title: Spontaneous harm reduction: a barrier for substance-dependent individuals seeking treatment?
abstract: OBJECTIVE
  Greater information regarding motivations and treatment barriers faced by substance-dependent individuals has clinical and public health implications. This study aimed to formulate hypotheses regarding psychological, social and family variables that can be constructed as motivations or subjective barriers for the early seeking of formal treatment.
  
  
  METHODS
  A qualitative study was conducted in an intentional sample (selected through saturation and variety of types) of 13 substance-dependent individuals who sought treatment. In-depth, semi-structured interviews were conducted using open questions, and the transcribed data were subjected to qualitative analysis.
  
  
  RESULTS
  Four types of spontaneous harm reduction measures were identified, according to the subjective logic of each participant: having some periods at rest (not using and recovering from adverse effects); caretaking by close acquaintances (relatives, partners, drug dealers and alcoholic beverage sellers); selectivity regarding substance source, type and means of administration; establishing "healthy" limits of ingestion.
  
  
  CONCLUSIONS
  The measures identified might represent barriers to the early seeking of treatment but might also represent spontaneous learning of abilities beneficial to future treatment. Health care professionals should take into consideration their existence and should address them in clinical settings. Issues representative of the formulated categories should be presented in structured questionnaires used in future quantitative studies of barriers to treatment in this population.
authors.affiliation: Department of Mental Health, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. bruno.fontanella@uol.com.br
authors.forename: Bruno José Barcellos
authors.initials: BJ
authors.lastname: Fontanella
authors.forename: Egberto Ribeiro
authors.initials: ER
authors.lastname: Turato
mesh_terms: D000293:Adolescent; D000328:Adult; D005190:Family; D005260:Female; D040261:Harm Reduction; D006801:Humans; D007406:Interview, Psychological / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D019966:Substance-Related Disorders / Q000523:psychology*