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Running Bear U, Poole EM, Muller C, Hanson JD, Noonan C, Trojan J, Rosenman R, Manson SM. The use of patient navigation to transition detoxification patients to substance use treatment in the Alaska Interior. PUBLIC HEALTH IN PRACTICE 2023; 6:100418. [PMID: 37635913 PMCID: PMC10448195 DOI: 10.1016/j.puhip.2023.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives Detoxification clinics manage acute intoxication and withdrawal from alcohol and other drugs. At discharge, patients are referred to treatment, yet many are readmitted to detoxification, creating a "revolving door" of discharges and admissions. This pattern disproportionately affects some groups such as Alaska Native and American Indian (AN/AI) people. The primary goals of this study are to: 1) test the effectiveness of a patient navigation intervention to increase rates of transition to alcohol treatment following detoxification, and 2) prevent readmission to detoxification within 12-months. The secondary goal is a cost-effectiveness and cost-benefit evaluation of patient navigation. Study design This randomized controlled comparative effectiveness trial plans to recruit 440 patients (∼70% AN/AI) admitted to alcohol detoxification. We collaborated with Fairbanks Native Association (FNA) to select an appropriate intervention, control condition, and other study-related decisions. Here, we describe intervention development, study design, challenges encountered during implementation, and collaborative processes to identify solutions. Methods Participants are equally randomized to the control (one motivational interviewing session) or intervention (one motivational interviewing session plus up to four weeks of patient navigation). The primary outcomes are successful transition to alcohol treatment within 30-days after discharge and detoxification readmission within 12-months. The secondary outcome is health-related quality of life. Conclusion Patient navigation is successful in other settings and for other health conditions. It may assist in overcoming barriers to successful transition to substance use treatment and may augment interventions, such as motivational interviewing, that are less resource-intensive but may not be optimally effective by themselves. ClinicalTrialsgov Identifier NCT03737864.
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Affiliation(s)
- Ursula Running Bear
- Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, 1301 North Columbia Rd., Grand Forks, ND, USA
| | - Erin M. Poole
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
| | - Clemma Muller
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Jessica D. Hanson
- Department of Applied Human Sciences, University of Minnesota Duluth, Duluth, MN, USA
| | - Carolyn Noonan
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | | | - Robert Rosenman
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
- School of Economic Sciences, Washington State University, Pullman, WA, USA
| | - Spero M. Manson
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
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Running Bear U, Hanson JD, Noonan C, Muller C, Trojan J, Manson SM. Factors associated with readmission to alcohol and opioid detoxification in the Alaska Interior. Am J Addict 2022; 31:406-414. [PMID: 35434885 PMCID: PMC9463080 DOI: 10.1111/ajad.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A "revolving door" of repeated admissions to detoxification treatment facilities has long plagued alcohol and drug use patients, yet few studies examine factors associated with readmission. This study examined risk factors for readmission to alcohol and opioid detoxification in a sample from the Alaska Interior. METHODS Data were extracted from electronic medical records for admissions between 2012 and 2016 at an inpatient detoxification facility in Fairbanks, Alaska. Data from 1014 patients admitted for alcohol detoxification and 267 patients admitted for opioid detoxification were analyzed. The analysis employed descriptive statistics for risk factors (substance use history, adverse life experiences, and psychosocial functioning) and prevalence of readmission to either alcohol or opioid detoxification. Inferential analyses used marginal standardization to calculate differences in readmission risk by patient characteristics. RESULTS Male, Alaska Native/American Indian, single-never married patients, and those seeking work were at higher risk for readmission to alcohol detoxification, while those with stable housing were at reduced risk. Being single-never married and completing detoxification treatment reduced readmission to opioid detoxification. Family involvement in detoxification reduced readmission risk for both alcohol and opioid patients. DISCUSSION AND CONCLUSIONS Further research that investigates the mechanism(s) by which family may act as a protective factor may be efficacious in eliminating the "revolving door" of detoxification. SCIENTIFIC SIGNIFICANCE This study is the first to examine both alcohol and opioid use risk and protective factors in the Alaska Interior. The results can be used in the development of interventions for subpopulations with high detoxification readmission rates.
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Affiliation(s)
- Ursula Running Bear
- Department of Population HealthUniversity of North DakotaGrand ForksNorth DakotaUSA
| | - Jessica D. Hanson
- Department of Applied Human SciencesUniversity of Minnesota DuluthDuluthMinnesotaUSA
| | - Carolyn Noonan
- Institute for Research and Education to Address Community HealthWashington State UniversitySeattleWashingtonUSA
| | - Clemma Muller
- Department of Medical Education and Clinical Science, Elson S. Floyd College of Medicine, Institute for Research and Education to Address Community HealthWashington State UniversitySeattleWashingtonUSA
| | | | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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Schreiter S, Fritz FD, Rössler W, Majić T, Schouler-Ocak M, Krausz MR, Bermpohl F, Gutwinski S. [Housing Situation Among People with Substance Use Disorder in a Psychiatric Centre in Berlin, Germany - A Cross-Sectional Patient Survey]. PSYCHIATRISCHE PRAXIS 2020; 48:156-160. [PMID: 33232977 DOI: 10.1055/a-1290-5091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the housing situation, service use and substance use among patients with substance use disorders seeking psychiatric treatment. METHODS Structured interview among 540 psychiatric inpatients including day clinics in a psychiatric centre in Berlin, Germany. RESULTS Patients under instable housing conditions were significantly more often diagnosed with a comorbid psychotic disorder and were significantly younger when first psychiatric or substance use treatment occurred, on average before onset of homelessness. CONCLUSION Homelessness among people with substance use disorder seeking psychiatric treatment is associated with disadvantageous treatment factors such as early age of psychiatric treatment and comorbid psychotic disorders. Therefore, addressing social difficulties especially after inpatient treatment and close cooperation between different care providers should be of high importance among these groups.
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Affiliation(s)
- Stefanie Schreiter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Francesco Domenico Fritz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Wulf Rössler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany.,Universität Zürich, Klinik für Psychiatrie und Psychotherapie, Zürich, Schweiz
| | - Tomislav Majić
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany.,Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Deutschland
| | - Meryam Schouler-Ocak
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany.,Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Deutschland
| | - Michael R Krausz
- Institute of Mental Health and Department of Psychiatry, University of British Columbia (UBC), Vancouver, Canada
| | - Felix Bermpohl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany.,Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Deutschland
| | - Stefan Gutwinski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Berlin, Germany.,Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Deutschland
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4
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Bear UR, Beals J, Novins DK, Manson SM. Gender differences among Alaska Native people seeking alcohol withdrawal treatment. Subst Abus 2016; 37:372-8. [PMID: 26731436 PMCID: PMC4906790 DOI: 10.1080/08897077.2015.1133473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Few studies focus on gender differences among patients who utilize detoxification services; even fewer focus on detoxification for Alaska Native people. This analysis focused on gender differences at admission among a sample of Alaska Native patients seeking alcohol withdrawal treatment. METHODS The sample included 383 adult Alaska Native patients admitted to an inpatient alcohol detoxification unit during 2006 and 2007. Logistic regression was used to estimate unadjusted and adjusted associations with gender. RESULTS Women were 88% more likely to have stable housing than men (odds ratio [OR] = 1.88, 95% confidence interval [CI] = 1.15, 3.05, P = .01). Women were 87% less likely to be seasonal workers (OR = 0.13, 95% CI = 0.03, 0.48, P = .003) and 50% less likely than men to be seeking employment (OR = 0.50, 95% CI = 0.29, 0.84, P = .01) at admission. Women had more than 5 times the odds of having children in the home at admission (OR = 5.64, 95% CI = 3.03, 10.56, P < .001) and almost 3 times the odds of experiencing physical abuse than men (OR = 2.96, 95% CI = 1.31, 6.66, P = .01). Additionally, women were 50% less likely to accept a referral to substance abuse treatment following detoxification (OR = 0.50, 95% CI = 0.30, 0.83, P = .01). CONCLUSIONS The study found significant differences based upon gender. For instance, women are in need of services that accommodate women with children and services that address histories of physical abuse. Conversely, men are in need of housing and employment opportunities. Post detoxification follow-up, case management, and transition to care should include gender as a factor in treatment planning.
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Affiliation(s)
- Ursula Running Bear
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Janette Beals
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Douglas K. Novins
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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5
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Collins SE, Duncan MH, Smart BF, Saxon AJ, Malone DK, Jackson TR, Ries RK. Extended-Release Naltrexone and Harm Reduction Counseling for Chronically Homeless People With Alcohol Dependence. Subst Abus 2015; 36:21-33. [DOI: 10.1080/08897077.2014.904838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Running Bear U, Anderson H, Manson SM, Shore JH, Prochazka AV, Novins DK. Impact of adaptive functioning on readmission to alcohol detoxification among Alaska Native People. Drug Alcohol Depend 2014; 140:168-74. [PMID: 24837583 PMCID: PMC4137759 DOI: 10.1016/j.drugalcdep.2014.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 04/16/2014] [Accepted: 04/16/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study examined predictors associated with readmission to detoxification in a sample of adult Alaska Native patients admitted to inpatient alcohol detoxification. Even though Alaska Native people diagnosed with alcoholism have been identified as frequent utilizers of the health care system and at elevated risk of death, little is known about factors associated with readmission to detoxification for this group. METHODS We sought to predict readmission using a retrospective cohort study. The sample included 383 adult Alaska Native patients admitted to an inpatient detoxification unit and diagnosed with alcohol withdrawal during 2006 and 2007. Cox proportional hazard modeling was used to estimate unadjusted and adjusted associations with time to readmission within one year. RESULTS Forty-two percent of the patients were readmitted within one year. Global Assessment Functioning (GAF; Axis V in the multi-axial diagnostic system of the Diagnostic and Statistical Manual of Mental Disorders [DSM IV]) score measured at the time of intake was associated with readmission. A one point increase in the GAF score (HR=.96, 95% CL=.94, .99, P=.002) was associated with a four percent decrease in readmission. The results also indicated that the GAF mediated the relationship between readmission and: employment and housing status. CONCLUSIONS The GAF measures both illness severity and adaptive functioning, is part of standard behavioral health assessments, and is easy to score. Readmission rates potentially could be decreased by creating clinical protocols that account for differences in adaptive functioning and illness severity during detoxification treatment and aftercare.
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Affiliation(s)
- Ursula Running Bear
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, 13055 East 17th Avenue, Aurora, CO 80045, United States of America.
| | - Heather Anderson
- University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Clinical Pharmacy, 12850 E. Montview Blvd, Mail Stop C238, Aurora, CO 80045, United States of America
| | - Spero M Manson
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, 13055 East 17th Avenue, Aurora, CO 80045, United States of America
| | - Jay H Shore
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, 13055 East 17th Avenue, Aurora, CO 80045, United States of America; University of Colorado Anschutz Medical Campus, Department of Psychiatry, 13055 East 17th Avenue, Aurora, CO 80045, United States of America
| | - Allan V Prochazka
- University of Colorado Anschutz Medical Campus, Department of Medicine, Academic Office One, 12631 E. 17th Avenue, Aurora, CO 80045, United States of America; Ambulatory Care 11B, Denver VA Medical Center, 1055 Clermont, Denver, CO 80220, United States of America
| | - Douglas K Novins
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, 13055 East 17th Avenue, Aurora, CO 80045, United States of America; University of Colorado Anschutz Medical Campus, Department of Psychiatry, 13055 East 17th Avenue, Aurora, CO 80045, United States of America
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7
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Jason LA, Light JM, Stevens EB, Beers K. Dynamic social networks in recovery homes. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2014; 53:324-34. [PMID: 24217855 PMCID: PMC4013246 DOI: 10.1007/s10464-013-9610-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Acute treatment aftercare in the form of sober living environments-i.e., recovery houses-provide an inexpensive and effective medium-term treatment alternative for many with substance use disorders. Limited evidence suggests that house-situated social relationships and associated social support are critical determinants of how successful these residential experiences are for their members, but little is known about the mechanisms underlying these relationships. This study explored the feasibility of using dynamic social network modeling to understand house-situated longitudinal associations among individual Alcoholics Anonymous related recovery behaviors, length of residence, dyadic interpersonal trust, and dyadic confidant relationship formation processes. Trust and confidant relationships were measured 3 months apart in U.S. urban-area recovery houses, all of which were part of a network of substance use recovery homes. A stochastic actor-based model was successfully estimated from this data set. Results suggest that confidant relationships are predicted by trust, while trust is affected by recovery behaviors and length of residence. Conceptualizing recovery houses as a set of independent, evolving social networks that can be modeled jointly appears to be a promising direction for research.
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Affiliation(s)
- Leonard A Jason
- Center for Community Research, DePaul University, Chicago, IL, 60614, USA,
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Svoboda T. Predictors of Frequent Withdrawal Management Unit Use among Chronically Homeless, Homeless, and Housed Men: A Retrospective Cohort Study. Am J Addict 2013; 22:226-32. [DOI: 10.1111/j.1521-0391.2012.12039.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 10/24/2011] [Accepted: 02/21/2012] [Indexed: 11/28/2022] Open
Affiliation(s)
- Tomislav Svoboda
- Department of Family and Community Medicine; Center for Research on Inner-City Health, Keenan Research Centre, St. Michael's Hospital, University of Toronto; Toronto, Ontario; Canada
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Collins SE, Clifasefi SL, Andrasik MP, Dana EA, Stahl N, Kirouac M, Welbaum C, King M, Malone DK. Exploring transitions within a project-based Housing First setting: qualitative evaluation and practice implications. J Health Care Poor Underserved 2012; 23:1678-97. [PMID: 23698682 PMCID: PMC3726311 DOI: 10.1353/hpu.2012.0187] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Housing First (HF) approach is a model of housing that entails the provision of immediate, permanent, low-barrier, supportive housing to chronically homeless individuals either in separate apartments within a larger community (known as scattered-site HF) or in a single building (known as project-based HF). One recent innovation is the application of project-based HF with chronically homeless individuals with alcohol problems. Although initial studies have shown its effectiveness, there is currently no research on residents' and staff 's experiences living and working in a project-based HF program. The purpose of this article was to document these experiences and highlight strengths and challenges of project-based HF programs. Using data collected from naturalistic observations, agency documentation, one-on-one resident interviews, and a staff focus group, we delineated transitional periods, including moving into project-based HF, community-building, managing day-to-day, and transitions from project-based HF. Findings are interpreted to help health care policymakers and providers envision the role of project-based HF in comprehensive public health efforts and to integrate lessons learned into their own clinical practice.
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Affiliation(s)
- Susan E Collins
- University of Washington, Harborview, CHAMMP, 325 Ninth Avenue, Box 359911, Seattle, WA 98104, USA.
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Collins SE, Clifasefi SL, Dana EA, Andrasik MP, Stahl N, Kirouac M, Welbaum C, King M, Malone DK. Where harm reduction meets housing first: exploring alcohol's role in a project-based housing first setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:111-9. [PMID: 21852096 PMCID: PMC3726334 DOI: 10.1016/j.drugpo.2011.07.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/07/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Housing first (HF) programmes provide low-barrier, nonabstinence-based, immediate, supportive and permanent housing to chronically homeless people who often have co-occurring substance-use and/or psychiatric disorders. Project-based HF programmes offer housing in the form of individual units within a larger housing project. Recent studies conducted at a specific project-based HF programme that serves chronically homeless individuals with alcohol problems found housing provision was associated with reduced publicly funded service utilisation, decreased alcohol use, and sizable cost offsets. No studies to date, however, have qualitatively explored the role of alcohol use in the lives of residents in project-based HF. METHODS We collected data in a project-based HF setting via naturalistic observation of verbal exchanges between staff and residents, field notes taken during staff rounds, and audio recorded staff focus groups and resident interview sessions. Qualitative data were managed and coded using a constant comparative process consistent with grounded theory methodology. The goal of the analysis was to generate a conceptual/thematic description of alcohol's role in residents' lives. RESULTS Findings suggest it is important to take into account residents' motivations for alcohol use, which may include perceived positive and negative consequences. Further, a harm reduction approach was reported to facilitate housing attainment and maintenance. Residents and staff reported that traditional, abstinence-based approaches are neither desirable nor effective for this specific population. Finally, elements of the moral model of alcohol dependence continue to pervade both residents' views of themselves and the community's perceptions of them. CONCLUSIONS Findings suggest it is necessary to set aside traditional models of alcohol use and approaches to better understand, align with, and address this population's needs. In doing so, we might gain further insights into how to enhance the existing project-based HF approach by applying more tailored, alcohol-specific, harm reduction interventions.
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Abstract
One of the largest examples of a community-based, mutual-help residential community for high risk substance abuse individuals is Oxford House. In the U.S., over 9,800 people live in these self-run dwellings where they obtain jobs, pay utility bills, and learn to be responsible citizens. Beginning with one single rented residence in the mid 1970s, Oxford Houses now number over 1,300. These rented homes are helping to deal with drug addiction and community re-entry by providing stable housing without any limits on length of stay, a network of job opportunities, and support for abstinence. An exploration of the research on these unique settings highlights the strengths of such a community-based approach to addressing addiction. New roles for psychologists in working with these types of support systems are identified.
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Podymow T, Turnbull J, Coyle D, Yetisir E, Wells G. Shelter-based managed alcohol administration to chronically homeless people addicted to alcohol. CMAJ 2006; 174:45-9. [PMID: 16389236 PMCID: PMC1319345 DOI: 10.1503/cmaj.1041350] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND People who are homeless and chronically alcoholic have increased health problems, use of emergency services and police contact, with a low likelihood of rehabilitation. Harm reduction is a policy to decrease the adverse consequences of substance use without requiring abstinence. The shelter-based Managed Alcohol Project (MAP) was created to deliver health care to homeless adults with alcoholism and to minimize harm; its effect upon consumption of alcohol and use of crisis services is described as proof of principle. METHODS Subjects enrolled in MAP were dispensed alcohol on an hourly basis. Hospital charts were reviewed for all emergency department (ED) visits and admissions during the 3 years before and up to 2 years after program enrollment, and the police database was accessed for all encounters during the same periods. The results of blood tests were analyzed for trends. A questionnaire was administered to MAP participants and staff about alcohol use, health and activities of daily living before and during the program. Direct program costs were also recorded. RESULTS Seventeen adults with an average age of 51 years and a mean duration of alcoholism of 35 years were enrolled in MAP for an average of 16 months. Their monthly mean group total of ED visits decreased from 13.5 to 8 (p = 0.004); police encounters, from 18.1 to 8.8 (p = 0.018). Changes in blood test findings were nonsignificant. All program participants reported less alcohol consumption during MAP, and subjects and staff alike reported improved hygiene, compliance with medical care and health. INTERPRETATION A managed alcohol program for homeless people with chronic alcoholism can stabilize alcohol intake and significantly decrease ED visits and police encounters.
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Affiliation(s)
- Tiina Podymow
- Inner City Health Project, University of Ottawa, and the Department of Medicine, Ottawa Hospital, Ottawa, Ont.
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Jason LA, Davis MI, Ferrari JR, Bishop PD. Oxford house: a review of research and implications for substance abuse recovery and community research. JOURNAL OF DRUG EDUCATION 2001; 31:1-27. [PMID: 11338963 DOI: 10.2190/tmnp-m3cc-bupn-9ee6] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
After treatment for substance abuse, whether it is in hospital-based treatment programs, therapeutic communities, or recovery homes, many patients return to former high-risk environments or stressful family situations. Returning to these settings without a network of people to support abstinence increases chances of a relapse. As a consequence, substance abuse recidivism following treatment is high for both men and women. Alternative approaches need to be explored, and there are some promising types of recovery homes. From a public health perspective, a series of studies conducted at DePaul University suggests that one type of recovery home for alcohol abuse recovery has much potential. For example, within this self-help communal living setting, recovering alcoholics were able to maintain employment, thereby reducing their need for government subsidies. Maintaining employment for recovering alcoholics may promote increased personal responsibility, which may impact self-efficacy beliefs. These pilot studies, then, raised both theoretical and practical issues needing further evaluation.
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Affiliation(s)
- L A Jason
- Department of Psychology DePaul University 2219 N. Kenmore Ave. Chicago, IL 60614
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Hayashida M, Alterman AI, McLellan AT, O'Brien CP, Purtill JJ, Volpicelli JR, Raphaelson AH, Hall CP. Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome. N Engl J Med 1989; 320:358-65. [PMID: 2913493 DOI: 10.1056/nejm198902093200605] [Citation(s) in RCA: 119] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We compared the effectiveness, safety, and costs of outpatient (n = 87) and inpatient (n = 77) detoxification from alcohol in a randomized, prospective trial involving 164 male veterans of low socioeconomic status. The outpatients were evaluated medically and psychiatrically and then were prescribed decreasing doses of oxazepam on the basis of daily clinic visits. The inpatient program combined comprehensive psychiatric and medical evaluation, detoxification with oxazepam, and the initiation of rehabilitation treatment. The mean duration of treatment was significantly shorter for outpatients (6.5 days) than for inpatients (9.2 days). On the other hand, significantly more inpatients (95 percent) than outpatient (72 percent) completed detoxification. There were no serious medical complications in either group. Outcome evaluations completed at one and six months for 93 and 85 percent of the patients, respectively, showed substantial improvement in both groups at both follow-up periods. At one month there were fewer alcohol-related problems among inpatients and fewer medical problems among outpatients. However, no group differences were found at the six-month follow-up, nor were differences found in the subsequent use of other alcoholism-treatment services. Costs were substantially greater for inpatients ($3,319 to $3,665 per patient) than for outpatients ($175 to $388). We conclude that outpatient medical detoxification is an effective, safe, and low-cost treatment for patients with mid-to-moderate symptoms of alcohol withdrawal.
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Affiliation(s)
- M Hayashida
- Veterans Administration Medical Center, Philadelphia, PA 19104
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