A qualitative study of health, social, and community professionals’ practices to reduce alcohol-related risks among people living in social precarity in the Greater Paris region

Alcohol-related harms constitute a major global public health challenge. Despite similar consumption levels to their more affluent counterparts, alcohol-related morbidity and mortality is disproportionately higher in socioeconomically deprived populations. People living in social precarity face multiple barriers to accessing traditional treatment services, making alcohol harm reduction (AHR) practices particularly relevant for them. This qualitative study, conducted in the Greater Paris region, described and analyzed AHR practices adopted by health, social, and community professionals working in different types of care facilities with people living in social precarity who consume alcohol. Semi-structured interviews were conducted with 31 professionals in 11 different facilities, including addiction care centers, harm reduction centers, and housing facilities. A thematic analysis of the data revealed three AHR practices: (i) authorizing the consumption of alcohol on the premises, (ii) managing users' level of alcohol consumption, and (iii) providing prevention interventions and information on alcohol consumption. Not all three practices were implemented by all 11 facilities. Specifically, the practices implemented depended on (i) whether alcohol cessation was the primary goal of the professional and the facility, and (b) the specific needs of the facility's users. All 11 facilities shared a common focus of building trust and adapting their practices to their user profile. In contrast, the level of patient engagement varied according to facility type from passive to active involvement. A consensual definition of the concept of AHR for people living in social precarity is essential to standardize related practices, with a view to objectively assessing their effects.