Disrupting “High-Risk Behaviours” For Good

Last month I read Saving Our Own Lives by Shira Hassan, a collection of essays and “love notes” about liberatory harm reduction. The whole collection was well worth the read, but the biggest learning I had was a framework that helps us challenge the problematic term “high-risk behaviours.”

As Hassan notes, “‘High-risk behaviour’ is a stigmatized way of talking about the gorgeous and varied coping strategies we reach for when we are trying to heal from trauma or just survive day to day.” She goes on to acknowledge that the term likely comes from expanding a medical term “high-risk” for actions that are statistically more likely to result in disease transmission or harm in general. Still, “it is a limited understanding of risk that’s based in stigma.”

The phrase sounds clinical and neutral. But it subtly centres the behaviour (and by extension, the individual) as the problem. It rarely asks what conditions made that behaviour more likely in the first place.

Enter Risk, Set, Setting. 

For some of you, Risk, Set, Setting will not be new. It is a widely recognized theory in harm reduction, but its applications go far beyond substance use. 

As Hassan describes it, Norman Zinberg, through his 1984 book Drug, Set, and Setting, “gave academic support to things that activists have been saying for decades.” 

In his theory, the term drug means any substance someone uses for mood- or mind-altering experiences. Mindset, or set, describes the mood or state of the person prior to using the substance. Setting refers to the social and physical environment in which use occurs. Hassan writes, “For example, a gay person sitting on a gay beach with friends during a butterfly migration using LSD will have a radically different drug experience compared to an isolated teenager in a dark bedroom using LSD alone.”

This three-part approach seems simple and even intuitive, but it has the potential to be deeply disruptive. 

Accountability, Reframed
The current dominant narrative collapses all of this into one word: choice. 

We are told that if someone is using drugs, it’s a personal failure. 
Or if someone is living in an encampment, it’s service refusal. 

Risk, Set, Setting (RSS) interrupts that reduction and widens the frame. It shifts the focus from isolated behaviour to shared conditions.

Traditional treatment and services centre the drug itself as the problem, and therefore commonly require abstinence or sobriety in order to access care. RSS challenges this practice by showing that harm is shaped by multiple components, many of which are structural. 

Hassan concludes, “When we understand RSS, we can begin to play with this triangle and address common outcomes. … We can rethink this model and apply it to intimate partner violence, police violence, self-injury, medication management, disability, chronic illness, houselessness, and more.” 

We can ask better questions: 

• What would make someone safer today?
• What would reduce harm in this setting?
• What stability might change the trajectory?

That doesn’t eliminate personal responsibility or agency. Rather, it locates it within reality.

And it does help us move from managing “high-risk behaviours” to reshaping high-risk environments.

From Individual Blame to Shared Environment
When we label behaviour as “high-risk” without examining the setting, we quietly absolve ourselves of responsibility for the conditions that produced it.

Importantly for our work, we can help (re)create those settings. 

Policies are part of setting. 
Shelter rules are part of setting. 
Even the stories we tell and the narratives we build are part of setting. 

And those settings shape outcomes. 
When we see through the RSS lens, the conversation shifts from individualism toward interconnectedness.
Because none of us operates outside of set and setting. We are all shaped by our histories. We are all navigating risk. We are all living within systems that either support or destabilize us.
The difference is that some people are navigating far harsher environments — often ones we collectively design or at least tolerate. And harsher environments predict harsher outcomes.

Disrupting Othering With ContextOne of the most powerful aspects of this framework is that it opens space for history and context, which is the kind of reframing the Frameworks Institute encourages communicators to use.

It allows us to say:

• The overdose crisis is not simply about individual irresponsibility; it is shaped by decades of policy decisions, criminalization, and an increasingly toxic supply.
• Encampments are not evidence of moral decline; they are evidence of structural scarcity.
• Relapse is not proof of bad character; it is often a predictable response to instability, trauma, and isolation.
  

When we zoom out, individual blame is harder to sustain. 

A Framework For Good
Risk, Set, and Setting is disruptive because it refuses simplistic explanations. It complicates the story in ways that demand we look at ourselves: at our policies, our budgets, and our narratives.

It reminds us that harm is not just a matter of willpower. It is shaped by environment.

If we want different outcomes, we cannot focus only on individual behaviour. We must reshape the settings we collectively create, including our narratives and shared understanding of homelessness and drug use.

We can continue policing “high-risk behaviours.”
Or we can redesign the conditions that make them high-risk in the first place.

The choice — collectively — is ours.