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Collins AB, Tan M, Smith M, Becker SJ. 'Everywhere I call, there's nothing available': Understanding the alcohol treatment landscape and needs among unstably housed people who use alcohol in Rhode Island. Drug Alcohol Rev 2024; 43:1235-1246. [PMID: 38623042 PMCID: PMC11223957 DOI: 10.1111/dar.13852] [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: 05/23/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Alcohol is a leading cause of morbidity and mortality in the United States and people who are unstably housed are disproportionately impacted by adverse alcohol-related health outcomes. Addressing the needs of unstably housed people with high-intensity alcohol use (i.e., heavy episodic use or binge drinking), including those whose goal is not abstinence, is critical to reducing harms among this population. This study explores the alcohol-related treatment and support needs among unstably housed people who use alcohol. METHODS Data collection included participant observation and semi-structured interviews (n = 25) with unstably housed people with high-intensity alcohol use. Data were analysed thematically, with attention to structural vulnerability and social-structural forces at shaping perceptions of and experiences with alcohol treatment. RESULTS Participants underscored how housing instability was critical in precipitating and maintaining heavy alcohol use, with alcohol often used to manage the stress and anxiety related to housing instability. While participants regularly engaged with alcohol treatment programs, program design and barriers to access undermined the effectiveness of these services for participants. Participants described the need for a range of program and service options across a continuum of care to be implemented to support participants in meeting their diverse needs and identified goals regarding alcohol use. DISCUSSION AND CONCLUSIONS Alcohol treatment and supports need to be modified so that they include a range of harm reduction and abstinence-based models to better meet people's diverse needs. Furthermore, treatment must be paired with permanent and affordable housing to address underlying drivers of alcohol-related harm for unstably housed people.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Michael Tan
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Megan Smith
- School of Social Work, Rhode Island College, Providence, USA
- House of Hope Community Development Corporation, Warwick, USA
- Warren Alpert Medical School, Providence, USA
| | - Sara J Becker
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, Chicago, USA
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Smith-Bernardin SM, Suen LW, Barr-Walker J, Cuervo IA, Handley MA. Scoping review of managed alcohol programs. Harm Reduct J 2022; 19:82. [PMID: 35879719 PMCID: PMC9311344 DOI: 10.1186/s12954-022-00646-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internationally, strategies focusing on reducing alcohol-related harms in homeless populations with severe alcohol use disorder (AUD) continue to gain acceptance, especially when conventional modalities focused on alcohol abstinence have been unsuccessful. One such strategy is the managed alcohol program (MAP), an alcohol harm reduction program managing consumption by providing eligible individuals with regular doses of alcohol as a part of a structured program, and often providing resources such as housing and other social services. Evidence to the role of MAPs for individuals with AUD, including how MAPs are developed and implemented, is growing. Yet there has been limited collective review of literature findings. METHODS We conducted a scoping review to answer, "What is being evaluated in studies of MAPs? What factors are associated with a successful MAP, from the perspective of client outcomes? What are the factors perceived as making them a good fit for clients and for communities?" We first conducted a systematic search in PubMed, Embase, PsycINFO, CINAHL, Sociological Abstracts, Social Services Abstracts, and Google Scholar. Next, we searched the gray literature (through focused Google and Ecosia searches) and references of included articles to identify additional studies. We also contacted experts to ensure relevant studies were not missed. All articles were independently screened and extracted. RESULTS We included 32 studies with four categories of findings related to: (1) client outcomes resulting from MAP participation, (2) client experience within a MAP; (3) feasibility and fit considerations in MAP development within a community; and (4) recommendations for implementation and evaluation. There were 38 established MAPs found, of which 9 were featured in the literature. The majority were located in Canada; additional research works out of Australia, Poland, the USA, and the UK evaluate potential feasibility and fit of a MAP. CONCLUSIONS The growing literature showcases several outcomes of interest, with increasing efforts aimed at systematic measures by which to determine the effectiveness and potential risks of MAP. Based on a harm reduction approach, MAPs offer a promising, targeted intervention for individuals with severe AUD and experiencing homelessness. Research designs that allow for longitudinal follow-up and evaluation of health- and housing-sensitive outcomes are recommended.
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Affiliation(s)
- Shannon M Smith-Bernardin
- School of Nursing, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA. .,UCSF Benioff Homelessness and Housing Initiative at ZSFG Hospital and Trauma Center, San Francisco, CA, USA.
| | - Leslie W Suen
- National Clinician Scholars Program, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Jill Barr-Walker
- ZSFG Library, University of California, San Francisco, San Francisco, CA, USA
| | | | - Margaret A Handley
- UCSF Benioff Homelessness and Housing Initiative at ZSFG Hospital and Trauma Center, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,PRISE Center: Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, CA, USA
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Pauly B, King V, Smith A, Tranquilli-Doherty S, Wishart M, Vallance K, Stockwell T, Sutherland C. Breaking the cycle of survival drinking: insights from a non-residential, peer-initiated and peer-run managed alcohol program. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2020.1764500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Bernie Pauly
- The Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Vashti King
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Ashley Smith
- St. Paul's Maternity Care, St. Paul's Hospital, Vancouver, BC, Canada
| | | | | | - Kate Vallance
- The Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Tim Stockwell
- The Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
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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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Pauly BB, Vallance K, Wettlaufer A, Chow C, Brown R, Evans J, Gray E, Krysowaty B, Ivsins A, Schiff R, Stockwell T. Community managed alcohol programs in Canada: Overview of key dimensions and implementation. Drug Alcohol Rev 2018; 37 Suppl 1:S132-S139. [DOI: 10.1111/dar.12681] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/23/2018] [Accepted: 01/29/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | - Kate Vallance
- Canadian Institute for Substance Use Research; Victoria Canada
| | | | - Clifton Chow
- Canadian Institute for Substance Use Research; Victoria Canada
| | - Randi Brown
- Canadian Institute for Substance Use Research; Victoria Canada
| | | | | | | | - Andrew Ivsins
- Canadian Institute for Substance Use Research; Victoria Canada
| | | | - Tim Stockwell
- Canadian Institute for Substance Use Research; Victoria Canada
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Healthcare Cost Reductions after Moving into a Wet Nursing Home Stay-A Case Series. Geriatrics (Basel) 2017; 2:geriatrics2040031. [PMID: 31011041 PMCID: PMC6371155 DOI: 10.3390/geriatrics2040031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 11/17/2022] Open
Abstract
Serious alcohol dependence is associated with high healthcare costs, especially when patients have chronic problems with alcohol, dementia and exhibit externalizing behavior. One option is to offer a wet nursing home for seriously ill patients for whom abstinence from alcohol is not a feasible option. In this case series, we present the healthcare costs 18 months before moving into a “wet nursing home”, and in the first 18 months of their stay, for three cases, one with low needs of care, one with medium needs, and one with high needs. Results: for all three patients, hospital costs were reduced by between 83.7 and 97.9% for patients with dementia, externalizing behavior, and chronic alcohol problems, a wet nursing home can produce substantial cost reductions in other parts of the healthcare sector.
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