The need for accessibility

There has always been a pressing need to engage drug users in services to reduce the possible harm or risks associated with drug using. The advent of HIV has heightened this need and has been reflected in the shift towards harm reduction policies. When abstinence was the dominant philosophy it was often argued that drug users would come to services when they were ready to stop using. HIV underlined the inadequacies of this approach.

Whether people are attempting to set up new services or re-profile existing ones, it is crucial to ensure that projects are viewed as approachable and accessible to potential clients.

Social, economic and legal factors may prevent people from accessing services. Often the user's lifestyle may require support to manage and may actively obstruct them from accessing services.

The location of services may influence the user's decision whether to attend the project or not. A team based in a psychiatric hospital may be viewed as less accessible than a team based in a shop front on a high street. In addition more obvious factors such as access to public transport and disabled access also will also affect this choice. A project's location in terms of the local community will also influence accessibility. A team based in a major drug using area may be attractive, and a team's location in relation to local ethnic communities may also help or impinge on access due to stigma or drug use and discrimination faced by drug users.

The range and style of services will also affect access. Users may feel happy attending only projects with a particular philosophy (e.g. 'Twelve Step' programme). Alternatively users may be clear from personal experience that only a certain type of service will work for them (e.g. residential services).

Users may prefer to use a project that can offer them support in a wide range of areas such as health care, welfare, benefits and housing advice etc, rather than one that exclusively focuses on their drug use. Others will judge a project by its style or friendliness and in particular this may affect the `word on the street' about a project.

The structure of services may also affect a user's ability to engage. Appointments systems may prove an obstruction to a user whose lifestyle is very unstructured. Asking people with drug dependence to spend all day being assessed when they need to be out raising money and buying drugs is a strategy likely to fail. The needs of parents and the employed also have to be considered.

Waiting times and ability to respond to a crisis is important as users may be influenced by a team's ability to respond quickly. Many users approach services at a point of crisis. If they are put on a three–month waiting list when they approach services they may have dropped out by the time the crisis has eased. The quality of services affects the `word on the street' about a project. A team that responds slowly, is able to offer a limited range of services and is viewed as judgmental is likely to struggle to access clients.

The drug user's self–esteem may be low and they may have poor self confidence; the client may find it difficult to consider change or feel confident enough to enter services. Accessible services need to develop strategies for coping with the consequences of low self–esteem.