Documenting experiential knowledge on harm reduction to improve support for alcohol users in France

BACKGROUND: Experimentations in France referring to the harm-reduction paradigm aim to deliver more efficient support to vulnerable alcohol consumers who don't look for consumption cessation. They take place both in healthcare (addictology centers) and social care facilities. Harm-reduction applied to alcohol use (HRA) cause debates within scientific and policy-making communities. Yet, few research details what innovating HRA interventions (HRAI) offer and how they work. The project SeRra (2020-2022) aimed to capitalize - i.e. to collect, document and circulate - experiential knowledge from field practitioners on HRAI to bridge that gap. METHODS: Steered by a multidisciplinary committee, SeRra followed 7 steps: 1/ identify and select HRAI nationwide; 2/ meet with practitioners for in-depth interviews on HRAI (development, implementation, effects); 3/ analyze, 4/ write and 5/ publish a capitalization form per HRAI. We 6/ drafted a cross-case analysis, 7/ debated with experts and practitioners, to formulate practice and policy recommendations. RESULTS: We capitalized 28 HRAI, including: projects of drug-use centers, emergency housing, specialized social work teams, new therapeutic education programs, etc. Projects often combined implementing institutional and organizational changes to align with HRA, with offering improved one-to-one support, and advocacy for HRA. HRAI improved wellness scores and access to prevention and care. Ultimately, HRAI improved empowerment and inclusion of vulnerable alcohol users. We identified levers and barriers to implement HRA practices. We formulated recommendations to keep improving HRA individual support methods and evaluation. More practitioners shall access training to gain relevant HRA skills. CONCLUSIONS: Successful HRAI experiences during Covid lockdowns drove French authorities to support further dissemination of HRAI. capitalization forms circulating among practitioners and recommendations in our final report benefit implementation efforts. KEY MESSAGES: • New harm-reduction approaches improve access to care and inclusion of vulnerable alcohol consumers. SeRra details experiences in social & medical settings and offers insights on dissemination levers. • Attention must be brought to experiential knowledge as it proves useful to improve professional practices. SeRra confronts experiential knowledge and expertise to further innovation and dissemination.