1
|
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.
Collapse
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
| |
Collapse
|
2
|
Hoffman R. Is it time to reconsider the medical use of ethanol in patients with alcohol use disorder? Clin Toxicol (Phila) 2024; 62:409-411. [PMID: 39034847 DOI: 10.1080/15563650.2024.2377886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Affiliation(s)
- Robert Hoffman
- Clinical Toxicology Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
3
|
O'Leary C, Ralphs R, Stevenson J, Smith A, Harrison J, Kiss Z, Armitage H. The effectiveness of abstinence-based and harm reduction-based interventions in reducing problematic substance use in adults who are experiencing homelessness in high income countries: A systematic review and meta-analysis: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1396. [PMID: 38645303 PMCID: PMC11032639 DOI: 10.1002/cl2.1396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Homelessness is a traumatic experience, and can have a devastating effect on those experiencing it. People who are homeless often face significant barriers when accessing public services, and have often experienced adverse childhood events, extreme social disadvantage, physical, emotional and sexual abuse, neglect, low self-esteem, poor physical and mental health, and much lower life expectancy compared to the general population. Rates of problematic substance use are disproportionately high, with many using drugs and alcohol to deal with the stress of living on the street, to keep warm, or to block out memories of previous abuse or trauma. Substance dependency can also create barriers to successful transition to stable housing. Objectives To understand the effectiveness of different substance use interventions for adults experiencing homelessness. Search Methods The primary source of studies for was the 4th edition of the Homelessness Effectiveness Studies Evidence and Gaps Maps (EGM). Searches for the EGM were completed in September 2021. Other potential studies were identified through a call for grey evidence, hand-searching key journals, and unpacking relevant systematic reviews. Selection Criteria Eligible studies were impact evaluations that involved some comparison group. We included studies that tested the effectiveness of substance use interventions, and measured substance use outcomes, for adults experiencing homelessness in high income countries. Data Collection and Analysis Descriptive characteristics and statistical information in included studies were coded and checked by at least two members of the review team. Studies selected for the review were assessed for confidence in the findings. Standardised effect sizes were calculated and, if a study did not provide sufficient raw data for the calculation of an effect size, author(s) were contacted to obtain these data. We used random-effects meta-analysis and robust-variance estimation procedures to synthesise effect sizes. If a study included multiple effects, we carried out a critical assessment to determine (even if only theoretically) whether the effects are likely to be dependent. Where dependent effects were identified, we used robust variance estimation to determine whether we can account for these. Where effect sizes were converted from a binary to continuous measure (or vice versa), we undertook a sensitivity analysis by running an additional analysis with these studies omitted. We also assessed the sensitivity of results to inclusion of non-randomised studies and studies classified as low confidence in findings. All included an assessment of statistical heterogeneity. Finally, we undertook analysis to assess whether publication bias was likely to be a factor in our findings. For those studies that we were unable to include in meta-analysis, we have provided a narrative synthesis of the study and its findings. Main Results We included 48 individual papers covering 34 unique studies. The studies covered 15, 255 participants, with all but one of the studies being from the United States and Canada. Most papers were rated as low confidence (n = 25, or 52%). By far the most common reason for studies being rated as low confidence was high rates of attrition and/or differential attrition of study participants, that fell below the What Works Clearinghouse liberal attrition standard. Eleven of the included studies were rated as medium confidence and 12 studies as high confidence. The interventions included in our analysis were more effective in reducing substance use than treatment as usual, with an overall effect size of -0.11 SD (95% confidence interval [CI], -0.27, 0.05). There was substantial heterogeneity across studies, and the results were sensitive to the removal of low confidence studies (-0.21 SD, 95% CI [-0.59, 0.17] - 6 studies, 17 effect sizes), the removal of quasi-experimental studies (-0.14 SD, 95% CI [-0.30, 0.02] - 14 studies, 41 effect sizes) and the removal of studies where an effect size had been converted from a binary to a continuous outcome (-0.08 SD, 95% CI [-0.31, 0.15] - 10 studies, 31 effect sizes). This suggests that the findings are sensitive to the inclusion of lower quality studies, although unusually the average effect increases when we removed low confidence studies. The average effect for abstinence-based interventions compared to treatment-as-usual (TAU) service provision was -0.28 SD (95% CI, -0.65, 0.09) (6 studies, 15 effect sizes), and for harm reduction interventions compared to a TAU service provision is close to 0 at 0.03 SD (95% CI, -0.08, 0.14) (9 studies, 30 effect sizes). The confidence intervals for both estimates are wide and crossing zero. For both, the comparison groups are primarily abstinence-based, with the exception of two studies where the comparison group condition was unclear. We found that both Assertative Community Treatment and Intensive Case Management were no better than treatment as usual, with average effect on substance use of 0.03 SD, 95% CI [-0.07, 0.13] and -0.47 SD, 95% CI [-0.72, -0.21] 0.05 SD, 95% CI [-0.28, 0.39] respectively. These findings are consistent with wider research, and it is important to note that we only examined the effect on substance use outcomes (these interventions can be effective in terms of other outcomes). We found that CM interventions can be effective in reducing substance use compared to treatment as usual, with an average effect of -0.47 SD, 95% CI (-0.72, -0.21). All of these results need to be considered in light of the quality of the underlying evidence. There were six further interventions where we undertook narrative synthesis. These syntheses suggest that Group Work, Harm Reduction Psychotherapy, and Therapeutic Communities are effective in reducing substance use, with mixed results found for Motivational Interviewing and Talking Therapies (including Cognitive Behavioural Therapy). The narrative synthesis suggested that Residential Rehabilitation was no better than treatment as usual in terms of reducing substance use for our population of interest. Authors' Conclusions Although our analysis of harm reduction versus treatment as usual, abstinence versus treatment as usual, and harm reduction versus abstinence suggests that these different approaches make little real difference to the outcomes achieved in comparison to treatment as usual. The findings suggest that some individual interventions are more effective than others. The overall low quality of the primary studies suggests that further primary impact research could be beneficial.
Collapse
Affiliation(s)
| | - Rob Ralphs
- Manchester Metropolitan UniversityManchesterUK
| | | | | | | | | | | |
Collapse
|
4
|
Michaud L, Kolla G, Rudzinski K, Guta A. Mapping a moral panic: News media narratives and medical expertise in public debates on safer supply, diversion, and youth drug use in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104423. [PMID: 38642543 DOI: 10.1016/j.drugpo.2024.104423] [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] [Received: 10/30/2023] [Revised: 02/26/2024] [Accepted: 04/06/2024] [Indexed: 04/22/2024]
Abstract
The ongoing overdose and drug toxicity crisis in North America has contributed momentum to the emergence of safer supply prescribing and programs in Canada as a means of providing an alternative to the highly volatile unregulated drug supply. The implementation and scale-up of safer supply have been met with a vocal reaction on the part of news media commentators, conservative politicians, recovery industry representatives, and some prominent addiction medicine physicians. This reaction has largely converged around several narratives, based on unsubstantiated claims and anecdotal evidence, alleging that safer supply programs are generating a "new opioid epidemic", reflecting an emerging alignment among key institutional and political actors. Employing situational analysis method, and drawing on the policy studies and social science scholarship on moral panics, this essay examines news media coverage from January to July 2023, bringing this into dialogue with other existing empirical sources on safer supply (e.g. Coroner's reports, program evaluations, debates among experts in medical journals). We employ eight previously established criteria delineating moral panics to critically appraise public dialogue regarding safer supply, diverted medication, and claims of increased youth initiation to drug use and youth overdose. In detailing the emergence of a moral panic regarding safer supply, we trace historic continuities with earlier drug scares in Canadian history mobilized as tools of racialized poverty governance, as well as previous backlashes towards healthcare interventions for people who use drugs (PWUD). The essay assesses the claims of moral entrepreneurs against the current landscape of opioid use, diversion, and overdose among youth, notes the key role played by medical expertise in this and previous moral panics, and identifies what the convergence of these narratives materialize for PWUD and healthcare access, as well as the broader policy responses such narratives activate.
Collapse
Affiliation(s)
- Liam Michaud
- Graduate Program in Socio-Legal Studies, York University, Toronto, ON, Canada; Nathanson Centre on Transnational Human Rights, Crime and Security, York University, Toronto, ON, Canada.
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada; Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | | | - Adrian Guta
- School of Social Work, University of Windsor, ON, Canada
| |
Collapse
|
5
|
Bailey A, Harps M, Belcher C, Williams H, Amos C, Donovan B, Sedore G, Victoria S, Graham B, Goulet-Stock S, Cartwright J, Robinson J, Farrell-Low A, Willson M, Sutherland C, Stockwell T, Pauly B. Translating the lived experience of illicit drinkers into program guidance for cannabis substitution: Experiences from the Canadian Managed Alcohol Program Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104244. [PMID: 37950943 DOI: 10.1016/j.drugpo.2023.104244] [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] [Received: 06/07/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/13/2023]
Abstract
A small but growing body of research has suggested the potential for cannabis substitution to support Managed Alcohol Program (MAP) service users to reduce acute and chronic alcohol-related harms. In 2022, researchers from the Canadian Managed Alcohol Program Study (CMAPS) noted a dearth of accessible, alcohol-specific educational resources to support service users and program staff to implement cannabis substitution pilots at several MAP sites in Canada. In this essay, we draw on over 10-years of collaboration between CMAPS, and organizations of people with lived experience (the Eastside Illicit Drinkers Group for Education (EIDGE) and SOLID Victoria) to describe our experiences co-creating cannabis education resources where none existed to support MAP sites interested in beginning to provide cannabis to participants. The research team relied on the unique lived experiences and informal cannabis-related harm reduction strategies described by EIDGE and SOLID members to create cannabis education resources that were accurate and relevant to MAP sites. EIDGE was familiar with creating peer-oriented educational resources and convened meetings and focus groups to engage peers. CMAPS research team members created standard cannabis unit equivalencies to support program delivery, and clinical advisors ensured that the stated risks and benefits of cannabis substitution, as well as tapering guidance for withdrawal management, were safe and feasible. The collaboration ultimately produced tailored client-facing and provider-facing resources. Our experience demonstrates that the lived expertise of drinkers can play an integral role in creating alcohol harm reduction informational materials, specifically those related to cannabis substitution, when combined with data from rigorous, community-based programs of research like CMAPS. We close by listing additional considerations for cannabis substitution program design for MAP settings emerging from this process of collaboration between illicit drinkers, service providers, clinicians, and researchers for consideration by other programs.
Collapse
Affiliation(s)
- Aaron Bailey
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada.
| | - Myles Harps
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada
| | - Clint Belcher
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada
| | - Henry Williams
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada
| | - Cecil Amos
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada
| | - Brent Donovan
- SOLID Victoria, 1056 N Park Street, Victoria, BC V8T 1C6, Canada
| | - George Sedore
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada
| | - Solid Victoria
- SOLID Victoria, 1056 N Park Street, Victoria, BC V8T 1C6, Canada
| | - Brittany Graham
- Vancouver Area Network of Drug Users, 380 E Hastings Street, Vancouver BC V6A 1P4, Canada
| | - Sybil Goulet-Stock
- Department of Psychology, University of Victoria, 3800 Finnerty Rd, Cornett Building (COR), A236, Victoria, BC V8P 5C2, Canada
| | - Jenny Cartwright
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada
| | - Jennifer Robinson
- Department of Anthropology, University of Victoria, 3800 Finnerty Rd, Cornett Building (COR), B228, Victoria, BC V8P 5C2, Canada
| | - Amanda Farrell-Low
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada
| | - Mark Willson
- SOLID Victoria, 1056 N Park Street, Victoria, BC V8T 1C6, Canada
| | - Christy Sutherland
- PHS Community Services Society, 9 E Hastings St, Vancouver, BC V6A 1M9, Canada
| | - Tim Stockwell
- Department of Psychology, University of Victoria, 3800 Finnerty Rd, Cornett Building (COR), A236, Victoria, BC V8P 5C2, Canada
| | - Bernie Pauly
- Department of Nursing, University of Victoria, 3800 Finnerty Rd, HSD Building, A402A, Victoria BC V8P 5C2, Canada
| |
Collapse
|
6
|
Bailey A, Graham B, Harps M, Sedore G. Vancouver's Alcohol Knowledge Exchange: lessons learned from creating a peer-involved alcohol harm reduction strategy in Vancouver's Downtown Eastside. Harm Reduct J 2023; 20:93. [PMID: 37495993 PMCID: PMC10373358 DOI: 10.1186/s12954-023-00838-2] [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: 09/01/2022] [Accepted: 07/22/2023] [Indexed: 07/28/2023] Open
Abstract
Despite high rates of harm attributable to alcohol use itself and the associated marginalization of illicit drinkers in Vancouver's Downtown Eastside (DTES), alcohol-specific harm reduction services there are under-resourced and highly disconnected from one another. In response to these conditions and high rates of death amongst its membership, the Eastside Illicit Drinkers Group for Education, an affiliate group of the Vancouver Area Network of Drug Users, convened a regular meeting of stakeholders, termed a "community of practice" in 2019 to bring together peers who used beverage and non-beverage alcohol, shelter and harm reduction service providers, public health professionals, clinicians, and policymakers to improve system-level capacity to reduce alcohol-related harm. The discussions that followed from these meetings were transformed into the Vancouver Alcohol Strategy (VAS), a comprehensive, harm reduction-oriented policy framework for alcohol harm reduction in the DTES. This article highlights our experiences producing community-led alcohol policy through the VAS with specific attention to the ways in which people who use alcohol themselves were centred throughout the policy development process. We also provide summary overviews of each of the VAS document's 6 thematic areas for action, highlighting a sampling of the 47 total unique recommendations. Historically, people who use non-beverage alcohol and whose use of alcohol in public spaces is criminalized due to housing precarity and visible poverty have been excluded from the development of population-level alcohol policies that can harm this specific population. The process of policy development undertaken by the VAS has attempted to resist this top-down approach to public health policy development related to alcohol control by intentionally creating space for people with lived experience to guide our recommendations. We conclude by suggesting that a grassroots enthusiasm for harm reduction focused policy development exists in Vancouver's DTES, and requires resources from governmental public health institutions to meaningfully prevent and reduce alcohol-related and policy-induced harms.
Collapse
Affiliation(s)
- Aaron Bailey
- Eastside Illicit Drinkers Group for Education, Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada.
| | - Brittany Graham
- Eastside Illicit Drinkers Group for Education, Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| | - Myles Harps
- Eastside Illicit Drinkers Group for Education, Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| | - George Sedore
- Eastside Illicit Drinkers Group for Education, Vancouver Area Network of Drug Users, 380 East Hastings Street, Vancouver, BC, V6A 1P4, Canada
| |
Collapse
|
7
|
Emslie C, Dimova E, O'Brien R, Whiteford M, Johnsen S, Rush R, Smith ID, Stockwell T, Whittaker A, Elliott L. The impact of alcohol minimum unit pricing on people with experience of homelessness: Qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104095. [PMID: 37307788 DOI: 10.1016/j.drugpo.2023.104095] [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: 03/21/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Alcohol Minimum Unit Pricing (MUP) was introduced in Scotland in May 2018. Existing evidence suggests MUP can reduce alcohol consumption in the general population, but there is little research about its impact on vulnerable groups. This qualitative study explored experiences of MUP among people with experience of homelessness. METHODS We conducted qualitative semi-structured interviews with a purposive sample of 46 people with current or recent experience of homelessness who were current drinkers when MUP was introduced. Participants (30 men and 16 women) were aged 21 to 73 years. Interviews focused on views and experiences of MUP. Data were analysed using thematic analysis. RESULTS People with experience of homelessness were aware of MUP but it was accorded low priority in their hierarchy of concerns. Reported impacts varied. Some participants reduced their drinking, or moved away from drinking strong white cider, in line with policy intentions. Others were unaffected because the cost of their preferred drink (usually wine, vodka or beer) did not change substantially. A minority reported increased involvement in begging. Wider personal, relational and social factors also played an important role in responses to MUP. CONCLUSION This is the first qualitative study to provide a detailed exploration of the impact of MUP among people with experience of homelessness. Our findings suggest that MUP worked as intended for some people with experience of homelessness, while a minority reported negative consequences. Our findings are of international significance to policymakers, emphasising the need to consider the impact of population level health policies on marginalised groups and the wider contextual factors that affect responses to policies within these groups. It is important to invest further in secure housing and appropriate support services and to implement and evaluate harm reduction initiatives such as managed alcohol programmes.
Collapse
Affiliation(s)
- Carol Emslie
- Research Centre for Health (ReaCH), Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK.
| | - Elena Dimova
- Research Centre for Health (ReaCH), Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
| | - Rosaleen O'Brien
- Research Centre for Health (ReaCH), Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
| | - Martin Whiteford
- Research Centre for Health (ReaCH), Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
| | - Sarah Johnsen
- Institute for Social Policy, Housing and Equalities Research (I-SPHERE), Heriot-Watt University, Riccarton, Edinburgh, EH14 4AS, Scotland, UK
| | - Robert Rush
- Independent consultant, 16a Denham Green Terrace, Edinburgh, EH5 3PF, Scotland, UK
| | - Iain D Smith
- Substance Use Service, St Ninians Community Hub, Mayfield Street, Stirling, FK7 0BS, Scotland, UK
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, Canada
| | - Anne Whittaker
- NMAHP Research Unit, Faculty of Health Sciences and Sport, Pathfoot Building, University of Stirling, FK9 4LA, Scotland, UK
| | - Lawrie Elliott
- Research Centre for Health (ReaCH), Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
| |
Collapse
|
8
|
Vu TT, Dario JP, Mateu-Gelabert P, Levine D, Punter MA, Borrell LN, Ngo VK. Alcohol Misuse, Binge Drinking, and their Associations with Psychosocial Factors during COVID-19 among Harlem Residents in New York City. J Urban Health 2023; 100:638-648. [PMID: 37249819 PMCID: PMC10228422 DOI: 10.1007/s11524-023-00738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
This study examined alcohol misuse and binge drinking prevalence among Harlem residents, in New York City, and their associations with psycho-social factors such as substance use, depression symptom severity, and perception of community policing during COVID-19. An online cross-sectional study was conducted among 398 adult residents between April and September 2021. Participants with a score of at least 3 for females or at least 4 for males out of 12 on the Alcohol Use Disorders Identification Test were considered to have alcohol misuse. Binge drinking was defined as self-reporting having six or more drinks on one occasion. Modified Poisson regression models were used to examine associations. Results showed that 42.7% used alcohol before COVID-19, 69.1% used it during COVID-19, with 39% initiating or increasing alcohol use during COVID-19. Alcohol misuse and binge drinking prevalence during COVID-19 were 52.3% and 57.0%, respectively. Higher severity of depression symptomatology, history of drug use and smoking cigarettes, and experiencing housing insecurity were positively associated with both alcohol misuse and binge drinking. Lower satisfaction with community policing was only associated with alcohol misuse, while no significant associations were found between employment insecurity and food insecurity with alcohol misuse or binge drinking. The findings suggest that Harlem residents may have resorted to alcohol use as a coping mechanism to deal with the impacts of depression and social stressors during COVID-19. To mitigate alcohol misuse, improving access to mental health and substance use disorder services, and addressing public safety through improving relations with police could be beneficial.
Collapse
Affiliation(s)
- Thinh T Vu
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA.
- Department of Community Health and Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA.
| | - Joseph P Dario
- Division of Pediatric Critical Care, Mount Sinai Kravis Children's Hospital, New York, NY, USA
| | - Pedro Mateu-Gelabert
- Department of Community Health and Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
| | - Deborah Levine
- Harlem Health Initiative, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
| | - Malcolm A Punter
- Harlem Congregations for Community Improvement, Inc., New York, NY, USA
| | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
| | - Victoria K Ngo
- Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
- Department of Community Health and Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, NY, USA
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Brothers TD, Walley AY, Rivers-Bowerman H, McLeod M, Genge L. Grayken lessons: between a rock and a hard place? A 37-year-old man with acute liver injury while enrolled in a managed alcohol program for severe alcohol use disorder. Addict Sci Clin Pract 2023; 18:14. [PMID: 36879279 PMCID: PMC9988200 DOI: 10.1186/s13722-023-00370-5] [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: 11/09/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Managed alcohol programs aim to reduce health and social harms associated with severe alcohol use disorder. Here, we describe a young man with severe alcohol use disorder enrolled in a managed alcohol program, who was admitted to hospital with acute liver injury. Fearing that alcohol was contributing, the inpatient care team discontinued the managed alcohol dose in hospital. He was ultimately diagnosed with cephalexin-induced liver injury. After consideration of risks, benefits, and alternative options, the patient and care team jointly decided to restart managed alcohol after hospital discharge. With this case, we describe managed alcohol programs and summarize the emerging evidence-base, including eligibility criteria and outcome measures; we explore clinical and ethical dilemmas in caring for patients with liver disease within managed alcohol programs; and we emphasize principles of harm reduction and patient-centered care when establishing treatment plans for patients with severe alcohol use disorder and unstable housing.
Collapse
Affiliation(s)
- Thomas D Brothers
- Department of Medicine, Dalhousie University, Halifax, NS, Canada. .,Institute of Epidemiology and Health Care, UCL Collaborative Centre for Inclusion Health, University College London, London, UK.
| | - Alexander Y Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, MA, USA
| | - Helen Rivers-Bowerman
- Mobile Outreach Street Health (MOSH), North End Community Health Centre, Halifax, NS, Canada
| | - Magnus McLeod
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Leah Genge
- Mobile Outreach Street Health (MOSH), North End Community Health Centre, Halifax, NS, Canada.,Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
11
|
Motta-Ochoa R, Incio-Serra N, Brulotte A, Flores-Aranda J. Motives for alcohol use, risky drinking patterns and harm reduction practices among people who experience homelessness and alcohol dependence in Montreal. Harm Reduct J 2023; 20:22. [PMID: 36829166 PMCID: PMC9955533 DOI: 10.1186/s12954-023-00757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 02/15/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND People experiencing homelessness are disproportionately affected by harms related to alcohol use. Indeed, their alcohol dependence is associated with numerous physical and mental health problems along with strikingly high rates of alcohol-related mortality. Recent research has extensively examined alcohol use patterns among people experiencing homelessness in an effort to develop interventions and treatments for this problem. However, only a few studies have incorporated the perspectives of the individuals under study about their drinking or examined the ways in which they manage the associated harms. To bridge this gap, we conducted a qualitative study exploring the relation between the drinking motives, risky drinking patterns and harm reduction practices of a group of people (n = 34) experiencing homelessness in Montreal, Canada. METHODS The qualitative methods we used consisted of semi-structured interviews (n = 12) and focus groups (n = 2, with a total of 22 participants). The content of the collected data was then analyzed. RESULTS Participants identified their various motives for alcohol use (coping with painful memories, dealing with harsh living conditions, socializing/seeking a sense of belonging, enjoying themselves/having fun); their risky drinking patterns (binge drinking, mixing alcohol with drugs, non-beverage alcohol drinking, failing to keep sufficient alcohol on hand to prevent acute withdrawal, drinking in public settings); their harm reduction practices (planning how much to drink, keeping a supply of alcohol to prevent acute withdrawal, hiding to drink, concealing alcohol, drinking alone, drinking/hanging out with others, drinking non-beverage alcohol, and taking benzodiazepines, cocaine or other stimulant drugs); and the rationales underpinning their alcohol use and harm reduction practices. CONCLUSION Associating the drinking motives of a group of study participants with their risky drinking patterns and harm reduction practices shed light on their rationales for alcohol use, yielding insights that could be used to better tailor policies and interventions to their needs.
Collapse
Affiliation(s)
- Rossio Motta-Ochoa
- grid.38678.320000 0001 2181 0211École de travail social, Université du Québec à Montréal, 455 René-Lévesque Blvd. Est Local W-4020, Montreal, QC H2L 4Y2 Canada ,grid.14848.310000 0001 2292 3357École de travail social, Université de Montréal, Pavillon Lionel-Groulx, 3150 Jean-Brillant Street (C-7075), Montreal, QC H3T 1J7 Canada ,Canada Research Chair in Sexually and Gender Diverse Individuals (SGD) and Their Psychoactive Substance Use Trajectories (TRADIS Chair), Montreal, Canada
| | - Natalia Incio-Serra
- grid.14709.3b0000 0004 1936 8649Faculty of Education, McGill University, 3700 McTavish Street, Montreal, QC H3A 1Y2 Canada
| | - Alexandre Brulotte
- grid.38678.320000 0001 2181 0211École de travail social, Université du Québec à Montréal, 455 René-Lévesque Blvd. Est Local W-4020, Montreal, QC H2L 4Y2 Canada ,Canada Research Chair in Sexually and Gender Diverse Individuals (SGD) and Their Psychoactive Substance Use Trajectories (TRADIS Chair), Montreal, Canada
| | - Jorge Flores-Aranda
- École de travail social, Université du Québec à Montréal, 455 René-Lévesque Blvd. Est Local W-4020, Montreal, QC, H2L 4Y2, Canada. .,Canada Research Chair in Sexually and Gender Diverse Individuals (SGD) and Their Psychoactive Substance Use Trajectories (TRADIS Chair), Montreal, Canada.
| |
Collapse
|
12
|
Dimova ED, Strachan H, Johnsen S, Emslie C, Whiteford M, Rush R, Smith I, Stockwell T, Whittaker A, Elliott L. Alcohol minimum unit pricing and people experiencing homelessness: A qualitative study of stakeholders' perspectives and experiences. Drug Alcohol Rev 2023; 42:81-93. [PMID: 36169446 PMCID: PMC10087680 DOI: 10.1111/dar.13548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Minimum unit pricing (MUP) may reduce harmful drinking in the general population, but there is little evidence regarding its impact on marginalised groups. Our study is the first to explore the perceptions of MUP among stakeholders working with people experiencing homelessness following its introduction in Scotland in May 2018. METHODS Qualitative semi-structured interviews were conducted with 41 professional stakeholders from statutory and third sector organisations across Scotland. We explored their views on MUP and its impact on people experiencing homelessness, service provision and implications for policy. Data were analysed using thematic analysis. RESULTS Participants suggested that the introduction of MUP in Scotland had negligible if any discernible impact on people experiencing homelessness and services that support them. Most service providers felt insufficiently informed about MUP prior to its implementation. Participants reported that where consequences for these populations were evident, they were primarily anticipated although some groups were negatively affected. People experiencing homelessness have complex needs in addition to alcohol addiction, and changes in the way services work need to be considered in future MUP-related discussions. DISCUSSION AND CONCLUSIONS This study suggests that despite initial concerns about potential unintended consequences of MUP, many of these did not materialise to the levels anticipated. As a population-level health policy, MUP is likely to have little beneficial impact on people experiencing homelessness without the provision of support to address their alcohol use and complex needs. The additional needs of certain groups (e.g., people with no recourse to public funds) need to be considered.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Anne Whittaker
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Scotland, UK
| | | |
Collapse
|
13
|
Johnson IM, Light MA, Perry TE, Moore M, Lewinson T. Understanding the Ephemeral Moment of COVID Avoidance Hotels: Lessons Learned from Acknowledging Housing as Central to Dignified Later Life. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:3-28. [PMID: 35695062 PMCID: PMC9744961 DOI: 10.1080/01634372.2022.2087129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Place and health are intricately bound. COVID has amplified system burdens and health risks within the housing care continuum, in which older adults with chronic illnesses are disproportionately represented. The paper identifies the health experiences of older adults with severe conditions living in and moving through temporary avoidance hotels during the COVID-19 pandemic. An interpretive descriptive approach was taken with qualitative chart data and provider observation to represent the experiences of 14 older avoidance hotel residents living with serious illnesses. Through provider documentation, we illustrate trends pre-pandemic, in the first nine months of the pandemic, and the second nine months. Such trends include strengths and opportunities such as the health-affirming nature of avoidance hotels, their potential in generating continuity of care and permanent housing, and synergy between harm reduction approaches and palliative care. Challenges were also identified in catering to the diverse medical, behavioral, and psychosocial-spiritual needs of older and seriously ill residents and the consequences of geographic dispersion on health care, health behaviors, and informal care networks. Through these strengths and challenges, avoidance hotels present essential lessons in considering future housing and healthcare intervention and implementation that addresses the needs of older seriously ill people facing homelessness and housing precarity.
Collapse
Affiliation(s)
- Ian M Johnson
- Dept of Social Work, University of Tennessee College of Social Work, Knoxville, Tennessee, USA
| | - Michael A Light
- Dept of Social Work, Palliative Care Training Center, University of Washington, Seattle, Washington, USA
| | - Tam E Perry
- Wayne State University School of Social Work, Detroit, Michigan, USA
| | - Megan Moore
- Dept of Social Work, University of Washington, Seattle, Washington, USA
| | - Terri Lewinson
- Dartmouth College Institute for Health Policy & Clinical Practice Lebanon, New Hampshire, USA
| |
Collapse
|
14
|
Lusk HM, Shaku D, Hemrajani A, Leverenz N, Moefu-Kaleopa J, Staley AF. Housing First: Harm Reduction at the Intersection of Homelessness and Substance Use. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:6-11. [PMID: 36660275 PMCID: PMC9783810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Despite a considerable overlap between people experiencing homelessness and people living with substance use disorder, there is a marked lack of integration between Hawai'i's systems of care for these populations. This gap in the current system of care often creates barriers to services for those living at the nexus of homelessness and substance use. This article describes Hawai'i's current homelessness and substance use systems of care, paying particular attention to the intersection between these two systems. With Hawai'i consistently ranking among the highest per capita rates of homelessness in the United States, this article argues that the intersection of homelessness and substance use is a pivotal site of intervention for addressing significant social problems. This article positions the Housing First paradigm as a critical model for bridging gaps and eliminating barriers in service provision through systems integration at the program level. Greater fidelity to the broader harm reduction principles underlying this model will effectively organize and equip programs to successfully address the needs of people experiencing homelessness and struggling with substance use.
Collapse
Affiliation(s)
- Heather M. Lusk
- Hawai‘i Health & Harm Reduction Center, Action with Aloha, Honolulu, HI (HML, DS, NL, JM-K, AFS)
| | - David Shaku
- Hawai‘i Health & Harm Reduction Center, Action with Aloha, Honolulu, HI (HML, DS, NL, JM-K, AFS)
| | | | - Nikos Leverenz
- Hawai‘i Health & Harm Reduction Center, Action with Aloha, Honolulu, HI (HML, DS, NL, JM-K, AFS)
| | - Juliana Moefu-Kaleopa
- Hawai‘i Health & Harm Reduction Center, Action with Aloha, Honolulu, HI (HML, DS, NL, JM-K, AFS)
| | - Andrea F. Staley
- Hawai‘i Health & Harm Reduction Center, Action with Aloha, Honolulu, HI (HML, DS, NL, JM-K, AFS)
| |
Collapse
|
15
|
Carver H, Parkes T, Masterton W, Booth H, Ball L, Murdoch H, Falzon D, Pauly BM. The Potential for Managed Alcohol Programmes in Scotland during the COVID-19 Pandemic: A Qualitative Exploration of Key Areas for Implementation Using the Consolidated Framework for Implementation Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15207. [PMID: 36429926 PMCID: PMC9690644 DOI: 10.3390/ijerph192215207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
People experiencing homelessness and alcohol dependence are at increased risk of a range of harms, including from COVID-19. Managed Alcohol Programmes (MAPs) are an alcohol harm reduction intervention specifically for this group. In this paper we report on qualitative findings of a mixed methods study investigating the potential utility of MAPs during the COVID-19 pandemic in Scotland. Interviews, conducted with 40 participants, explored potential views of implementing MAPs during the pandemic. Theoretically, we drew on the Consolidated Framework for Implementation Research (CFIR) to inform data collection and analysis. Six themes were identified which mapped onto three CFIR domains: perceptions of MAPs and the evidence base; necessary components of MAPs; changing culture of alcohol harm reduction; MAPs as a moral and ethical grey area; addressing a service gap; and securing buy-in and partnership working. Participants were generally positive about MAPs and viewed them as a key intervention to address a service gap. Several necessary components were identified for successful implementation of MAPs. Securing buy-in from a range of stakeholders and partnership working were deemed important. Finally, MAPs require careful, long-term planning before implementation. We conclude that MAPs are needed in Scotland and require long-term funding and appropriate resources to ensure they are successful.
Collapse
Affiliation(s)
- Hannah Carver
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - Wendy Masterton
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - Hazel Booth
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - Lee Ball
- Homelessness Services Unit, The Salvation Army, London SE1 6BN, UK
| | - Helen Murdoch
- Homelessness Services Unit, The Salvation Army, London SE1 6BN, UK
| | - Danilo Falzon
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK
| | - Bernie M. Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada
| |
Collapse
|
16
|
Myers N, Hutnyan M, Wright G, Lee G, Woodward P, Wilkey J, Young W, Bromley E. Lessons in "Slow" Engagement From Staff and Administrators at a Prebooking Jail Diversion Program. Psychiatr Serv 2022; 73:1117-1122. [PMID: 35414189 DOI: 10.1176/appi.ps.202100317] [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: 11/30/2022]
Abstract
OBJECTIVE In this study, the authors elicited the perspectives of criminal justice and mental health stakeholders about a prebooking jail diversion program, the Judge Ed Emmett Mental Health Diversion Center, serving primarily individuals experiencing chronic homelessness and diagnosed as having a serious mental illness. METHODS The authors analyzed semistructured interviews with 19 participants and observational fieldnotes from 60 hours of ethnographic fieldwork, conducted from January to July 2020 and including five administrative-level meetings. They used qualitative coding to develop themes. Administrative data were also reviewed. RESULTS Engagement of clients in the program was a major theme. Barriers to engagement included clients’ fear of police involvement and strict rules around smoking. Facilitators to engagement included “slow” engagement, or gradual, gentle microengagements over time and across multiple visits, ideally with peer counselors. CONCLUSIONS To promote client use of services at this critical point of care, jail diversion programs might consider ongoing negotiations with clients to balance expectations between the criminal justice and mental health systems of care by using “slow” client engagement, limiting police involvement, and adopting trauma-informed and harm-reduction approaches.
Collapse
Affiliation(s)
- Neely Myers
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Matthew Hutnyan
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Gillian Wright
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Garrett Lee
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Paula Woodward
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Justin Wilkey
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Wayne Young
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Elizabeth Bromley
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| |
Collapse
|
17
|
Abstract
Although many of the tenets of harm reduction have been around for centuries and more traditional harm reduction services such as syringe services programs have been in existence for decades, there has been a recent increase in interest and acceptance of harm reduction as an essential component of a public health approach to substance use. This article provides an overview of harm reduction and its application to alcohol, tobacco, and drug use. It discusses the importance of integrating harm reduction principles and services with traditional psychiatric, medical, and addiction treatment programs.
Collapse
Affiliation(s)
- Avinash Ramprashad
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 701 W Pratt St, 2nd Floor Suite 289, Baltimore, MD 21201, USA
| | - Gregory Malik Burnett
- Center for Addiction Medicine, University of Maryland Midtown Campus, 827 Linden Avenue 4th Floor, Suite 405, Baltimore MD 21201 USA; Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 22 S. Greene Street S-1-D-04, Baltimore, MD 21201, USA.
| | - Christopher Welsh
- Division of Addiction Research and Treatment, Department of Psychiatry, University of Maryland School of Medicine, 22 S. Greene Street S-1-D-04, Baltimore, MD 21201, USA
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Lugoboni F, Stella L, Zamboni L, Campagnari S, Fusina F, De Bernardis E. COVID-19 vaccination and drug users: Past, present, and future. J Public Health Res 2022; 11:22799036221105314. [PMID: 35966046 PMCID: PMC9373134 DOI: 10.1177/22799036221105314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022] Open
Abstract
Vaccination against COVID-19 is crucial in the attempt of containing the virus’
spread, but facing a viral pathogen with such a high prevalence means that
vaccination strategies are facing an unprecedented situation. People that use
illicit drugs may have elevated risk of adverse outcomes from COVID-19 given
their high prevalence of underlying medical conditions, including respiratory
and pulmonary disease, chronic liver disease, cardiovascular and cerebrovascular
conditions, diabetes, and compromised immune systems. Despite a widespread
distribution on the Italian territory, a large presence of health personnel and
a long-standing experience in vaccinations, addiction clinics have yet to be
involved in the vaccination campaign against COVID-19. The aim of this study was
to investigate the beliefs of drug users attending some Italian addiction
clinics, in order to envisage any vaccine administration strategies involving
the services themselves. A questionnaire used for the Italian general population
to investigate the relative importance of some factors in influencing the
propensity to vaccinate against COVID-19, was administrated to drug users in a
multicenter survey. The majority of respondents expressed general confidence in
vaccines and a good willingness to undergo vaccination. Given strong peer
networks, high coverage of treatment and harm reduction interventions, Italian
public addiction clinics could play a strategic role in administering the
vaccine in this hard-to-reach population, usefully aiding the global campaign
against the virus.
Collapse
Affiliation(s)
- Fabio Lugoboni
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | | | - Lorenzo Zamboni
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy.,Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Campagnari
- Department of Medicine, Addiction Medicine Unit, Verona University Hospital, Verona, Italy
| | - Francesca Fusina
- Department of General Psychology, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | | |
Collapse
|
20
|
Motta-Ochoa R, Incio-Serra N, Poliquin H, MacDonald SA, Huỳnh C, Côté PB, Fallu JS, Flores-Aranda J. "A place to be safe, feel at home and get better": including the experiential knowledge of potential users in the design of the first wet service in Montreal, Canada. Harm Reduct J 2022; 19:34. [PMID: 35382814 PMCID: PMC8985343 DOI: 10.1186/s12954-022-00616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background The harmful use of alcohol is one of the leading health risk factors for people’s health worldwide, but some populations, like people who experience homelessness, are more vulnerable to its detrimental effects. In the past decades, harm reduction interventions that target these complex issues has been developed. For example, wet services include a wide range of arrangements (wet shelters, drop-in centers, transitory housing, etc.) that allow indoor alcohol use and Managed Alcohol Programs provide regulated doses of alcohol in addition to accommodation and services. Although the positive impacts of these interventions have been reported, little is known about how to integrate the knowledge of people experiencing homelessness and alcohol dependence into the design of such programs. The aim of this study is to present the findings of such an attempt in a first wet service in Montreal, Canada.
Methods Community based participatory research approach and qualitative methods—including semi-structured interviews and focus groups—were used to collect the knowledge of potential users (n = 34) of the wet service. The data collected was thematically analyzed. Results Participants reported experiencing harsh living conditions, poverty, stigmatization and police harassment, which increased their alcohol use. The intersection between participants’ alcohol dependence and homelessness with the high barriers to access public services translated into their exclusion from several of such services. Participants envisioned Montreal’s wet service as a safe space to drink, a place that would provide multiple services, a home, and a site of recovery. Conclusions Integrating the knowledge of potential users into the design of harm reduction interventions is essential to develop better and more adapted services to meet complex needs. We propose that it could fosters users’ engagement and contribute to their sense of empower, which is crucial for a group that is typically discriminated against and suffers from marginalization.
Collapse
Affiliation(s)
- Rossio Motta-Ochoa
- École de travail social, Université du Québec à Montréal, 455, boul. René-Lévesque Est Local W-4020, Montreal, Québec, H2L 4Y2, Canada
| | - Natalia Incio-Serra
- Faculty of Education, McGill University, 3700 McTavish Street, Montreal, Québec, H3A 1Y2, Canada
| | - Hélène Poliquin
- National Collaborating Center for Healthy Public Policies at Institut national de santé publique du Québec, 190 Boul Crémazie E, Montreal, Québec, H2P 1E2, Canada
| | - Sue-Ann MacDonald
- École de travail social, Université de Montréal. Pavillon Lionel-Groulx, 3150, Jean-Brillant (C- 7069), Montreal, Québec, H3T 1J7, Canada
| | - Christophe Huỳnh
- École de psychoéducation, Université de Montréal. Pavillon Marie-Victorin, 90, av. Vincent- d'Indy, Montreal, Québec, H2V 2S9, Canada.,Département de psychiatrie et d'addictologie, Pavillon Roger-Gaudry, 2900, boul. Édouard- Montpetit, bureau S-750, Montreal, Québec, H3T 1J4, Canada.,Institut universitaire sur les dépendances, 950 rue de Louvain Est, Montreal, Québec, H2M 2E8, Canada
| | - Philippe-Benoit Côté
- Département de sexologie, Université du Québec à Montréal, 455, Boul. René-Lévesque Est, Montreal, Québec, H2L 4Y2, Canada
| | - Jean-Sébastien Fallu
- École de psychoéducation, Université de Montréal. Pavillon Marie-Victorin, 90, av. Vincent- d'Indy, Montreal, Québec, H2V 2S9, Canada.,Institut universitaire sur les dépendances, 950 rue de Louvain Est, Montreal, Québec, H2M 2E8, Canada
| | - Jorge Flores-Aranda
- École de travail social, Université du Québec à Montréal, 455, boul. René-Lévesque Est Local W-4020, Montreal, Québec, H2L 4Y2, Canada. .,Institut universitaire sur les dépendances, 950 rue de Louvain Est, Montreal, Québec, H2M 2E8, Canada.
| |
Collapse
|
21
|
Zhao J, Stockwell T, Pauly B, Wettlaufer A, Chow C. Participation in Canadian Managed Alcohol Programs and Associated Probabilities of Emergency Room Presentation, Hospitalization and Death: A Retrospective Cohort Study. Alcohol Alcohol 2022; 57:246-260. [PMID: 34999760 DOI: 10.1093/alcalc/agab078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Managed Alcohol Programs (MAPs) are designed to improve health and housing outcomes for unstably housed people with an alcohol use disorder (AUD). The present study assesses the association of MAP participation with healthcare and mortality outcomes. METHODS A retrospective cohort study assessed health outcomes for 205 MAP participants and 128 controls recruited from five Canadian cities in 2006-2017. Survival and negative binomial regression models were used to calculate hazard ratios (HR) of death and emergency room (ER) visits and hospital bed days (HBDs). Covariates included age, sex, AUD severity and housing stability score. RESULTS In fully adjusted models, compared with times outside MAPs, participants had significantly reduced risk of mortality (HR = 0.37, P = 0.0001) and ER attendance (HR = 0.74, P = 0.0002), and fewer HBDs yearly (10.40 vs 20.08, P = 0.0184). Over the 12 years, people enrolled in a MAP at some point had significantly fewer HBDs per year than controls after MAP enrolment (12.78 vs 20.08, P = 0.0001) but not significantly different rates of death or ER presentation. MAP participants had significantly more alcohol-related but significantly fewer nonalcohol-related ER presentations than controls. CONCLUSION Attendance at a MAP was associated with reduced risk of mortality or morbidity and less hospital utilization for individuals with unstable housing and severe AUDs. MAPs are a promising approach to reduce mortality risk and time spent in hospital for people with an AUD and experiencing homelessness.
Collapse
Affiliation(s)
- Jinhui Zhao
- University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada
| | - Tim Stockwell
- University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada
| | - Bernie Pauly
- University of Victoria, Canadian Institute for Substance Use Research (CISUR), 2300 McKenzie Ave, Victoria, BC V8N 5M8, Canada
| | - Ashley Wettlaufer
- Centre for Addiction & Mental Health, Institute for Mental Health Policy Research, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada
| | - Clifton Chow
- Vancouver Coastal Health Authority, 200-520 West 6th Avenue, Vancouver, BC V5Z 4H5, Canada
| |
Collapse
|
22
|
Brocious H, Trawver K, Demientieff LX. Managed alcohol: one community's innovative response to risk management during COVID-19. Harm Reduct J 2021; 18:125. [PMID: 34872581 PMCID: PMC8647061 DOI: 10.1186/s12954-021-00574-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/21/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Harm reduction programs often lack community-based support and can be controversial, despite data demonstrating effectiveness. This article describes one small Alaskan community's development of a harm reduction managed alcohol program (MAP) in the context of a city-run quarantine site for individuals experiencing homelessness. The MAP was developed to support quarantining by COVID-19-exposed or COVID-positive individuals who also experienced chronic homelessness, a severe alcohol use disorder, and heightened health risks related to potentially unsupported alcohol withdrawal. METHOD Five interviews with key informants involved in planning or implementation of the MAP were conducted using rapid qualitative analysis and narrative analysis techniques. OUTCOME This study documents the planning and implementation of an innovative application of a managed alcohol harm reduction intervention in the context of the COVID-19 pandemic. In this instance, a MAP was used specifically to limit hospital admissions for alcohol withdrawal during a surge of cases in the community, as well as to mitigate spread of the virus. Key informants report no residents enrolled in the MAP program as a part of quarantine required hospitalization for withdrawal or for COVID symptoms, and no shelter resident left the quarantine site while still contagious with COVID-19. Additionally, the level of community support for the program was much higher than originally expected by organizers. CONCLUSIONS This program highlighted an example of how a community recognized the complexity and potential risk to individuals experiencing structural vulnerability related to homelessness and a severe AUD, and the community at large, and was able to create an alternative path to minimize those risks using a harm reduction strategy.
Collapse
Affiliation(s)
- Heidi Brocious
- University of Alaska Anchorage, Professional Studies Building, Suite 234, 3211 Providence Drive, Anchorage, AK 99508 USA
| | - Kathi Trawver
- University of Alaska Anchorage, Professional Studies Building, Suite 234, 3211 Providence Drive, Anchorage, AK 99508 USA
| | | |
Collapse
|
23
|
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.
Collapse
|
24
|
Westenberg JN, Kamel MM, Addorisio S, Abusamak M, Wong JSH, Outadi A, Jang KL, Krausz RM. Non-beverage alcohol consumption among individuals experiencing chronic homelessness in Edmonton, Canada: a cross-sectional study. Harm Reduct J 2021; 18:108. [PMID: 34657618 PMCID: PMC8522138 DOI: 10.1186/s12954-021-00555-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Among individuals experiencing homelessness, the prevalence of alcohol use disorder is extremely high. Alcohol-related harms are compounded by the use of non-beverage alcohol (NBA; e.g. rubbing alcohol, cooking wine). The dangers of NBA consumption pose significant risks to the individual and to others when consumed in large quantities and when mixed with other substances. The objectives of this paper are to describe the alcohol consumption patterns of individuals experiencing homelessness, identify substance use patterns, psychological stressors, and related harms associated with NBA consumption, and compare NBA consumers to non-NBA consumers in relation to their use of services and perceived barriers to care. METHODS Using a cross-sectional survey, 150 individuals experiencing homelessness were recruited from Edmonton's inner city and adjoining areas. Frequency, quantity, and volume of alcohol consumption were used to assess patterns of alcohol use in the last 6 months. Descriptive statistics and bivariate analyses were used to compare participants reporting NBA consumption and non-NBA consumption (p ≤ 0.05). RESULTS The majority of participants were male (71.3%) and self-identified as Indigenous (74.0%). Overall, 24% (n = 36) reported NBA consumption within the last six months. NBA consumers were older than non-NBA consumers (p = 0.005), reported different perceived living stability (p = 0.022), and had higher psychological distress (p = 0.038). The majority of NBA consumers reported not receiving harm reduction services while also not needing such services (n = 18, 51.4%), which differed from non-NBA consumers (p = 0.003). Structural barriers (e.g. availability, location, cost) were most frequently reported as reasons for unmet harm reduction (60.9%) and hospital care (58.3%) needs, while barriers to skills training (58.5%) and counselling services (53.6%) were mostly motivational (e.g. personal beliefs). CONCLUSIONS Within such an already marginalized population experiencing homelessness, individuals who consume NBA represent a vulnerable subpopulation who require adapted and distinct health and social services to stabilize and recover. Current harm reduction services are not prepared to effectively assist this group of individuals, and specific treatment programs are rare. Managed alcohol programs are a feasible approach but must be tailored to the specific needs of those who consume NBA, which is especially important for Indigenous people. More comprehensive assessments of NBA consumption are needed for program development and policy recommendations.
Collapse
Affiliation(s)
- Jean Nicolas Westenberg
- Department of Psychiatry, University of British Columbia (UBC), David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Mostafa Mamdouh Kamel
- Department of Psychiatry, University of British Columbia (UBC), David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
- Department of Psychiatry, Tanta University, Tanta, Egypt
| | - Sindi Addorisio
- School of Public Health, University of Alberta, Edmonton, AB Canada
| | | | - James S. H. Wong
- Department of Psychiatry, University of British Columbia (UBC), David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Ava Outadi
- Department of Psychiatry, University of British Columbia (UBC), David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Kerry L. Jang
- Department of Psychiatry, University of British Columbia (UBC), David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - R. Michael Krausz
- Department of Psychiatry, University of British Columbia (UBC), David Strangway Building, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| |
Collapse
|
25
|
Parkes T, Carver H, Matheson C, Browne T, Pauly B. ‘It’s like a safety haven’: considerations for the implementation of managed alcohol programs in Scotland. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2021.1945536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Tessa Parkes
- 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
| | - Catriona Matheson
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Tania Browne
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| |
Collapse
|
26
|
Pauly B, Brown M, Chow C, Wettlaufer A, Graham B, Urbanoski K, Callaghan R, Rose C, Jordan M, Stockwell T, Thomas G, Sutherland C. "If I knew I could get that every hour instead of alcohol, I would take the cannabis": need and feasibility of cannabis substitution implementation in Canadian managed alcohol programs. Harm Reduct J 2021; 18:65. [PMID: 34162375 PMCID: PMC8220712 DOI: 10.1186/s12954-021-00512-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background While there is robust evidence for strategies to reduce harms of illicit drug use, less attention has been paid to alcohol harm reduction for people experiencing severe alcohol use disorder (AUD), homelessness, and street-based illicit drinking. Managed Alcohol Programs (MAPs) provide safer and regulated sources of alcohol and other supports within a harm reduction framework. To reduce the impacts of heavy long-term alcohol use among MAP participants, cannabis substitution has been identified as a potential therapeutic tool. Methods To determine the feasibility of cannabis substitution, we conducted a pre-implementation mixed-methods study utilizing structured surveys and open-ended interviews. Data were collected from MAP organizational leaders (n = 7), program participants (n = 19), staff and managers (n = 17) across 6 MAPs in Canada. We used the Consolidated Framework for Implementation Research (CFIR) to inform and organize our analysis. Results Five themes describing feasibility of CSP implementation in MAPs were identified. The first theme describes the characteristics of potential CSP participants. Among MAP participants, 63% (n = 12) were already substituting cannabis for alcohol, most often on a weekly basis (n = 8, 42.1%), for alcohol cravings (n = 15, 78.9%,) and withdrawal (n = 10, 52.6%). Most MAP participants expressed willingness to participate in a CSP (n = 16, 84.2%). The second theme describes the characteristics of a feasible and preferred CSP model according to participants and staff. Participants preferred staff administration of dry, smoked cannabis, followed by edibles and capsules with replacement of some doses of alcohol through a partial substitution model. Themes three and four highlight organizational and contextual factors related to feasibility of implementing CSPs. MAP participants requested peer, social, and counselling supports. Staff requested education resources and enhanced clinical staffing. Critically, program staff and leaders identified that sustainable funding and inexpensive, legal, and reliable sourcing of cannabis are needed to support CSP implementation. Conclusion Cannabis substitution was considered feasible by all three groups and in some MAPs residents are already using cannabis. Partial substitution of cannabis for doses of alcohol was preferred. All three groups identified a need for additional supports for implementation including peer support, staff education, and counselling. Sourcing and funding cannabis were identified as primary challenges to successful CSP implementation in MAPs.
Collapse
Affiliation(s)
- Bernie Pauly
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada.,School of Nursing, University of Victoria, Victoria, BC, Canada
| | - Meaghan Brown
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada. .,School of Nursing, University of Victoria, Victoria, BC, Canada.
| | - Clifton Chow
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada.,Vancouver Coastal Health, Victoria, BC, Canada
| | - Ashley Wettlaufer
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Brittany Graham
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada.,Vancouver Area Network of Drug Users (VANDU), Vancouver, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Russell Callaghan
- Northern Medical Program, University of Northern British Columbia (UNBC), Prince George, BC, Canada.,School of Population and Public Health, University of British Columbia (UBC), Vancouver, BC, Canada
| | - Cindy Rose
- Canadian Mental Health Association Sudbury/Manitoulin, Sudbury, Ontario, Canada
| | | | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility, 2300 McKenzie Ave, Victoria, BC, V8P 5C2, Canada.,Department of Psychology, University of Victoria, Victoria, BC, Canada
| | - Gerald Thomas
- Ministry of Health, Province of British Columbia, Victoria, BC, USA
| | - Christy Sutherland
- PHS Community Services Society, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
27
|
Ristau J, Mehtani N, Gomez S, Nance M, Keller D, Surlyn C, Eveland J, Smith-Bernardin S. Successful implementation of managed alcohol programs in the San Francisco Bay Area during the COVID-19 crisis. Subst Abus 2021; 42:140-147. [PMID: 33848451 DOI: 10.1080/08897077.2021.1892012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: The COVID-19 crisis presents new challenges and opportunities in managing alcohol use disorders, particularly for people unable to shelter in place due to homelessness or other reasons. Requiring abstinence for shelter engagement is impractical for many with severe alcohol use disorders and poses a modifiable barrier to self-isolation orders. Managed alcohol programs (MAPs) have successfully increased housing adherence for those with physical alcohol dependence in Canada, but to our knowledge, they have not been implemented in the United States. To avoid life-threatening alcohol withdrawal syndromes and to support adherence to COVID-19 self-isolation and quarantine orders, MAPs were piloted by the public health departments of San Francisco and Alameda counties. Development of MAPs: We describe implementation of a first-in-the-nation alcohol use disorder intervention of a MAP that emerged at three public health isolation settings within San Francisco and Alameda counties in California. All three interventions utilized a similar process to develop the protocol and implement the MAP that included identification of champions for system-level advocacy and engagement of stakeholders. Implementation of MAPs: We describe the creation and implementation of the distinct protocols. We provide examples of iterative changes to workflow processes and key lessons learned pertaining to protocol development, acceptability by stakeholders, alcohol procurement, documentation, and assessment. We discuss safety considerations, noting that there were no deaths or serious adverse events in any of the patients of the MAP during the 2-month implementation period. Conclusions: MAP pilots have been implemented in the US to aid adherence to isolation and quarantine setting guidelines. Lessons learned provide a foundation for their expansion as a recognized public health intervention for individuals with severe alcohol use disorders who are unable to stabilize within existing care systems. Based on the success of MAP implementation, efforts are under way to investigate alcohol management in homeless populations more broadly.
Collapse
Affiliation(s)
- Jessica Ristau
- Division of General Internal Medicine, University of California, San Francisco, California, USA
| | - Nicky Mehtani
- Division of HIV, ID and Global Medicine, University of California, San Francisco, California, USA
| | - Seth Gomez
- Health Care for the Homeless, Alameda County Health Care Services Agency, San Leandro, California, USA
| | - Michelle Nance
- Department of Whole Person Integrated Care, San Francisco Department of Public Health, San Francisco, California, USA
| | - Devora Keller
- Department of Whole Person Integrated Care, San Francisco Department of Public Health, San Francisco, California, USA
| | - Colleen Surlyn
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Joanna Eveland
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Shannon Smith-Bernardin
- School of Nursing-Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, San Francisco, CA
| |
Collapse
|
28
|
Carver H, Parkes T, Browne T, Matheson C, Pauly B. Investigating the need for alcohol harm reduction and managed alcohol programs for people experiencing homelessness and alcohol use disorders in Scotland. Drug Alcohol Rev 2020; 40:220-230. [PMID: 33006255 DOI: 10.1111/dar.13178] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION AND AIMS Managed alcohol programs (MAP) are a harm reduction approach for those experiencing alcohol use disorders (AUD) and homelessness. These programs were developed in Canada and have had positive results; very few exist in the UK and Ireland. The aim of this study was to scope the feasibility and acceptability of implementing MAPs in Scotland. DESIGN AND METHODS Using mixed-methods, we conducted two linked phases of work. Quantitative data were collected from the case records of 33 people accessing eight third sector services in Scotland and analysed in SPSS using descriptive and inferential statistics. Qualitative data were collected in Scotland via semi-structured interviews with 29 individuals in a range of roles, including strategic informants (n = 12), service staff (n = 8) and potential beneficiaries (n = 9). Data were analysed using Framework Analysis in NVivo. RESULTS The case record review revealed high levels of alcohol use, related health and social harms, illicit drug use, withdrawal symptoms, and mental and physical health problems. Most participants highlighted a lack of alcohol harm reduction services and the potential of MAPs to address this gap for this group. DISCUSSION AND CONCLUSIONS Our findings highlight the potential for MAPs in Scotland to prevent harms for those experiencing homelessness and AUDs, due to high levels of need. Future research should examine the implementation of MAPs in Scotland in a range of service contexts to understand their effectiveness in addressing harms and promoting wellbeing for those experiencing AUDs and homelessness.
Collapse
Affiliation(s)
- Hannah Carver
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Tessa Parkes
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Tania Browne
- Salvation Army Centre for Addiction Services and Research, Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Bernie Pauly
- School of Nursing, University of Victoria, Victoria, Canada
| |
Collapse
|
29
|
Purcell-Khodr GC, Lee KSK, Conigrave JH, Webster E, Conigrave KM. What can primary care services do to help First Nations people with unhealthy alcohol use? A systematic review: Australia, New Zealand, USA and Canada. Addict Sci Clin Pract 2020; 15:31. [PMID: 32811549 PMCID: PMC7437002 DOI: 10.1186/s13722-020-00204-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 08/07/2020] [Indexed: 11/24/2022] Open
Abstract
Background First Nations peoples of Australia, New Zealand, the United States of America (USA) and Canada are more likely to be non-drinkers than other people in these countries. However, those who do drink may be at greater risk of alcohol-related harms (at a population level) due to the ongoing impacts from colonisation and associated oppression. Addressing unhealthy drinking (drinking above recommended limits including alcohol use disorders) in primary care settings is one important way to increase accessibility of treatment. Methods This systematic review identifies peer-reviewed studies of alcohol treatments delivered in primary care or other non-residential settings for First Nations peoples of Australia, New Zealand, USA and Canada. Literature searches were conducted in seven academic databases from their inception until March, 2020. We assessed evidence of treatment or implementation effectiveness, perceived acceptability or accessibility, and the study quality as assessed by the AXIS tool and by a measure of community participation in the research process. Results Twenty-eight studies were included, published between 1968 and 2018. Studies reported on a range of alcohol treatments, from brief intervention to ambulatory withdrawal management, relapse prevention medicines, and cultural therapies. Brief intervention was the most studied approach. Cultural healing practices and bicultural approaches were a key theme amongst several studies. Four studies measured treatment effectiveness, including one randomised controlled trial (naltrexone vs naltrexone plus sertraline vs placebo) and two uncontrolled trials of disulfiram. Of the six implementation studies, three were (hybrid) effectiveness-implementation designs. Most of the remaining studies (n = 21) focused on treatment accessibility or acceptability. Community participation in the research process was poorly reported in most studies. Conclusions Research evidence on how best to care for First Nations peoples with unhealthy alcohol use is limited. Trials of naltrexone and disulfiram presented promising results. Cultural and bicultural care were perceived as highly important to clinical staff and clients in several studies. More effectiveness studies on the full scope of alcohol treatments are needed. Greater community participation in research and more transparent reporting of this in study methods will be key to producing quality research that combines scientific rigour with cultural appropriateness.
Collapse
Affiliation(s)
- Gemma C Purcell-Khodr
- Faculty of Medicine and Health, Sydney School of Medicine; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Camperdown, NSW, Australia.
| | - K S Kylie Lee
- Faculty of Medicine and Health, Sydney School of Medicine; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Camperdown, NSW, Australia.,Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia
| | - James H Conigrave
- Faculty of Medicine and Health, Sydney School of Medicine; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Camperdown, NSW, Australia
| | - Emma Webster
- Faculty of Medicine and Health, School of Rural Health, The University of Sydney, Dubbo, NSW, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Sydney School of Medicine; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Camperdown, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| |
Collapse
|
30
|
Fond G, Tinland A, Boucekine M, Girard V, Loubière S, Boyer L, Auquier P. Improving the treatment and remission of major depression in homeless people with severe mental illness: The multicentric French Housing First (FHF) program. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109877. [PMID: 31987919 DOI: 10.1016/j.pnpbp.2020.109877] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 11/16/2022]
Abstract
AIMS The objectives of the present study were to determine the rates and associated factors of (i) MDD, (ii) antidepressant prescription and (iii) MDD non-remission in homeless subjects with bipolar disorder (BD) or schizophrenia (SZ). METHODS This multicenter study was conducted in 4 French cities. MDD was defined with the section L of the MINI. Unremitted MDD was defined by current antidepressant treatment and current MDD. RESULTS 700 subjects, mean aged 38 years and 82.5% men were included: 55.4% were diagnosed with MDD but only 10.4% were administered antidepressants. Violent victimization in the past 6 months, alcohol use disorder and current substance abuse disorder were associated with increased rates of MDD. 71.2% antidepressant-treated subjects were unremitted. BD diagnosis and substance abuse disorder were found to be associated with increased risk of unremitted MDD. BD-MDD patients were found to be twice more frequently administered antidepressants than SZ-MDD ones, however the non-remission rates were higher in BD subjects compared to SZ. No antidepressant class and no specific antipsychotic or mood stabilizer has been associated with higher or lower rates of remitted MDD. CONCLUSION MDD seems to be highly prevalent, underdiagnosed and undertreated in BD and SZ homeless subjects. Beyond antidepressants, add-on strategies including complementary agents, lithium, lamotrigine/carbamazepine or anti-inflammatory drugs and the specific care of alcohol and substance use disorders may be recommended to improve the prognosis of this specific population in addition to other interventions including housing and resocialization. Violent victimization is also frequent and should be specifically prevented in this vulnerable population.
Collapse
Affiliation(s)
- G Fond
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France.
| | - A Tinland
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France
| | - M Boucekine
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France; Assistance Publique Hôpitaux de Marseille, Service Epidémiologie et Economie de la Santé, Marseille, France
| | - V Girard
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France; Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - S Loubière
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France; Assistance Publique Hôpitaux de Marseille, Service Epidémiologie et Economie de la Santé, Marseille, France
| | - L Boyer
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France; Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France
| | - P Auquier
- Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France
| | | |
Collapse
|