors describe evaluation of a newly-required substance use and social work practice course within one University’s MSW curriculum. Evaluation assessed students’ attitudes towards harm reduction. Results and implications for practice will be discussed, focusing on the utility of harm reduction in expanding equitable access to substance use treatment services.Proposal text: In 2020, 40.3 million people in the United States had a diagnosable substance use disorder (SUD; SAMHSA, 2021). Substance-related health disparities disproportionately impact populations including Black individuals, LGBT individuals, rurally-located individuals, and unhoused individuals (SAMHSA, 2021). Harm reduction (HR) is a public health approach prioritizing the reduction of negative consequences related to drug use (Denning & Little, 2012). HR utilizes non-judgmental, person-centered care to address individuals’ practical needs and acknowledges the impact of racism, poverty, social isolation, and sex-based discrimination on one’s ability to obtain treatment (NHRC, 2020). HR has gained popularity among health professionals as an effective approach to improve health equity (Taylor et al., 2021). However, acceptability of HR remains varied (Davis & Rosenberg, 2013).
Social workers constitute a critical component of the health professions workforce that can advance health equity by promoting HR (Lushin & Anastas, 2011). To maximize the impact of social workers, schools of social work must provide comprehensive educational opportunities to develop, strengthen, diversify, and standardize health-related content within their curricula (Ruth et al., 2017). Doing so encourages students to embrace approaches such as HR and contribute to the workforce (Browne et al., 2017). Coursework combining substance use education and social work practice provides an opportunity to integrate content on health equity and HR (Browne et al., 2017). Evidence supports the role of substance use education in improving attitudes towards HR among social work students and other health professions students (Estreet et al., 2017; Sheridan et al., 2018).

Methodology
The 14-week substance use and social work practice course was grounded in a social justice framework. Course content included: nature, etiology, and treatment of SUDs; intersection of substance use and systemic oppression; drug/alcohol policies; substance-related health disparities; principles and practices of HR; and opioid overdose prevention training. Technical assistance was provided to support instructors and to standardize course content and delivery.
This study evaluated changes in MSW students’ attitudes towards HR before and after the course and across seven different instructors. Students completed the Harm Reduction Assessment Scale (HRAS; Goddard, 2003) before and after course completion. The HRAS is a 25-item, self-report measure assessing attitudes related to HR. Items are rated along a 5-point Likert scale (1 indicated “strongly agree”, 5 indicated “strongly disagree”).

Results
The sample included MSW students (Nf70) enrolled in one of seven sections of the substance use and social work practice course in Spring 2020. The sample was primarily White (83%), non-Hispanic (87%), and female (89%), with a mean age of 28. Paired samples t-tests indicated statistically significant improvements in HRAS scores from pre- (M=51.71, SD=14.48) to post-course (M=42.03; SD=10.58); t(69) = 7.37, p