Over the last two decades, the Opioid Epidemic has caused immense harm to communities nationwide. Over 400,000 fatal opioid overdoses occurred in the United States between 1999 and 2017 (CDC, 2019). Professional counselors are among the front-line treatment providers addressing substance use, including Opioid Use Disorders. Professional counselors have a unique professional identity that is built upon humanistic values, a commitment to social justice, and client empowerment. These values align closely with contemporary approaches to substance use treatment, including harm reduction strategies. Harm reduction is an approach to substance use treatment that involves mitigating risks and improving the quality of life of individuals, regardless of their willingness or ability to stop using substances. There are several harm reduction strategies that reduce the risk of fatal opioid overdose or secondary harms of opioid use specifically, including medication-assisted treatment and the distribution of naloxone for overdose reversal. This study examined the acceptability of harm reduction strategies for Opioid Use Disorder among addiction treatment professionals, with a focus on professional counselors. In addition to measuring the level of acceptance of harm reduction for Opioid Use Disorder among professional counselors, counselors were also compared to other professionals who treat substance use. Predictors of acceptability of harm reduction for Opioid Use Disorder were examined based on overlapping components of professional counseling identity and harm reduction philosophy among professional counselors as well. The results of this study provided a baseline for the level of harm reduction acceptance among counselors who treat substance use. Counselors did not have higher levels of harm reduction acceptance for OUD compared to social workers with advanced degrees or bachelor's level substance use treatment providers. Social justice attitudes and empathy were statistically significant predictors of acceptance among counselors. This research indicates that these two factors are key components of counselor identity that explain harm reduction acceptance. The findings of this study highlight a need for more research about harm reduction acceptance for OUD among counselors, including further examination of provider factors that influence acceptance and examination of a broader array of professionals. This research contributed to the understanding of how professional counselors perceive novel approaches for addressing Opioid Epidemic. / Doctor of Philosophy / The Opioid Epidemic is a public health crisis that has led to hundreds of thousands of overdose deaths over the last two decades. Counselors are among the treatment professionals addressing substance use in the United States, including responding to the Opioid Epidemic. Harm reduction is a unique approach to substance use treatment that focuses on keeping people who use substances alive and healthy, regardless of their ability or intent to stop using substances. The current study sought to explore the perceptions of harm reduction strategies for people who use opioids among counselors, including comparing their attitudes to other professionals and exploring the impact of their professional identity. Counselors were not found to be more accepting of harm reduction than other professionals who treat substance use and social justice and empathy were key aspects of counselor professional identity that predicted accepting attitudes towards harm reduction. More research is needed to understand how counselor identity affects harm reduction perceptions.

Il contributo presenta i risultati di un progetto multi-fase che ha avuto come obiettivo la creazione di un nuovo modello di azione collettiva solidarity-based. Sviluppatosi in tre fasi conseguenti e necessarie, tale progetto mira a fornire indicazioni teoriche, metodologiche ed applicative per interventi di cittadinanza globale capaci di favorire condizioni di giustizia sociale. La prima fase consta di uno studio cross-culturale condotto in Italia, Austria e Stati Uniti volto a rilevare le rappresentazioni sociali dei concetti di obbedienza e disobbedienza in gruppi di giovani-adulti. La discussione dei risultati evidenzia similitudini e differenze cross-culturali tra le rappresentazioni e definisce, per la prima volta in letteratura, attraverso l’utilizzo di mixed methods completamente bottom-up i concetti di obbedienza e disobbedienza. Nella seconda fase è stato creato e validato uno strumento psicometrico in grado di misurare l’atteggiamento relativo alla disobbedienza pro-sociale poiché, nella terza e ultima fase, tale costrutto, insieme alle variabili ragionamento morale e valori di impegno, sono state testate come predittrici del modello EMSICA, modello esplicativo di un’azione collettiva a favore di un out-group in condizioni di svantaggio sociale. La discussione dei risultati indica la rilevanza empirica di tali variabili offrendo interessanti spunti di riflessione per i policy maker. / This dissertation presents the results of a multi-phase project whose goal was the creation of a new model of solidarity-based collective action. Developed in three consequential and necessary phases, this project aims to provide theoretical, methodological and practical guidance for interventions of global citizenship to favor conditions of social justice. The first phase consists of a cross-cultural study conducted in Italy, Austria and the United States aimed at detecting the social representations of the concepts of obedience and disobedience in young adults groups. The discussion of the results highlights the similarities and the differences between cross-cultural representations and defines the concepts of obedience and disobedience for the first time in literature, through the use of completely bottom-up mixed methods. In the second phase has been created and validated a psychometric instrument that can measure the attitude related to pro-social disobedience because, in the third and final stage, this construct, along with the variables moral reasoning and engagement values, have been tested as predictors of the EMSICA model, that explains collective action in favor of a disadvantaged out-group. The discussion of the results indicates the empirical relevance of these variables offering interesting insights for policy makers.