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Alawadhi YT, Shinagawa E, Taylor EM, Jackson C, Fragasso A, Howard M, Fan L, Kolpikova E, Karra S, Frohe T, Clifasefi SL, Duncan MH, Collins SE. Safer-use strategies in the context of harm-reduction treatment for people experiencing homelessness and alcohol use disorder. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 129:104448. [PMID: 38905941 DOI: 10.1016/j.drugpo.2024.104448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Two, randomized controlled trials found harm-reduction treatment for AUD (HaRT-A) improves alcohol outcomes for adults experiencing homelessness. HaRT-A, which neither requires nor precludes abstinence, entails tracking alcohol-related harm, harm-reduction goals, and safer-use strategies. This secondary dual study qualitatively describes this last component, safer-use strategies, and their quantitative association with treatment outcomes. METHODS Participants were people who experienced homelessness and AUD and were enrolled in the active HaRT-A treatment arms in 2 randomized control trials (Trial 1 N = 86; Trial 2 N = 208). Trial 1was a 2-arm study with randomization to HaRT-A or services as usual. Trial 2 was a 4-arm study combining HaRT-A and extended release naltrexone. In HaRT-A sessions, participants received a list of 3 categories of safer-use strategies (i.e., buffering alcohol's effects on the body, changing the manner of drinking to be safer and healthier, and reducing alcohol use). Mixed methods were used to qualitatively describe safer-use strategies implemented and quantitatively test their association with alcohol outcomes (i.e., peak quantity, frequency, alcohol-related harm). RESULTS In Trial 1, but not Trial 2, participants committed to more safer-use strategies across time, which was associated with reductions in alcohol frequency over the past 30 days. In both trials, participants committing to reducing alcohol consumption drank on a quarter fewer days overall, and in Trial 2, experienced 15 % less alcohol-related harm. In Trial 1, participants who committed to changing the manner of drinking were heavier drinkers overall, and although they showed significant reductions in alcohol-related harm, their reduction rate was slower than for participants who selected other strategies. In Trial 2, strategies to buffer alcohol's effects were associated with a monthly 14 % decrease of alcohol-related harm. CONCLUSION This study replicated prior findings that people experiencing homelessness and AUD regularly adopt strategies to reduce alcohol-related harm. The implementation of safer-use strategies was favorably associated with alcohol outcomes, but specific associations differed by trial and outcome. Discussion of safer-use strategies appears helpful; however, further research is needed to firmly establish how this HaRT-A component works.
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Affiliation(s)
| | - Emma Shinagawa
- University of Washington, Seattle, WA, USA; Washington State University, Pullman, WA, USA.
| | | | | | | | | | - Liying Fan
- University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Susan E Collins
- University of Washington, Seattle, WA, USA; Washington State University, Pullman, WA, USA
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Sussman S, Sinclair DL, Clifasefi SL, Collins SE. Commentary: Similarities and Differences Between Harm-Reduction and Substitute Addiction-- Implications for the Health Professions. Eval Health Prof 2024; 47:75-80. [PMID: 38247290 DOI: 10.1177/01632787241227225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
"Substitute addiction" refers to the process of achieving abstinence or resolution of one addictive behavior and subsequently engaging in one or more additional addictive behaviors in its place. Substitute addiction, a concept in the abstinence-based recovery field for decades, is viewed as a cause for concern because resolving one addictive behavior might not fully remove harm or ensure recovery. Conversely, "harm-reduction treatment" refers to a counseling orientation that focuses on helping service users reduce substance-related harm and improve their quality of life without necessarily requiring abstinence or use reduction. Harm-reduction treatment assesses a constellation of addictive behaviors in the larger context of a person's life to holistically reduce harm in that constellation. In this commentary, we define and compare both constructs and point out their implications for addictions treatment.
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Marvin AF, Buckingham SL. "It's time for a change. I need to. I have to": Substance misuse recovery turning points of unhoused Alaskans. J Prev Interv Community 2024; 52:35-53. [PMID: 38622963 DOI: 10.1080/10852352.2024.2332124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Substance misuse is a pernicious health concern for many unhoused people. A deep understanding of turning points - what propels someone to take concrete action toward addressing substance misuse - is needed to inform recovery policies and practices. This study sought to identify common elements in turning points among unhoused people vis-à-vis a phenomenological qualitative approach. Twenty people (Mage = 47.47, SD = 9.75; 50% female) who self-identified as being in recovery while unhoused participated in semi-structured interviews in Anchorage, Alaska, a community with high rates of both houselessness and substance misuse. Survival (life- and health-sustaining), individual (intrapersonal), and relational (interpersonal) motivations all shaped turning points. Limitations include the possible underrepresentation of individuals using a harm-reduction approach or capturing differences by housing type. Programs to address substance misuse should consider these motivations. Future research should identify and refine turning points and work to understand how they interact with change processes.
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Wolfe DM, Hutton B, Corace K, Chaiyakunapruk N, Ngorsuraches S, Nochaiwong S, Presseau J, Grant A, Dowson M, Palumbo A, Suschinsky K, Skidmore B, Bartram M, Garner G, DiGioacchino L, Pump A, Peters B, Konefal S, Eves AP, Thavorn K. Service-level barriers to and facilitators of accessibility to treatment for problematic alcohol use: a scoping review. Front Public Health 2023; 11:1296239. [PMID: 38106884 PMCID: PMC10722420 DOI: 10.3389/fpubh.2023.1296239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Services to treat problematic alcohol use (PAU) should be highly accessible to optimize treatment engagement. We conducted a scoping review to map characteristics of services for the treatment of PAU that have been reported in the literature to be barriers to or facilitators of access to treatment from the perspective of individuals with PAU. Methods A protocol was developed a priori, registered, and published. We searched MEDLINE®, Embase, the Cochrane Library, and additional grey literature sources from 2010 to April 2022 to identify primary qualitative research and surveys of adults with current or past PAU requiring treatment that were designed to identify modifiable characteristics of PAU treatment services (including psychosocial and pharmacologic interventions) that were perceived to be barriers to or facilitators of access to treatment. Studies of concurrent PAU and other substance use disorders were excluded. Study selection was performed by multiple review team members. Emergent barriers were coded and mapped to the accessibility dimensions of the Levesque framework of healthcare access, then descriptively summarized. Results One-hundred-and-nine included studies reported an extensive array of unique service-level barriers that could act alone or together to prevent treatment accessibility. These included but were not limited to lack of an obvious entry point, complexity of the care pathway, high financial cost, unacceptably long wait times, lack of geographically accessible treatment, inconvenient appointment hours, poor cultural/demographic sensitivity, lack of anonymity/privacy, lack of services to treat concurrent PAU and mental health problems. Discussion Barriers generally aligned with recent reviews of the substance use disorder literature. Ranking of barriers may be explored in a future discrete choice experiment of PAU service users. The rich qualitative findings of this review may support the design of new or modification of existing services for people with PAU to improve accessibility. Systematic Review Registration Open Science Framework doi: 10.17605/OSF.IO/S849R.
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Affiliation(s)
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kim Corace
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, ON, Canada
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
- Informatics, Decision Enhancement, and Analytics Sciences (IDEAS) Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | | | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Alyssa Grant
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Kelly Suschinsky
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | | | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, ON, Canada
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
| | - Gordon Garner
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | | | - Andrew Pump
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | - Brianne Peters
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | - Sarah Konefal
- Canadian Centre on Substance Use and Addiction, Ottawa, ON, Canada
| | - Amy Porath Eves
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Pharmaceutical Care, Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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Carmichael C, Schiffler T, Smith L, Moudatsou M, Tabaki I, Doñate-Martínez A, Alhambra-Borrás T, Kouvari M, Karnaki P, Gil-Salmeron A, Grabovac I. Barriers and facilitators to health care access for people experiencing homelessness in four European countries: an exploratory qualitative study. Int J Equity Health 2023; 22:206. [PMID: 37803317 PMCID: PMC10559410 DOI: 10.1186/s12939-023-02011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 09/12/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context. METHODS We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically. RESULTS Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers. CONCLUSIONS The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care. TRIAL REGISTRATION This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687.
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Affiliation(s)
- Christina Carmichael
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, East Rd, Cambridge, CB1 1PT, UK
- School of Psychology, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Tobias Schiffler
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria.
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, East Rd, Cambridge, CB1 1PT, UK
| | - Maria Moudatsou
- PRAKSIS - Programs of Development, Social Support and Medical Cooperation, Stournari 57, Athens, 104 32, Greece
| | - Ioanna Tabaki
- PRAKSIS - Programs of Development, Social Support and Medical Cooperation, Stournari 57, Athens, 104 32, Greece
| | - Ascensión Doñate-Martínez
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, Valencia, 46022, Spain
| | - Tamara Alhambra-Borrás
- Polibienestar Research Institute, University of Valencia, Carrer del Serpis, 29, Valencia, 46022, Spain
| | - Matina Kouvari
- Environmental and Occupational Health, PROLEPSIS - Institute of Preventive Medicine, Fragoklisias street 7, Athens, 151 25, Greece
| | - Pania Karnaki
- Environmental and Occupational Health, PROLEPSIS - Institute of Preventive Medicine, Fragoklisias street 7, Athens, 151 25, Greece
| | - Alejandro Gil-Salmeron
- International Foundation for Integrated Care, Linton Road, Oxford, OX2 6UD, UK
- International University of Valencia, Calle del Pintor Sorolla, 21, Valencia, 46002, Spain
| | - Igor Grabovac
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Kinderspitalgasse 15, Vienna, 1090, Austria
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Mostofi N, Collins SE. Impact of Harm Reduction Treatment with or without Pharmacotherapy on Polysubstance Use among People Experiencing Homelessness and Alcohol Use Disorder. J Addict Med 2023; 17:574-579. [PMID: 37788612 PMCID: PMC10593979 DOI: 10.1097/adm.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES A prior randomized controlled trial showed behavioral harm reduction treatment for alcohol use disorder (AUD), or HaRT-A, was effective in improving alcohol outcomes and quality of life for people experiencing homelessness and AUD when provided with or without pharmacotherapy (ie, extended-release naltrexone). Because nearly 80% of the sample also reported baseline polysubstance use, this secondary study tested whether HaRT-A also positively impacted other substance use. METHODS In the parent study, 308 adults with AUD and homelessness were randomized to receive HaRT-A plus intramuscular injections of 380-mg extended-release naltrexone (HaRT-A + extended-release naltrexone), HaRT-A plus placebo (HaRT-A + placebo), HaRT-A alone, or community-based services as usual (control). In this secondary study, we used random intercept models to detect changes in other substance use after exposure to any of the HaRT-A conditions. For less prevalent behaviors, outcomes included past-month use (cocaine, amphetamines/methamphetamines, opioids). For more prevalent behaviors (polysubstance, cannabis), outcomes were past-month use frequency. RESULTS Compared with controls, participants who received HaRT-A showed significantly reduced 30-day frequency of cannabis use (incident rate ratio = 0.59, 95% CI = 0.40-0.86, P = 0.006) and polysubstance use (incident rate ratio = 0.65, 95% CI = 0.43-0.98, P = 0.040). No other significant changes were detected. CONCLUSIONS Compared with services as usual, HaRT-A is associated with reduced cannabis and polysubstance use frequency. The benefits of HaRT-A may thus extend beyond its impact on alcohol and quality of life outcomes to positively reshape overall substance use patterns. A randomized controlled trial is needed to further investigate the efficacy of such combined pharmacobehavioral harm reduction treatment for polysubstance use.
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Affiliation(s)
| | - Susan E. Collins
- University of Washington School of Medicine
- Department of Psychology, Washington State University
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Azevedo FO, Neto A, Gama A, Subtil A, Fuertes R, Pereira C, Tavares J, Medinas RL, Silva AV, Dias S. Problemas ligados ao álcool em centros de emergência (PLACE)-People experiencing homelessness with alcohol-related problems in Lisbon's emergency shelters during the COVID-19 pandemic: a description and analysis of a harm reduction intervention. Front Psychol 2023; 14:1165322. [PMID: 37275696 PMCID: PMC10236796 DOI: 10.3389/fpsyg.2023.1165322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/10/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Alcohol-related problems disproportionally affect people experiencing homelessness. As the first wave of the COVID-2019 pandemic spread in 2020, a number of emergency shelters were opened in Lisbon. Increased difficulties in obtaining alcohol could have led to an increased incidence of alcohol withdrawal. Therefore, a low-threshold harm reduction intervention was introduced to these emergency shelters. This consisted of a fixed medication treatment, made available immediately for those with specific conditions, without the need for a medical evaluation or abstinence from alcohol, together with an offer of subsequent access to specialized addiction centers. The Problemas Ligados ao Álcool em Centros de Emergência (PLACE) study (alcohol-related problems in emergency shelters) is a retrospective mixed-methods observational study. It describes the demographic, health, and social characteristics of shelter users participating in the program and aims to evaluate the intervention as well as the experience of the patients, professionals, and decision-makers involved. Results A total of 69 people using shelters self-reported alcohol-related problems. Among them, 36.2% of the people accepted a pharmacological intervention, and 23.2% selected an addiction appointment. The take-up of the intervention was associated with better housing outcomes. A description of an individual's trajectory after leaving the shelter is provided. Discussion This study suggests that non-abstinence-focused interventions can be useful and well-tolerated in treating addiction in this population.
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Affiliation(s)
- Filipe Oliveira Azevedo
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Neto
- Unidade de Alcoologia de Lisboa, Divisão para a Intervenção em Comportamentos Aditivos e Dependências, Associação Regional de Saúde, Instituto Público, Lisbon, Portugal
| | - Ana Gama
- Nova Escola Nacional de Saúde Pública, Public Health Research Centre, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Subtil
- Nova Escola Nacional de Saúde Pública, Public Health Research Centre, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | | | - Raquel Luis Medinas
- Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana V. Silva
- Unidade de Alcoologia de Lisboa, Divisão para a Intervenção em Comportamentos Aditivos e Dependências, Associação Regional de Saúde, Instituto Público, Lisbon, Portugal
| | - Sónia Dias
- Nova Escola Nacional de Saúde Pública, Public Health Research Centre, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
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Marzana D, Martinez‐Damia S, Gaboardi M, Scollato A, Marta E. “The group gives me strength”: A group‐based intervention to promote trust and social connectedness among women experiencing homelessness. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2023. [DOI: 10.1002/casp.2683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Daniela Marzana
- Department of Psychology Università Cattolica del Sacro Cuore Milan Italy
| | | | - Marta Gaboardi
- Department of Developmental and Social Psychology University of Padova Padua Italy
| | | | - Elena Marta
- Department of Psychology Università Cattolica del Sacro Cuore Milan Italy
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Moghanibashi-Mansourieh A, Puyan D, Radfar R, Jafarian M, Legl T, Mattsson R, Hornberg E, Atefi F, Neuretter I, de Witte C, Farnam R, Binazade M, Deilamizade A. Challenges and Prescriptions for Homeless Drug Users’ Social Reintegration; An Experience of Partnerships Between Iran and Europe NGOs. JOURNAL OF DRUG ISSUES 2023. [DOI: 10.1177/00220426231151372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The research addressed challenges and prescriptions for reintegration of homeless people who use drugs. Data were collected through conducting semi-structured interviews. Twenty-nine participants were recruited. The primary codes were extracted and divided into two main categories of challenges and prescriptions; the former included becoming homeless after a long term recovery, workplace stigma, service users’ different cultural backgrounds, dismissing the 12-Step Program, message fatigue, negative effect of relapse on groups and cyberspace overuse; and the latter included connection by hook or by crook, abstinence-harm reduction orientation, organizational service collection, pushing boundaries of interventions, and expanding services umbrella.
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Affiliation(s)
- Amir Moghanibashi-Mansourieh
- Social Work Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Rebirth Charity Society NGO, Tehran, Iran
| | | | - Ramin Radfar
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Thomas Legl
- European Treatment Centers for Drug Addiction, Vienna, Austria
- Therapiesalon im Wald, Vienna, Austria
| | | | | | | | - Iris Neuretter
- European Treatment Centers for Drug Addiction, Vienna, Austria
| | | | - Rabert Farnam
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
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Ward R, Roderique-Davies G, Hughes H, Heirene R, Newstead S, John B. Alcohol-related brain damage: A mixed-method evaluation of an online awareness-raising programme for frontline care and support practitioners. Drug Alcohol Rev 2023; 42:46-58. [PMID: 36097437 PMCID: PMC10087889 DOI: 10.1111/dar.13545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Alcohol-related brain damage (ARBD) is an umbrella term referring to the neurocognitive impairments caused by excessive and prolonged alcohol use and the associated nutritional deficiencies. This study evaluated the outcomes of an online research-informed training program for ARBD which aimed to improve client outcomes by promoting support staff's awareness and confidence in working with clients who may have (or who are at risk of developing) the condition. METHODS Staff working within a large non-governmental non-profit housing organisation (n = 883) enrolled in the training program. Questionnaires were used pre- and post-training to collect self-reported awareness of ARBD and confidence in supporting individuals with the condition. Semi-structured interviews were conducted with 27 staff members approximately 10 weeks post-completion of the program. Interviews were audio-recorded, transcribed verbatim and analysed by employing qualitative content analysis. RESULTS Findings from the questionnaires indicated a significant increase in all measures after completing the training program. Three main themes were developed based on the interview data: changes to awareness and understanding; professional practice; and training-specific characteristics. Participants reported changes in their ability to identify potential service users with ARBD and confidence in doing so. DISCUSSION AND CONCLUSION Our findings demonstrate that online training programs can be effective in improving support staff's ability to identify ARBD, potentially leading an increase in signposting service users to relevant services. The research-informed nature of the training demonstrates that translating research findings directly to frontline workers can have a substantial impact and may improve outcomes for this client group.
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Affiliation(s)
- Rebecca Ward
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.,Department of Psychology, Swansea University, Swansea, UK
| | | | - Harriet Hughes
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Robert Heirene
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.,College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
| | - Simon Newstead
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Bev John
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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Nelson LA, Collins SE, Birch J, Burns R, McPhail G, Onih J, Cupp C, Ubay T, King V, Taylor E, Masciel K, Slaney T, Bunch J, King R, Mahinalani-Garza C, Piper BKS, Squetimkin-Anquoe A. Content Analysis of Preferred Recovery Pathways Among Urban American Indians and Alaska Natives Experiencing Alcohol Use Disorders. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2022. [DOI: 10.1177/00220221221132778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approximately three fourths of the American Indian and Alaska Native (AI/AN) population lives in urban areas, and urban AI/ANs are disproportionately affected by alcohol-related morbidity and mortality. Although no studies have documented alcohol use disorder (AUD) treatment outcomes specific to urban AI/ANs, studies in other Native communities highlight concerns about the cultural acceptability of directive, abstinence-based approaches, such as cognitive behavioral therapy and 12-step programs. Understanding this population’s desired recovery pathways in their own words may help providers create more culturally appropriate, patient-centered, and effective approaches. Participants ( N = 31) were urban AI/ANs who screened positive for AUD using the AUDIT-C. They participated in semi-structured interviews eliciting their experiences in AUD treatment to date and suggestions for redesigning AUD treatment in their own vision. Conventional content analysis was used to create a thematic description. Findings indicated that intrinsic motivation and not extrinsic pressure (e.g., mandated treatment) was associated with positive treatment engagement and outcomes. Participants appreciated feeling safe and supported in AUD treatment, but also felt AUD treatment could be institutional and oppressive. Participants preferred compassionate counselors with lived experience who could provide insights into recovery; they largely did not appreciate a “tough love” approach or power struggles with counselors. Native-led treatment centers providing access to cultural practices were preferred. Moving forward, participants suggested AUD treatment providers should help patients meet basic needs, prioritize patient-driven versus provider-driven goal-setting, support patients’ reconnection with meaningful activities, facilitate access to a supportive community network, and recognize cultural activities as important recovery pathways.
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Affiliation(s)
| | - Susan E. Collins
- Washington State University, Spokane, USA
- University of Washington School of Medicine, Seattle, USA
| | | | | | | | | | | | | | | | - Emily Taylor
- University of Washington School of Medicine, Seattle, USA
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Matheson C, Foster R, Schofield J, Browne T. Long-acting depot buprenorphine in people who are homeless: Views and experiences. J Subst Abuse Treat 2022; 139:108781. [DOI: 10.1016/j.jsat.2022.108781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/13/2022] [Accepted: 04/05/2022] [Indexed: 12/18/2022]
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Adolphe A, Quinlan E, Calvert F. Examining the Experiences of and Perceived Treatment Needs for Social Anxiety and Substance Use Among Homeless Men. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Parkes T, Matheson C, Carver H, Foster R, Budd J, Liddell D, Wallace J, Pauly B, Fotopoulou M, Burley A, Anderson I, Price T, Schofield J, MacLennan G. Assessing the feasibility, acceptability and accessibility of a peer-delivered intervention to reduce harm and improve the well-being of people who experience homelessness with problem substance use: the SHARPS study. Harm Reduct J 2022; 19:10. [PMID: 35120539 PMCID: PMC8815224 DOI: 10.1186/s12954-021-00582-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 12/07/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND For people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that the development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise, but the evidence base is still developing. METHODS The study used mixed methods to assess the feasibility, acceptability and accessibility of a peer-delivered, relational intervention to reduce harms and improve health/well-being, quality of life and social functioning, for people experiencing homelessness and problem substance use. Four Peer Navigators were employed to support individuals (n = 68 total, intervention participants). They were based in outreach services and hostels in Scotland and England. Qualitative interviews were conducted with intervention participants, Peer Navigators and staff in services, and observations were conducted in all settings. Quantitative outcomes relating to participants' substance use, physical and mental health, and quality of the Peer Navigator relationship, were measured via a 'holistic health check' with six questionnaires completed at two time-points. RESULTS The intervention was found to be acceptable to, and feasible and accessible for, participants, Peer Navigators, and service staff. Participants reported improvements to service engagement, and feeling more equipped to access services independently. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling trusting, authentic, and meaningful relationships to be developed. Some challenges were experienced in relation to the 'fit' of the intervention within some settings. Among participants there were reductions in drug use and risky injecting practices. There were increases in the number of participants receiving opioid substitution therapy. Overall, the intervention was positively received, with collective recognition that the intervention was unique and highly valuable. While most of the measures chosen for the holistic health check were found to be suitable for this population, they should be streamlined to avoid duplication and participant burden. CONCLUSIONS The study established that a peer-delivered, relational harm reduction intervention is acceptable to, and feasible and accessible for, people experiencing homelessness and problem substance use. While the study was not outcomes-focused, participants did experience a range of positive outcomes. A full randomised controlled trial is now required to assess intervention effectiveness. TRIAL REGISTRATION Study registered with ISRCTN: 15900054.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK.
- Faculty of Social Sciences, University of Stirling, Stirling, UK.
| | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - John Budd
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | - Bernie Pauly
- The Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Maria Fotopoulou
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Tracey Price
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Joe Schofield
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
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Parkes T, Matheson C, Carver H, Foster R, Budd J, Liddell D, Wallace J, Pauly B, Fotopoulou M, Burley A, Anderson I, MacLennan G. A peer-delivered intervention to reduce harm and improve the well-being of homeless people with problem substance use: the SHARPS feasibility mixed-methods study. Health Technol Assess 2022; 26:1-128. [PMID: 35212621 PMCID: PMC8899911 DOI: 10.3310/wvvl4786] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND For people experiencing homelessness and problem substance use, access to appropriate services can be challenging. There is evidence that development of trusting relationships with non-judgemental staff can facilitate service engagement. Peer-delivered approaches show particular promise, but the evidence base is still developing. This study tested the feasibility and acceptability of a peer-delivered intervention, through 'Peer Navigators', to support people who are homeless with problem substance use to address a range of health and social issues. OBJECTIVES The study objectives were to design and implement a peer-delivered, relational intervention to reduce harms and improve health/well-being, quality of life and social functioning for people experiencing homelessness and problem substance use, and to conduct a concurrent process evaluation to inform a future randomised controlled trial. DESIGN A mixed-methods feasibility study with concurrent process evaluation was conducted, involving qualitative interviews [staff interviews (one time point), n = 12; Peer Navigator interviews (three or four time points), n = 15; intervention participant interviews: first time point, n = 24, and second time point, n = 10], observations and quantitative outcome measures. SETTING The intervention was delivered in three outreach services for people who are homeless in Scotland, and three Salvation Army hostels in England; there were two standard care settings: an outreach service in Scotland and a hostel in England. PARTICIPANTS Participants were people experiencing homelessness and problem substance use (n = 68) (intervention). INTERVENTION This was a peer-delivered, relational intervention drawing on principles of psychologically informed environments, with Peer Navigators providing practical and emotional support. MAIN OUTCOME MEASURES Outcomes relating to participants' substance use, participants' physical and mental health needs, and the quality of Peer Navigator relationships were measured via a 'holistic health check', with six questionnaires completed at two time points: a specially created sociodemographic, health and housing status questionnaire; the Patient Health Questionnaire-9 items plus the Generalised Anxiety Disorder-7; the Maudsley Addiction Profile; the Substance Use Recovery Evaluator; the RAND Corporation Short Form survey-36 items; and the Consultation and Relational Empathy Measure. RESULTS The Supporting Harm Reduction through Peer Support (SHARPS) study was found to be acceptable to, and feasible for, intervention participants, staff and Peer Navigators. Among participants, there was reduced drug use and an increase in the number of prescriptions for opioid substitution therapy. There were reductions in risky injecting practice and risky sexual behaviour. Participants reported improvements to service engagement and felt more equipped to access services on their own. The lived experience of the Peer Navigators was highlighted as particularly helpful, enabling the development of trusting, authentic and meaningful relationships. The relationship with the Peer Navigator was measured as excellent at baseline and follow-up. Some challenges were experienced in relation to the 'fit' of the intervention within some settings and will inform future studies. LIMITATIONS Some participants did not complete the outcome measures, or did not complete both sets, meaning that we do not have baseline and/or follow-up data for all. The standard care data sample sizes make comparison between settings limited. CONCLUSIONS A randomised controlled trial is recommended to assess the effectiveness of the Peer Navigator intervention. FUTURE WORK A definitive cluster randomised controlled trial should particularly consider setting selection, outcomes and quantitative data collection instruments. TRIAL REGISTRATION This trial is registered as ISRCTN15900054. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - John Budd
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | | | | | - Bernie Pauly
- The Canadian Institute for Substance Use Research, University of Victoria, Greater Victoria, BC, Canada
| | - Maria Fotopoulou
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Adam Burley
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
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Bowen E, Irish A, LaBarre C, Capozziello N, Nochajski T, Granfield R. Qualitative insights in item development for a comprehensive and inclusive measure of recovery capital. ADDICTION RESEARCH & THEORY 2022; 30:403-413. [PMID: 36721868 PMCID: PMC9886235 DOI: 10.1080/16066359.2022.2055002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Item specification is foundational to measurement development but rarely reported in depth. We address this gap by explicating our use of qualitative methods to ground and develop items for a new recovery capital measure, the Multidimensional Inventory of Recovery Capital. METHOD We recruited a diverse sample of service providers (n = 9) and people in recovery from alcohol problems (n = 23) to provide feedback on an item pool assessing social, human, physical, community, and cultural capital. Using applied qualitative analysis, we coded findings from interviews and focus groups and made final decisions by consensus regarding item elimination, retention, or revision. This process yielded a 49-item draft measure. RESULTS Only nine items from an initial 90-item list were retained in their original form. Participant feedback guided item elimination, addition, and revision for linguistic or conceptual clarity. We detected little systematic variation in feedback based on income or race; however, there were stark divergences on particular items based on recovery pathway (i.e. 12-step versus other approaches). CONCLUSIONS The high degree of alteration to the item pool highlights the importance of establishing validity with respondents. Response variation based on recovery pathway suggests the need for broad heterogeneity in respondents. Measures that are sensitive, psychometrically sound, and aligned with theory are critical for advancing research on recovery capital and related disparities for diverse populations.
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Affiliation(s)
- Elizabeth Bowen
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Andrew Irish
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Charles LaBarre
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Nicole Capozziello
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Thomas Nochajski
- University at Buffalo – School of Social Work, State University of New York, Buffalo, NY, USA
| | - Robert Granfield
- Vice Provost for Faculty Affairs, University at Buffalo – State University of New York, Buffalo, NY, USA
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Exploring the Potential of Implementing Managed Alcohol Programmes to Reduce Risk of COVID-19 Infection and Transmission, and Wider Harms, for People Experiencing Alcohol Dependency and Homelessness in Scotland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312523. [PMID: 34886249 PMCID: PMC8657286 DOI: 10.3390/ijerph182312523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023]
Abstract
People who experience homelessness and alcohol dependency are more vulnerable than the general population to risks/harms relating to COVID-19. This mixed methods study explored stakeholder perspectives concerning the impact of COVID-19 and the potential utility of introducing managed alcohol programmes (MAPs) in Scotland as part of a wider health/social care response for this group. Data sources included: 12 case record reviews; 40 semi-structured qualitative interviews; and meeting notes from a practitioner-researcher group exploring implementation of MAPs within a third sector/not-for-profit organisation. A series of paintings were curated as a novel part of the research process to support knowledge translation. The case note review highlighted the complexity of health problems experienced, in addition to alcohol dependency, including polysubstance use, challenges related to alcohol access/use during lockdown, and complying with stay-at-home rules. Qualitative analysis generated five subthemes under the theme of ‘MAPs as a response to COVID-19′: changes to alcohol supply/use including polysubstance use; COVID-19-related changes to substance use/homelessness services; negative changes to services for people with alcohol problems; the potential for MAPs in the context of COVID-19; and fears and concerns about providing MAPs as a COVID-19 response. We conclude that MAPs have the potential to reduce a range of harms for this group, including COVID-19-related harms.
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18
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McKinsey E, Pruitt AS, Austin T. "It's not the end of the story:" Understanding the continued recovery from homelessness using Photovoice and content analysis. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:1100-1120. [PMID: 34033684 DOI: 10.1002/jcop.22605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
In this multipart study, participants in a Housing First program on the Island of O'ahu conducted a Photovoice project involving participatory analysis to investigate the recovery process from homelessness several years after being housed. University researchers then conducted a secondary analysis of the Photovoice study content to expand on findings and examine the unique contributions of the different methods. Findings suggest that individuals who have experienced homelessness will likely need continued support, particularly social support and opportunities for community engagement, well after initial housing. Findings also suggests that a combination of iterative analytic methods that remain participatory may be most useful for examining lived experiences of individuals recovering from homelessness. The study represents a participatory investigation of recovery from homelessness, as well as a rigorous inquiry into the research methods best suited to investigate this lived experience.
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Affiliation(s)
- Eva McKinsey
- North Carolina State University, Raleigh, North Carolina, USA
| | - Anna S Pruitt
- University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Tien Austin
- University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
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19
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Collins SE, Goldstein SC, King VL, Orfaly VE, Gu J, Clark A, Vess A, Lee G, Taylor EM, Fentress T, Braid AK, Clifasefi SL. Characterizing components of and attendance at resident-driven Housing First programming in the context of community-based participatory research. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:1376-1392. [PMID: 33301627 PMCID: PMC8190162 DOI: 10.1002/jcop.22491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 09/16/2020] [Accepted: 11/04/2020] [Indexed: 06/12/2023]
Abstract
AIMS This secondary study characterized components of and engagement in the life-enhancing alcohol-management program (LEAP), which is resident-driven housing first programming. METHODS We used a process akin to conventional content analysis to operationalize the LEAP according to its component activities. We used generalized linear modeling to identify predictors of LEAP activity participation and to predict alcohol and quality-of-life outcomes from participation in specific LEAP activities categories. RESULTS Overall, 86% of participants attended at least one LEAP activity, which comprised three categories: administrative leadership opportunities, meaningful activities, and pathways to recovery. Employment status alone predicted LEAP activity attendance: Employed residents attended 88% fewer LEAP activities than unemployed residents. Participants who sought out more pathways to recovery activities were more likely daily drinkers and more impacted by alcohol-related harm. Those engaging in administrative leadership opportunities were overall less impacted by alcohol use and had a higher quality of life generally, and their alcohol outcomes further improved over time. CONCLUSIONS Programming developed with Housing First residents was well-attended but could be made more inclusive by including evening programming to accommodate residents employed full time and engaging more severely impacted participants in administrative leadership activities, where the greatest benefits of programming were seen.
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Affiliation(s)
- Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Silvi C Goldstein
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Victorio L King
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Victoria E Orfaly
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jingyan Gu
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Alex Clark
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Alexander Vess
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Gary Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Emily M Taylor
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Taurmini Fentress
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Ashley K Braid
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Seema L Clifasefi
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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20
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Gaboardi M, Santinello M, Shinn M. Beyond behaviour: rethinking integration for people experiencing homelessness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:846-855. [PMID: 33560560 DOI: 10.1111/hsc.13314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 12/28/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
Integration is one of the main goals of homeless services. Despite the growing research on integration and homelessness, few studies start with the perspective of people experiencing homelessness. Integration is often measured as participation in a list of standard behaviours. This process assesses behaviour in accordance with social norms but ignores people's own feelings and understanding of integration. The main aim of this study is to explore the meaning of integration from the perspective of people experiencing homelessness. Data were collected through semi-structured interviews involving 26 people in homeless service programmes. Five main themes regarding the meanings of integration were generated: work, housing, respectful relationships, family and personal dignity. Moreover, two themes of obstacles and facilitators affecting integration were identified. A new conceptualisation of integration is generated that captures the participants' sense of personal dignity, respect and recognition from others and a sense of utility within their living environments (work, house and family). Implications of the results are discussed with respect to homeless services and research on homelessness.
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Affiliation(s)
- Marta Gaboardi
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Massimo Santinello
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Marybeth Shinn
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
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21
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Combining behavioral harm-reduction treatment and extended-release naltrexone for people experiencing homelessness and alcohol use disorder in the USA: a randomised clinical trial. Lancet Psychiatry 2021; 8:287-300. [PMID: 33713622 PMCID: PMC9875110 DOI: 10.1016/s2215-0366(20)30489-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The rate of alcohol-related mortality in people experiencing homelessness and alcohol use disorder is high and necessitates accessible and effective treatment for alcohol use disorder. However, typical abstinence-based treatments do not optimally engage this population. Recent studies have shown that harm-reduction treatment, which does not require abstinence, but instead aims to incrementally reduce alcohol-related harm and improve health-related quality of life, is acceptable to and effective for this population. The aim of this study was to test the efficacy of combined pharmacological and behavioural harm-reduction treatment for alcohol use disorder (HaRT-A) in people experiencing homelessness and alcohol use disorder. METHODS This randomised clinical trial was done at three community-based service sites (low-barrier shelters and housing programmes) in Seattle (WA, USA). Eligible participants were adults (aged 21-65 years) who met the DSM-IV-TR criteria for alcohol use disorder and who experienced homelessness in the past year. Participants were randomly assigned (1:1:1:1) by permuted block randomisation, stratified by site, to receive either HaRT-A plus intramuscular injections of 380 mg extended-release naltrexone (XR-NTX; HaRT-A plus XR-NTX group); HaRT-A plus placebo injection (HaRT-A plus placebo group); HaRT-A alone (HaRT-A alone group); or community-based supportive services as usual (services-as-usual control group). Patients assigned to receive HaRT-A attended sessions at baseline (week 0) and in weeks 1, 4, 8, and 12. XR-NTX and placebo injections were administered in weeks 0, 4, and 8. During the study, participants, interventionists, and investigators were masked to group assignment in the two injection arms. All participants were invited to follow-up assessments at weeks 4, 8, 12, 24, and 36. The primary outcomes were self-reported alcohol use quantity (ie, alcohol quantity consumed on peak drinking occasion, as measured with the Alcohol Quantity Use Assessment questionnaire) and frequency (measured with the Addiction Severity Index), alcohol-related harm (measured with the Short Inventory of Problems-2R questionnaire), and physical and mental health-related quality of life (measured with the Short Form-12 survey). Using piecewise growth modelling and an intention-to-treat model, we compared the effects of the three active treatment groups with the services-as-usual control group, and the HaRT-A plus XR-NTX group with the HaRT-A plus placebo group, over the 12-week treatment course and during the 24 weeks following treatment withdrawal. Safety analyses were done on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT01932801. FINDINGS Between Oct 14, 2013, and Nov 30, 2017, 417 individuals experiencing homelessness and alcohol use disorder were screened, of whom 308 were eligible and randomly assigned to the HaRT-A plus XR-NTX group (n=74), the HaRT-A plus placebo group (n=78), the HaRT-A alone group (n=79), or the services-as-usual control group (n=77). Compared with the services-as-usual control group, the HaRT-A plus XR-NTX group showed significant improvements from baseline to 12 weeks post-treatment across four of the five primary outcomes: peak alcohol quantity (linear B -0·48 [95% CI -0·79 to -0·18] p=0·010; full model Cohen's d=-0·68), alcohol frequency (linear B -4·42 [-8·09 to -0·76], p=0·047; full model Cohen's d=-0·16), alcohol-related harm (linear B -2·22 [-3·39 to -1·06], p=0·002; full model Cohen's d=-0·56), and physical health-related quality of life (linear B 0·66 [0·23 to 1·10], p=0·012; full model Cohen's d=0·43). Compared with the services-as-usual control group, the HaRT-A plus placebo group showed significant improvements in three of the five primary outcomes: peak alcohol quantity (linear B -0·41 [95% CI -0·67 to -0·15] p=0·010; full model Cohen's d=-0·23), alcohol frequency (linear B -5·95 [-9·72 to -2·19], p=0·009; full model Cohen's d=-0·13), and physical health-related quality of life (linear B 0·53 [0·09 to 0·98], p=0·050; full model Cohen's d=0·35). Compared with the services-as-usual control group, the HaRT-A alone group showed significant improvements in two of the five primary outcomes: alcohol-related harm (linear B -1·58 [95% CI -2·73 to -0·42] p=0·025; full model Cohen's d=-0·40) and physical health-related quality of life (linear B 0·63 [0·18 to 1·07], p=0·020; full model Cohen's d=0·41). After treatment discontinuation at 12 weeks, the active treatment groups plateaued, whereas the services-as-usual group showed improvements. Thus, during the post-treatment period (weeks 12 to 36), the services-as-usual control group showed greater reductions in alcohol-related harm compared with both the HaRT-A plus XR-NTX group (linear B 0·96 [0·24 to 1·67], p=0·028; full model Cohen's d=0·24) and the HaRT-A alone group (linear B 1·02 [0·35 to 1·70], p=0·013; full model Cohen's d=0·26). During the post-treatment period, the services-as-usual control group significantly improved on mental health-related quality of life compared with the HaRT-A alone group (linear B -0·46 [-0·79 to -0·12], p=0·024; full model Cohen's d=-0·28), and on physical health-related quality of life compared with the HaRT-A plus XR-NTX group (linear B -0·42 [-0·67 to -0·17], p=0·006; full model Cohen's d=-0·27), the HaRT-A plus placebo group (linear B -0·42 [-0·69 to -0·15], p=0·009; full model Cohen's d=-0·27), and the HaRT-A alone group (linear B -0·47 [-0·72 to -0·22], p=0·002; full model Cohen's d=-0·31). For all other primary outcomes, there were no significant linear differences between the services-as-usual and active treatment groups. When comparing the HaRT-A plus placebo group with the HaRT-A plus XR-NTX group, there were no significant differences for any of the primary outcomes. Missing data analysis indicated that participants were more likely to drop out in the services-as-usual control group than in the active treatment groups; however, primary outcome findings were found to be robust to attrition. Participants in the HaRT-A plus XR-NTX, HaRT-A plus placebo, and HaRT-A alone groups were not more likely to experience adverse events than those in the services-as-usual control group. INTERPRETATION Compared with existing services, combined pharmacological and behavioural harm-reduction treatment resulted in decreased alcohol use and alcohol-related harm and improved physical health-related quality of life during the 12-week treatment period for people experiencing homelessness and alcohol use disorder. Although not as consistent, there were also positive findings for behavioural harm-reduction treatment alone. Considering the non-significant differences between participants receiving HaRT-A plus placebo and HaRT-A plus XR-NTX, the combined pharmacological and behavioural treatment effect cannot be attributed to XR-NTX alone. Future studies are needed to further investigate the relative contributions of the pharmacological and behavioural components of harm-reduction treatment for alcohol use disorder, and to ascertain whether a maintenance treatment approach could extend these positive outcome trajectories. FUNDING National Institute on Alcohol Abuse and Alcoholism.
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22
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Eriksen LL, Hoeck B. The construction of meaning in alcohol addiction: A narrative study of socially excluded people’s stories about alcohol. NORDIC STUDIES ON ALCOHOL AND DRUGS 2021; 39:76-88. [PMID: 35308472 PMCID: PMC8899271 DOI: 10.1177/1455072521999220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/17/2022] Open
Abstract
Aim: The aim of this study is to illuminate the experience of living with alcohol addiction from the perspective of socially excluded people outside the healthcare system. It presents the results from a qualitative study of five personal narratives from socially excluded men living with alcohol addiction in Denmark. The group is rarely heard and often underprioritised in the Danish healthcare system, contributing to the social inequality in public health. Therefore, giving them a voice will contribute important insight into the individuals’ own experiences and understandings of their situations. Design: Five semi-structured interviews were conducted with socially excluded people living with alcohol addiction. Positioned in a narrative methodology, the focus of the study was on the construction of meaning on a structural, performative and thematic level of the narratives of addiction, as told by the person with addiction. Results: Social identities as “alcoholics” were constructed across the narratives; however, there was a distinct difference between the different informants’ own positions. Some constructed meaning in their addiction by including an identity as a stereotypical “drunk” defined as a certain type of unhealthy, unkempt, low-income addict. Others distanced themselves from this identity. Furthermore, alcohol was presented with a double meaning, being associated with positive memories and relationships as well as negative consequences and bad experiences, complicating a potential wish for sobriety. Conclusions: The study illuminates the individual perspectives in the identity construction of socially excluded people with alcohol addiction. When relating to the characteristics of the stereotypical “drunk”, the individuals’ self-perspectives may differ from the common understanding. The constructed identities reflected the participants’ lived experience with addiction, with alcohol as an unavoidable life companion, consequently creating individual meaning in one’s addiction.
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Affiliation(s)
| | - Bente Hoeck
- University of Southern Denmark, Odense, Denmark
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Collins SE, Goldstein SC, Suprasert B, Doerr SAM, Gliane J, Song C, Orfaly VE, Moodliar R, Taylor EM, Hoffmann G. Jail and Emergency Department Utilization in the Context of Harm Reduction Treatment for People Experiencing Homelessness and Alcohol Use Disorder. J Urban Health 2021; 98:83-90. [PMID: 33185824 PMCID: PMC7873130 DOI: 10.1007/s11524-020-00452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
People experiencing homelessness are disproportionately affected by alcohol use disorder (AUD). Abstinence-based treatment, however, does not optimally engage or treat this population. Thus, Harm Reduction Treatment for Alcohol (HaRT-A) was developed together with people with the lived experience of homelessness and AUD and community-based agencies that serve them. HaRT-A is a compassionate and pragmatic approach that aims to help people reduce alcohol-related harm and improve quality of life (QoL) without requiring abstinence or use reduction. The parent RCT showed that HaRT-A precipitated statistically significant reductions in alcohol use, alcohol-related harm, AUD symptoms, and positive urine toxicology tests. This secondary study tested HaRT-A effects on more distal, 6-month pre-to-posttreatment changes on jail and emergency department (ED) utilization. People experiencing homelessness and AUD (N = 168; 24% women) were recruited in community-based clinical and social services settings. Participants were randomized to receive HaRT-A or services as usual. Over four sessions, HaRT-A interventionists delivered three components: (a) collaborative tracking of participant-preferred alcohol metrics, (b) elicitation of harm-reduction and QoL goals, and (c) discussion of safer-drinking strategies. Administrative data on jail and ED utilization were extracted for 6 months pre- and posttreatment. Findings indicated no statistically significant treatment group differences on 6-month changes in jail or ED utilization (ps > .23). Exploratory analyses showed that 2-week frequency of alcohol use was positively correlated with number of jail bookings in the 12 months surrounding their study participation. Additionally, self-reported alcohol-related harm, importance of reducing alcohol-related harm, and perceived physical functioning predicted more ED visits. Future studies are needed to further assess how harm-reduction treatment may be enhanced to move the needle in criminal justice and healthcare utilization in the context of larger samples, longer follow-up timeframes, and more intensive interventions.
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Affiliation(s)
- Susan E Collins
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA.
| | - Silvi C Goldstein
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Bow Suprasert
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Samantha A M Doerr
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Joanne Gliane
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Clarissa Song
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Victoria E Orfaly
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Rddhi Moodliar
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Emily M Taylor
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
| | - Gail Hoffmann
- University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA
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Mackelprang JL, Clifasefi SL, Grazioli VS, Collins SE. Content Analysis of Health Concerns among Housing First Residents with a History of Alcohol Use Disorder. J Health Care Poor Underserved 2021; 32:463-486. [PMID: 33678708 PMCID: PMC9940994 DOI: 10.1353/hpu.2021.0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Previous research has utilized survey and administrative data to document health problems among Housing First (HF) residents; however, little is known about residents' personal perspectives on their health. The purpose of this study was to utilize conventional content analysis to analyze health-related concerns among HF residents with histories of alcohol use disorder. Between June and December 2013, we interviewed 44 adults who had histories of chronic homelessness and alcohol use disorder and were residing in single-site HF in Seattle, Washington. Responses centered on five primary topics: alcohol-related harm, perceived health vulnerability, concern for fellow residents' health, end of life, and health and safety promotion. HF residents experience complex alcohol-exacerbated health difficulties and existing health services may not meet the needs of those whose health is particularly compromised. Considering that HF facilitates aging in place, end-of-life care and grief counseling should be integrated into HF services.
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Affiliation(s)
- Jessica L. Mackelprang
- Department of Psychological Sciences, School of Health Sciences at Swinburne University of Technology
| | - Seema L. Clifasefi
- Harm Reduction Research and Treatment Center, Psychiatry & Behavioral Sciences at the University of Washington-Harborview Medical Center
| | - Véronique S. Grazioli
- Department of Vulnerabilities & Social Medicine, Center for Primary Care & Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University
| | - Susan E. Collins
- Harm Reduction Research and Treatment Center, Psychiatry & Behavioral Sciences at the University of Washington-Harborview Medical Center and with Washington State University
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Dionisi T, Mosoni C, Di Sario G, Tarli C, Antonelli M, Sestito L, D'Addio S, Tosoni A, Ferrarese D, Iasilli G, Vassallo GA, Mirijello A, Gialloreti LE, Di Giuda D, Gasbarrini A, Addolorato G. Make Mission Impossible Feasible: The Experience of a Multidisciplinary Team Providing Treatment for Alcohol Use Disorder to Homeless Individuals. Alcohol Alcohol 2020; 55:547-553. [PMID: 32533164 DOI: 10.1093/alcalc/agaa052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/12/2022] Open
Abstract
AIM People experiencing homelessness are often excluded from treatment programs for alcohol use disorder (AUD). The goal of this study was to describe the impact of a multidisciplinary treatment program on alcohol consumption and social reintegration in individuals with AUD experiencing homelessness. METHODS Thirty-one individuals with AUD experiencing homelessness were admitted to an inpatient unit for 5-6 days for clinical evaluation and to treat potential alcohol withdrawal syndrome. A group of volunteers, in collaboration with the Community of Sant'Egidio, provided social support aimed to reintegrate patients. After inpatient discharge, all patients were followed as outpatients. Alcohol intake (number drinks/day), craving and clinical evaluation were assessed at each outpatient visit. Biological markers of alcohol use were evaluated at enrollment (T0), at 6 months (T1) and 12 months (T2). RESULTS Compared with T0, patients at T1 showed a significant reduction in alcohol consumption [10 (3-24) vs 2 (0-10); P = 0.015] and in γ-glutamyl-transpeptidase [187 (78-365) vs 98 (74-254); P = 0.0021]. The reduction in alcohol intake was more pronounced in patients with any housing condition [10 (3-20) vs 1 (0-8); P = 0.008]. Similarly, compared with T0, patients at T2 showed significant reduction in alcohol consumption [10 (3-24) vs 0 (0-15); P = 0.001], more pronounced in patients with any housing condition [10 (3-20) vs 0 (0-2); P = 0.006]. Moreover, at T2 patients showed a significant reduction in γ-glutamyl-transpeptidase [187 (78-365) vs 97 (74-189); P = 0.002] and in mean cell volume [100.2 (95-103.6) vs 98.3 (95-102); P = 0.042]. CONCLUSION Patients experiencing homelessness may benefit from a multidisciplinary treatment program for AUD. Strategies able to facilitate and support their social reintegration and housing can improve treatment outcomes.
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Affiliation(s)
- Tommaso Dionisi
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carolina Mosoni
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanna Di Sario
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Tarli
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mariangela Antonelli
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luisa Sestito
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano D'Addio
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Tosoni
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniele Ferrarese
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanna Iasilli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Comunity of Sant'Egidio, Rome, Italy
| | | | - Antonio Mirijello
- Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Leonardo Emberti Gialloreti
- Comunity of Sant'Egidio, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Daniela Di Giuda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Gasbarrini
- Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Internal Medicine and Gastroenterology, Catholic University of Rome, Rome, Italy
| | - Giovanni Addolorato
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Internal Medicine and Gastroenterology, Catholic University of Rome, Rome, Italy
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Harrison R, Van Hout MC, Cochrane M, Eckley L, Noonan R, Timpson H, Sumnall H. Experiences of Sustainable Abstinence-Based Recovery: an Exploratory Study of Three Recovery Communities (RC) in England. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-018-9967-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Carver H, Ring N, Miler J, Parkes T. What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography. Harm Reduct J 2020; 17:10. [PMID: 32005119 PMCID: PMC6995160 DOI: 10.1186/s12954-020-0356-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background People experiencing homelessness have higher rates of problematic substance use but difficulty engaging with treatment services. There is limited evidence regarding how problematic substance use treatment should be delivered for these individuals. Previous qualitative research has explored perceptions of effective treatment by people who are homeless, but these individual studies need to be synthesised to generate further practice-relevant insights from the perspective of this group. Methods Meta-ethnography was conducted to synthesise research reporting views on substance use treatment by people experiencing homelessness. Studies were identified through systematic searching of electronic databases (CINAHL; Criminal Justice Abstracts; Health Source; MEDLINE; PsycINFO; SocINDEX; Scopus; and Web of Science) and websites and were quality appraised. Original participant quotes and author interpretations were extracted and coded thematically. Concepts identified were compared to determine similarities and differences between studies. Findings were translated (reciprocally and refutationally) across studies, enabling development of an original over-arching line-of-argument and conceptual model. Results Twenty-three papers published since 2002 in three countries, involving 462 participants, were synthesised. Findings broadly related, through personal descriptions of, and views on, the particular intervention components considered effective to people experiencing homelessness. Participants of all types of interventions had a preference for harm reduction-oriented services. Participants considered treatment effective when it provided a facilitative service environment; compassionate and non-judgemental support; time; choices; and opportunities to (re)learn how to live. Interventions that were of longer duration and offered stability to service users were valued, especially by women. From the line-of-argument synthesis, a new model was developed highlighting critical components of effective substance use treatment from the service user’s perspective, including a service context of good relationships, with person-centred care and an understanding of the complexity of people’s lives. Conclusion This is the first meta-ethnography to examine the components of effective problematic substance use treatment from the perspective of those experiencing homelessness. Critical components of effective problematic substance use treatment are highlighted. The way in which services and treatment are delivered is more important than the type of treatment provided. Substance use interventions should address these components, including prioritising good relationships between staff and those using services, person-centred approaches, and a genuine understanding of individuals’ complex lives.
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Affiliation(s)
- Hannah Carver
- Salvation Army Centre for Addiction Services and Research, 4T26, RG Bomont Building, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK.
| | - Nicola Ring
- School of Health and Social Care, Sighthill Campus, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - Joanna Miler
- Salvation Army Centre for Addiction Services and Research, 4T26, RG Bomont Building, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, 4T26, RG Bomont Building, Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
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Needs Assessment for a Comprehensive Reemployment Program Among Residents of a Work Rehabilitation Program for Individuals With Unstable or Lack of Housing. J Occup Environ Med 2019; 62:163-170. [PMID: 31834137 DOI: 10.1097/jom.0000000000001794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Individuals in transitional housing programs often have a goal of reaching stable employment, but the unique needs and barriers for achieving this warrants further study. METHODS A structured interview guide was administered orally and descriptive data analysis was done for this exploratory mixed-methods study. RESULTS Commonly reported reemployment challenges included legal barriers and unmet transportation, housing, and financial needs. More than two-thirds of residents reported no place to live after the program regardless of if they had previous precarious housing. Emerging themes included challenges regarding sufficient time for the transition to being employed, fear of relapse, and lack of long-term goals and planning. CONCLUSIONS Findings suggest that residential rehabilitation programs are an important resource. While these programs tend to focus on reemployment, their services could be enhanced by assessing individual needs and allowing for variation in reemployment preparation.
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Scholes G. Problematic alcohol consumption in homeless Australians: A narrative review of the causes, barriers to receiving help and possible solutions. Health Promot J Austr 2019; 31:279-286. [PMID: 31446632 DOI: 10.1002/hpja.289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/19/2019] [Indexed: 11/06/2022] Open
Abstract
ISSUE ADDRESSED Problematic alcohol consumption (PAC) affects one-third of homeless Australians, and it is expected that the rates will increase as the population ages. However, current policy does not recognise the importance of this problem. The aim of this narrative review was to examine the social determinants and other risk factors contributing to PAC in homeless Australians, the barriers to receiving help and possible solutions for the Australian context. METHODS PubMed and PsycINFO databases and Australian government websites were examined for the keywords "alcohol" and "homeless," and pertinent articles were selected for inclusion and for citation tracking of further relevant articles. RESULTS The causes of PAC in homeless Australians are multifactorial, and multidirectional, and include risk factors such as low socio-economic status, mental illness and having experienced trauma. There is significant stigma associated with both homelessness and PAC, which further isolates this group. Current policies to address PAC in the homeless are inadequate; however, there are a range of possible programs to reduce PAC in this group, and international harm reduction strategies have also shown success in improving outcomes for this group. CONCLUSION There are numerous social risk factors that influence the development of PAC in the homeless. The introduction of harm reduction strategies, programs to enhance motivation and personal skills, as well as better mental health treatment, would all fill important gaps in services for homeless Australians with PAC. SO WHAT?: Health professionals can be advised that there are many social determinants that influence PAC in homeless Australians. There are important structural barriers to providing this marginalised group with the services they require; however, there is scope for the introduction of new programs, including harm reduction strategies, to meet the fundamental needs of this group.
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30
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Collins SE, Clifasefi SL, Nelson LA, Stanton J, Goldstein SC, Taylor EM, Hoffmann G, King VL, Hatsukami AS, Cunningham ZL, Taylor E, Mayberry N, Malone DK, Jackson TR. Randomized controlled trial of harm reduction treatment for alcohol (HaRT-A) for people experiencing homelessness and alcohol use disorder. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 67:24-33. [PMID: 30851620 PMCID: PMC6488431 DOI: 10.1016/j.drugpo.2019.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/05/2018] [Accepted: 01/01/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND People experiencing homelessness are disproportionately affected by alcohol use disorder (AUD). Abstinence-based treatment, however, does not optimally engage or treat this population. Thus, harm reduction treatment for alcohol (HaRT-A) was developed together with people with lived experience of homelessness and AUD and community-based agencies that serve them. HaRT-A is a compassionate and pragmatic approach that aims to help people reduce alcohol-related harm and improve quality of life (QoL) without requiring abstinence or use reduction. A three-month, two-arm randomized controlled trial was conducted to test the initial efficacy of HaRT-A compared to a services-as-usual control condition. METHODS People experiencing homelessness and AUD (N = 168; 24% women) were recruited in community-based clinical and social services settings. Self-reported alcohol use, alcohol-related harm, motivation, and QoL as well as urinary ethyl glucuronide were assessed over a 3-month follow-up. Participants were randomized to receive HaRT-A or services as usual. Over four sessions, HaRT-A interventionists delivered three components: a) collaborative tracking of participant-preferred alcohol metrics, b) elicitation of harm-reduction and QoL goals, and c) discussion of safer-drinking strategies. RESULTS Compared to control participants, HaRT-A participants reported significantly greater increases in confidence to engage in harm reduction and decreases in peak alcohol use, alcohol-related harm, AUD symptoms, and positive urinary ethyl glucuronide tests (ps < .05). Findings were inconclusive regarding group differences on QoL (ps > .12). CONCLUSION A low-barrier, low-intensity, patient-driven, harm-reduction approach has at least short-term efficacy in improving AUD outcomes in this population. Future studies are needed to establish its longer-term efficacy.
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Affiliation(s)
| | | | | | - Joey Stanton
- University of Washington, United States; Downtown Emergency Service Center, United States
| | | | | | | | | | | | | | | | | | | | - T Ron Jackson
- University of Washington, United States; Evergreen Treatment Services - REACH
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Parkes T, Matheson C, Carver H, Budd J, Liddell D, Wallace J, Pauly B, Fotopoulou M, Burley A, Anderson I, MacLennan G, Foster R. Supporting Harm Reduction through Peer Support (SHARPS): testing the feasibility and acceptability of a peer-delivered, relational intervention for people with problem substance use who are homeless, to improve health outcomes, quality of life and social functioning and reduce harms: study protocol. Pilot Feasibility Stud 2019; 5:64. [PMID: 31164989 PMCID: PMC6489271 DOI: 10.1186/s40814-019-0447-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/09/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND While people who are homeless often experience poor mental and physical health and problem substance use, getting access to appropriate services can be challenging. The development of trusting relationships with non-judgemental staff can facilitate initial and sustained engagement with health and wider support services. Peer-delivered approaches seem to have particular promise, but there is limited evidence regarding peer interventions that are both acceptable to, and effective for, people who are homeless and using drugs and/or alcohol. In the proposed study, we will develop and test the use of a peer-to-peer relational intervention with people experiencing homelessness. Drawing on the concept of psychologically informed environments, it will focus on building trusting and supportive relationships and providing practical elements of support such as access to primary care, treatment and housing options. METHODS A mixed-method feasibility study with concurrent process evaluation will be conducted to explore the feasibility and acceptability of a peer-delivered, relational intervention for people with problem substance use who are homeless. Peer Navigators will be based in homelessness outreach and residential services in Scotland and England. Peer Navigators will work with a small number of participants for up to 12 months providing both practical and emotional support. The sample size for the intervention is 60. Those receiving the intervention must be currently homeless or at risk of homelessness, over the age of 18 years and self-report alcohol/drug problems. A holistic health check will be conducted in the first few months of the intervention and repeated towards the end. Health checks will be conducted by a researcher in the service where the Peer Navigator is based. Semi-structured qualitative interviews with intervention participants and staff in both intervention and standard care settings, and all Peer Navigators, will be conducted to explore their experiences with the intervention. Non-participant observation will be conducted in intervention and standard care sites to document similarities and differences between care pathways. DISCUSSION The SHARPS study will provide evidence regarding whether a peer-delivered harm reduction intervention is feasible and acceptable to people experiencing homelessness and problem substance use in order to develop a definitive trial. TRIAL REGISTRATION SRCTN registry ISRCTN15900054, protocol version 1.3, March 12, 2018.
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Affiliation(s)
- Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - John Budd
- Edinburgh Access Practice, NHS Lothian, 22-24 Spittal Street, Edinburgh, EH3 9DU UK
| | - Dave Liddell
- Scottish Drugs Forum, 91 Mitchell Street, Glasgow, G1 3LN UK
| | - Jason Wallace
- Scottish Drugs Forum, 91 Mitchell Street, Glasgow, G1 3LN UK
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, Technology Enterprise Facility, University of Victoria, Room 273, Victoria, British Columbia V8P 5C2 Canada
| | - Maria Fotopoulou
- Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Adam Burley
- The Access Point, 17/23 Leith Street, Edinburgh, EH1 3AT UK
| | - Isobel Anderson
- Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
| | - Graeme MacLennan
- The Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Rebecca Foster
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Colin Bell Building, Stirling, FK9 4LA UK
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Crabtree A, Latham N, Morgan R, Pauly B, Bungay V, Buxton JA. Perceived harms and harm reduction strategies among people who drink non-beverage alcohol: Community-based qualitative research in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:85-93. [PMID: 30071398 DOI: 10.1016/j.drugpo.2018.06.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There has been increasing interest in harm reduction initiatives for street-involved people who drink alcohol, including non-beverage alcohol such as mouthwash and hand sanitizer. Limited evidence exists to guide these initiatives, and a particular gap is in research that prioritizes the experiences and perspectives of drinkers themselves. This research was conducted to explore the harms of what participants termed "illicit drinking" as perceived by people who engage in it, to characterize the steps this population takes to reduce harms, and to identify additional interventions that may be of benefit. METHODS This participatory qualitative research drew on ethnographic approaches including a series of 14″town hall"-style meetings facilitatied and attended by people who self identify as drinking illicit or non-beverage alcohol (n = 60) in Vancouver, British Columbia. This fieldwork was supplemented with four focus groups to explore emerging issues. RESULTS Participants in the meetings described the harms they experienced as including unintentional injury; harms to physical health; withdrawal; violence, theft, and being taken advantage of; harms to mental health; reduced access to services; and interactions with police. Current harm reduction strategies involved balancing the risks and benefits of drinking in groups and adopting techniques to avoid withdrawal. Proposed future initiatives included non-residential managed alcohol programs and peer-based supports. CONCLUSIONS Illicit drinkers describe harms and harm reductions strategies that have much in common with those of other illicit substances, and can be interpreted as examples of and responses to structural and everyday violence. Understanding the perceived harms of alcohol use by socially marginalized drinkers and their ideas about harm reduction will help tailor programs to meet their needs.
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Affiliation(s)
- Alexis Crabtree
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada; British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada.
| | - Nicole Latham
- Eastside Illicit Drinkers Group for Education, 380 E Hastings St, Vancouver, BC, V6A 1P4, Canada
| | - Rob Morgan
- Eastside Illicit Drinkers Group for Education, 380 E Hastings St, Vancouver, BC, V6A 1P4, Canada
| | - Bernadette Pauly
- Centre for Addiction Research of British Columbia, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Victoria Bungay
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada; British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
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