1
|
Wolfe DM, Hutton B, Corace K, Chaiyakunapruk N, Ngorsuraches S, Nochaiwong S, Presseau J, Grant A, Dowson M, Palumbo A, Suschinsky K, Skidmore B, Bartram M, Garner G, DiGioacchino L, Pump A, Peters B, Konefal S, Eves AP, Thavorn K. Service-level barriers to and facilitators of accessibility to treatment for problematic alcohol use: a scoping review. Front Public Health 2023; 11:1296239. [PMID: 38106884 PMCID: PMC10722420 DOI: 10.3389/fpubh.2023.1296239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Services to treat problematic alcohol use (PAU) should be highly accessible to optimize treatment engagement. We conducted a scoping review to map characteristics of services for the treatment of PAU that have been reported in the literature to be barriers to or facilitators of access to treatment from the perspective of individuals with PAU. Methods A protocol was developed a priori, registered, and published. We searched MEDLINE®, Embase, the Cochrane Library, and additional grey literature sources from 2010 to April 2022 to identify primary qualitative research and surveys of adults with current or past PAU requiring treatment that were designed to identify modifiable characteristics of PAU treatment services (including psychosocial and pharmacologic interventions) that were perceived to be barriers to or facilitators of access to treatment. Studies of concurrent PAU and other substance use disorders were excluded. Study selection was performed by multiple review team members. Emergent barriers were coded and mapped to the accessibility dimensions of the Levesque framework of healthcare access, then descriptively summarized. Results One-hundred-and-nine included studies reported an extensive array of unique service-level barriers that could act alone or together to prevent treatment accessibility. These included but were not limited to lack of an obvious entry point, complexity of the care pathway, high financial cost, unacceptably long wait times, lack of geographically accessible treatment, inconvenient appointment hours, poor cultural/demographic sensitivity, lack of anonymity/privacy, lack of services to treat concurrent PAU and mental health problems. Discussion Barriers generally aligned with recent reviews of the substance use disorder literature. Ranking of barriers may be explored in a future discrete choice experiment of PAU service users. The rich qualitative findings of this review may support the design of new or modification of existing services for people with PAU to improve accessibility. Systematic Review Registration Open Science Framework doi: 10.17605/OSF.IO/S849R.
Collapse
Affiliation(s)
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kim Corace
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Institute of Mental Health Research at the Royal, Ottawa, ON, Canada
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
- Informatics, Decision Enhancement, and Analytics Sciences (IDEAS) Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, United States
| | | | - Surapon Nochaiwong
- Department of Pharmaceutical Care, Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Alyssa Grant
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Kelly Suschinsky
- Substance Use and Concurrent Disorders Program, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | | | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, ON, Canada
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
| | - Gordon Garner
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | | | - Andrew Pump
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | - Brianne Peters
- Community Addictions Peer Support Association, Ottawa, ON, Canada
| | - Sarah Konefal
- Canadian Centre on Substance Use and Addiction, Ottawa, ON, Canada
| | - Amy Porath Eves
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Pharmaceutical Care, Pharmacoepidemiology and Statistics Research Center, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
2
|
Lyden J, Loh R, Braun H, Terasaki D. Characterizing safer drinking strategies among hospitalized adults with severe alcohol use disorder; a cross-sectional secondary analysis. J Addict Dis 2023:1-5. [PMID: 37946362 DOI: 10.1080/10550887.2023.2275555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Safer drinking strategies (SDS) reduce alcohol-related harms in outpatient settings. Little is known about SDS among hospitalized patients. OBJECTIVE Evaluate SDS among hospitalized patients with alcohol use disorder (AUD) and assess for association with past-year acute-care utilization. METHODS We conducted a cross-sectional, secondary analysis of hospitalized adults with AUD at a safety-net hospital in Colorado from January-December 2021. Participants completed a questionnaire on SDS and were categorized as low (≤2 reported) or high SDS (≥3 reported). Past-year emergency department visits and hospital admissions were identified using the electronic health record. A Mann-Whitney test compared encounters between low and high SDS groups. RESULTS Among 43 hospitalized adults with AUD, 38 (88.4%) reported ≥1 SDS and 21 (48.8%) reported ≥3 SDS. The low SDS group had fewer past-year admissions than the high SDS group (U = 145.0, p = 0.015). CONCLUSION SDS are frequently identified by patients and may be an acceptable form of inpatient AUD management.
Collapse
Affiliation(s)
- Jennifer Lyden
- Division of Hospital Medicine, Department of Medicine, Denver Health, Denver, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ryan Loh
- Department of Behavioral Health, Denver Health, Denver, CO, USA
| | - Hannan Braun
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Medicine, Denver Health, Denver, CO, USA
| | - Dale Terasaki
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Behavioral Health, Denver Health, Denver, CO, USA
| |
Collapse
|
3
|
Terasaki D. Self-reported Past Experiences With Naltrexone and Attitudes Toward Daily Adherence Among High-utilization Patients With Alcohol Use Disorder. J Addict Med 2023; 17:371-372. [PMID: 37267196 DOI: 10.1097/adm.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Dale Terasaki
- Department of Behavioral Health Denver Health & Hospital Authority University of Colorado School of Medicine
| |
Collapse
|
4
|
Hawk KF, D'Onofrio G. Time to Treat Alcohol Use Disorder in the Emergency Department. Ann Emerg Med 2023; 81:450-452. [PMID: 36775724 DOI: 10.1016/j.annemergmed.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/20/2022] [Accepted: 11/14/2022] [Indexed: 02/13/2023]
Affiliation(s)
- Kathryn F Hawk
- Department of Emergency Medicine Yale School of Medicine, New Haven, CT
| | - Gail D'Onofrio
- Department of Emergency Medicine Yale School of Medicine, New Haven, CT.
| |
Collapse
|
5
|
Ciraldo K, Seraydarian M, Gasper J, DeFries T, Martin M. Extended-release naltrexone for people with alcohol use disorder on therapeutic anticoagulation: A case series. J Clin Pharm Ther 2022; 47:2393-2396. [PMID: 36511083 DOI: 10.1111/jcpt.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Individuals with medication adherence challenges or a preference for long-acting medications may benefit from extended-release naltrexone (XR-NTX) for treatment of alcohol use disorder (AUD). Individuals on therapeutic anticoagulation were excluded from XR-NTX studies and its safety in this population has not been reported. CASE SUMMARY We conducted structured retrospective chart review of six individuals who received XR-NTX for AUD while on therapeutic anticoagulation between November 2019 and Deccember 2020. We found no documented complications among six individuals who received up to 11 doses of XR-NTX while on therapeutic anticoagulation. WHAT IS NEW AND CONCLUSION XR-NTX may be safely tolerated by patients on therapeutic anticoagulation. We need larger studies evaluating XR-NTX administration in patients on therapeutic anticoagulation and those with coagulopathies, including individuals with alcohol-related liver disease, to better quantify risks and benefits for shared decision-making.
Collapse
Affiliation(s)
- Katrina Ciraldo
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Miami, Miami, Florida, USA.,Department of Family Medicine and Community Health, University of Miami, Miami, Florida, USA
| | | | - James Gasper
- Department of Family and Community Medicine, San Francisco General Hospital, San Francisco, California, USA
| | - Triveni DeFries
- San Francisco General Hospital, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Marlene Martin
- San Francisco General Hospital, San Francisco, California, USA.,Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
6
|
Collins SE, Goldstein SC, King VL, Orfaly VE, Gu J, Clark A, Vess A, Lee G, Taylor EM, Fentress T, Braid AK, Clifasefi SL. Characterizing components of and attendance at resident-driven Housing First programming in the context of community-based participatory research. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:1376-1392. [PMID: 33301627 PMCID: PMC8190162 DOI: 10.1002/jcop.22491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 09/16/2020] [Accepted: 11/04/2020] [Indexed: 06/12/2023]
Abstract
AIMS This secondary study characterized components of and engagement in the life-enhancing alcohol-management program (LEAP), which is resident-driven housing first programming. METHODS We used a process akin to conventional content analysis to operationalize the LEAP according to its component activities. We used generalized linear modeling to identify predictors of LEAP activity participation and to predict alcohol and quality-of-life outcomes from participation in specific LEAP activities categories. RESULTS Overall, 86% of participants attended at least one LEAP activity, which comprised three categories: administrative leadership opportunities, meaningful activities, and pathways to recovery. Employment status alone predicted LEAP activity attendance: Employed residents attended 88% fewer LEAP activities than unemployed residents. Participants who sought out more pathways to recovery activities were more likely daily drinkers and more impacted by alcohol-related harm. Those engaging in administrative leadership opportunities were overall less impacted by alcohol use and had a higher quality of life generally, and their alcohol outcomes further improved over time. CONCLUSIONS Programming developed with Housing First residents was well-attended but could be made more inclusive by including evening programming to accommodate residents employed full time and engaging more severely impacted participants in administrative leadership activities, where the greatest benefits of programming were seen.
Collapse
Affiliation(s)
- Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Silvi C Goldstein
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Victorio L King
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Victoria E Orfaly
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jingyan Gu
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Alex Clark
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Alexander Vess
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Gary Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Emily M Taylor
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Taurmini Fentress
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Ashley K Braid
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Seema L Clifasefi
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| |
Collapse
|
7
|
Mielau J, Vogel M, Gutwinski S, Mick I. New Approaches in Drug Dependence: Opioids. CURRENT ADDICTION REPORTS 2021; 8:298-305. [PMID: 34055568 PMCID: PMC8149259 DOI: 10.1007/s40429-021-00373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/16/2022]
Abstract
Purpose of Review This article aims to provide an overview of standard and adjunctive treatment options in opioid dependence in consideration of therapy-refractory courses. The relevance of oral opioid substitution treatment (OST) and measures of harm reduction as well as heroin-assisted therapies are discussed alongside non-pharmacological approaches. Recent Findings Currently, recommendation can be given for OST with methadone, buprenorphine, slow-release oral morphine (SROM), and levomethadone. Heroin-assisted treatment using diamorphine shall be considered as a cost-effective alternative for individuals not responding to the afore-mentioned opioid agonists in order to increase retention and reduce illicit opioid use. The modalities of application and the additional benefits of long-acting formulations of buprenorphine should be sufficiently transferred to clinicians and the eligible patients; simultaneously methods to improve planning of actions and self- management need to be refined. Regarding common primary outcomes in research on opioid treatment, evidence of the effectiveness of adjunctive psychological interventions is scarce. Summary Maintaining a harm reduction approach in the treatment of opioid addiction, a larger range of formulations is available for the prescribers. Embedding the pharmacological, ideally individualized treatment into a holistic, structure-giving concept also requires a reduction of fragmentation of ancillary services available, drug policies, and treatment philosophies on a global scale.
Collapse
Affiliation(s)
- Juliane Mielau
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital of Charité at St. Hedwig Hospital, Große Hamburger Straße 5- 11, 10115 Berlin, Germany
| | - Marc Vogel
- Department of Addictive Disorders, Psychiatric University Clinic Basel, Basel, Switzerland.,Department of Addictive Disorders, Psychiatric Services Thurgau, Muensterlingen, Switzerland
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital of Charité at St. Hedwig Hospital, Große Hamburger Straße 5- 11, 10115 Berlin, Germany
| | - Inge Mick
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital of Charité at St. Hedwig Hospital, Große Hamburger Straße 5- 11, 10115 Berlin, Germany
| |
Collapse
|
8
|
Combining behavioral harm-reduction treatment and extended-release naltrexone for people experiencing homelessness and alcohol use disorder in the USA: a randomised clinical trial. Lancet Psychiatry 2021; 8:287-300. [PMID: 33713622 PMCID: PMC9875110 DOI: 10.1016/s2215-0366(20)30489-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The rate of alcohol-related mortality in people experiencing homelessness and alcohol use disorder is high and necessitates accessible and effective treatment for alcohol use disorder. However, typical abstinence-based treatments do not optimally engage this population. Recent studies have shown that harm-reduction treatment, which does not require abstinence, but instead aims to incrementally reduce alcohol-related harm and improve health-related quality of life, is acceptable to and effective for this population. The aim of this study was to test the efficacy of combined pharmacological and behavioural harm-reduction treatment for alcohol use disorder (HaRT-A) in people experiencing homelessness and alcohol use disorder. METHODS This randomised clinical trial was done at three community-based service sites (low-barrier shelters and housing programmes) in Seattle (WA, USA). Eligible participants were adults (aged 21-65 years) who met the DSM-IV-TR criteria for alcohol use disorder and who experienced homelessness in the past year. Participants were randomly assigned (1:1:1:1) by permuted block randomisation, stratified by site, to receive either HaRT-A plus intramuscular injections of 380 mg extended-release naltrexone (XR-NTX; HaRT-A plus XR-NTX group); HaRT-A plus placebo injection (HaRT-A plus placebo group); HaRT-A alone (HaRT-A alone group); or community-based supportive services as usual (services-as-usual control group). Patients assigned to receive HaRT-A attended sessions at baseline (week 0) and in weeks 1, 4, 8, and 12. XR-NTX and placebo injections were administered in weeks 0, 4, and 8. During the study, participants, interventionists, and investigators were masked to group assignment in the two injection arms. All participants were invited to follow-up assessments at weeks 4, 8, 12, 24, and 36. The primary outcomes were self-reported alcohol use quantity (ie, alcohol quantity consumed on peak drinking occasion, as measured with the Alcohol Quantity Use Assessment questionnaire) and frequency (measured with the Addiction Severity Index), alcohol-related harm (measured with the Short Inventory of Problems-2R questionnaire), and physical and mental health-related quality of life (measured with the Short Form-12 survey). Using piecewise growth modelling and an intention-to-treat model, we compared the effects of the three active treatment groups with the services-as-usual control group, and the HaRT-A plus XR-NTX group with the HaRT-A plus placebo group, over the 12-week treatment course and during the 24 weeks following treatment withdrawal. Safety analyses were done on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, NCT01932801. FINDINGS Between Oct 14, 2013, and Nov 30, 2017, 417 individuals experiencing homelessness and alcohol use disorder were screened, of whom 308 were eligible and randomly assigned to the HaRT-A plus XR-NTX group (n=74), the HaRT-A plus placebo group (n=78), the HaRT-A alone group (n=79), or the services-as-usual control group (n=77). Compared with the services-as-usual control group, the HaRT-A plus XR-NTX group showed significant improvements from baseline to 12 weeks post-treatment across four of the five primary outcomes: peak alcohol quantity (linear B -0·48 [95% CI -0·79 to -0·18] p=0·010; full model Cohen's d=-0·68), alcohol frequency (linear B -4·42 [-8·09 to -0·76], p=0·047; full model Cohen's d=-0·16), alcohol-related harm (linear B -2·22 [-3·39 to -1·06], p=0·002; full model Cohen's d=-0·56), and physical health-related quality of life (linear B 0·66 [0·23 to 1·10], p=0·012; full model Cohen's d=0·43). Compared with the services-as-usual control group, the HaRT-A plus placebo group showed significant improvements in three of the five primary outcomes: peak alcohol quantity (linear B -0·41 [95% CI -0·67 to -0·15] p=0·010; full model Cohen's d=-0·23), alcohol frequency (linear B -5·95 [-9·72 to -2·19], p=0·009; full model Cohen's d=-0·13), and physical health-related quality of life (linear B 0·53 [0·09 to 0·98], p=0·050; full model Cohen's d=0·35). Compared with the services-as-usual control group, the HaRT-A alone group showed significant improvements in two of the five primary outcomes: alcohol-related harm (linear B -1·58 [95% CI -2·73 to -0·42] p=0·025; full model Cohen's d=-0·40) and physical health-related quality of life (linear B 0·63 [0·18 to 1·07], p=0·020; full model Cohen's d=0·41). After treatment discontinuation at 12 weeks, the active treatment groups plateaued, whereas the services-as-usual group showed improvements. Thus, during the post-treatment period (weeks 12 to 36), the services-as-usual control group showed greater reductions in alcohol-related harm compared with both the HaRT-A plus XR-NTX group (linear B 0·96 [0·24 to 1·67], p=0·028; full model Cohen's d=0·24) and the HaRT-A alone group (linear B 1·02 [0·35 to 1·70], p=0·013; full model Cohen's d=0·26). During the post-treatment period, the services-as-usual control group significantly improved on mental health-related quality of life compared with the HaRT-A alone group (linear B -0·46 [-0·79 to -0·12], p=0·024; full model Cohen's d=-0·28), and on physical health-related quality of life compared with the HaRT-A plus XR-NTX group (linear B -0·42 [-0·67 to -0·17], p=0·006; full model Cohen's d=-0·27), the HaRT-A plus placebo group (linear B -0·42 [-0·69 to -0·15], p=0·009; full model Cohen's d=-0·27), and the HaRT-A alone group (linear B -0·47 [-0·72 to -0·22], p=0·002; full model Cohen's d=-0·31). For all other primary outcomes, there were no significant linear differences between the services-as-usual and active treatment groups. When comparing the HaRT-A plus placebo group with the HaRT-A plus XR-NTX group, there were no significant differences for any of the primary outcomes. Missing data analysis indicated that participants were more likely to drop out in the services-as-usual control group than in the active treatment groups; however, primary outcome findings were found to be robust to attrition. Participants in the HaRT-A plus XR-NTX, HaRT-A plus placebo, and HaRT-A alone groups were not more likely to experience adverse events than those in the services-as-usual control group. INTERPRETATION Compared with existing services, combined pharmacological and behavioural harm-reduction treatment resulted in decreased alcohol use and alcohol-related harm and improved physical health-related quality of life during the 12-week treatment period for people experiencing homelessness and alcohol use disorder. Although not as consistent, there were also positive findings for behavioural harm-reduction treatment alone. Considering the non-significant differences between participants receiving HaRT-A plus placebo and HaRT-A plus XR-NTX, the combined pharmacological and behavioural treatment effect cannot be attributed to XR-NTX alone. Future studies are needed to further investigate the relative contributions of the pharmacological and behavioural components of harm-reduction treatment for alcohol use disorder, and to ascertain whether a maintenance treatment approach could extend these positive outcome trajectories. FUNDING National Institute on Alcohol Abuse and Alcoholism.
Collapse
|
9
|
Clifasefi SL, Collins SE, Torres NI, Grazioli VS, Mackelprang JL. The life-enhancing alcohol-management program: Results from a 6-month nonrandomized controlled pilot study assessing a community based participatory research program in housing first. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:763-776. [PMID: 31778585 PMCID: PMC9970685 DOI: 10.1002/jcop.22291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
A 2-arm, 6-month, nonrandomized controlled pilot trial was conducted to test the initial effectiveness of the Life Enhancing Alcohol-management Program (LEAP) as an adjunct to Housing First (HF; e.g., permanent supportive housing) on alcohol and quality-of-life (QoL) outcomes. The LEAP entails resident-driven leadership opportunities, meaningful activities, and pathways to recovery aimed at reducing alcohol-related harm and improving QoL. Data analyses were conducted to test between- and within-subjects effects of the LEAP on self-reported alcohol and QoL outcomes among HF residents. At the 6-month follow up, between groups analysis revealed nonsignificant findings for alcohol quantity or alcohol-related harm (ps > 0.06); however, LEAP participants reported significantly more engagement in meaningful activities than control participants (p < .001), and within-subjects analyses indicated that high levels of LEAP programming engagement predicted significant reductions in alcohol quantity and alcohol-related harm (ps < 0.01). The LEAP was associated with increased engagement in meaningful activities, and greater involvement in the LEAP programming was associated with reduced alcohol use and alcohol-related harm. Planning is underway for a future, large-scale randomized controlled trial to establish the efficacy of this approach, its generalizability across HF programs, and potential mechanisms of action.
Collapse
Affiliation(s)
| | - Susan E. Collins
- University of Washington – Harborview Medical Center, Seattle, Washington, USA
| | - Nicole I. Torres
- University of Washington – Harborview Medical Center, Seattle, Washington, USA
| | | | - Jessica L. Mackelprang
- University of Washington-Harborview Injury Prevention and Research Center, Seattle, Washington, USA
| |
Collapse
|
10
|
Collins SE, Clifasefi SL, Nelson LA, Stanton J, Goldstein SC, Taylor EM, Hoffmann G, King VL, Hatsukami AS, Cunningham ZL, Taylor E, Mayberry N, Malone DK, Jackson TR. Randomized controlled trial of harm reduction treatment for alcohol (HaRT-A) for people experiencing homelessness and alcohol use disorder. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 67:24-33. [PMID: 30851620 PMCID: PMC6488431 DOI: 10.1016/j.drugpo.2019.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/05/2018] [Accepted: 01/01/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND People experiencing homelessness are disproportionately affected by alcohol use disorder (AUD). Abstinence-based treatment, however, does not optimally engage or treat this population. Thus, harm reduction treatment for alcohol (HaRT-A) was developed together with people with lived experience of homelessness and AUD and community-based agencies that serve them. HaRT-A is a compassionate and pragmatic approach that aims to help people reduce alcohol-related harm and improve quality of life (QoL) without requiring abstinence or use reduction. A three-month, two-arm randomized controlled trial was conducted to test the initial efficacy of HaRT-A compared to a services-as-usual control condition. METHODS People experiencing homelessness and AUD (N = 168; 24% women) were recruited in community-based clinical and social services settings. Self-reported alcohol use, alcohol-related harm, motivation, and QoL as well as urinary ethyl glucuronide were assessed over a 3-month follow-up. Participants were randomized to receive HaRT-A or services as usual. Over four sessions, HaRT-A interventionists delivered three components: a) collaborative tracking of participant-preferred alcohol metrics, b) elicitation of harm-reduction and QoL goals, and c) discussion of safer-drinking strategies. RESULTS Compared to control participants, HaRT-A participants reported significantly greater increases in confidence to engage in harm reduction and decreases in peak alcohol use, alcohol-related harm, AUD symptoms, and positive urinary ethyl glucuronide tests (ps < .05). Findings were inconclusive regarding group differences on QoL (ps > .12). CONCLUSION A low-barrier, low-intensity, patient-driven, harm-reduction approach has at least short-term efficacy in improving AUD outcomes in this population. Future studies are needed to establish its longer-term efficacy.
Collapse
Affiliation(s)
| | | | | | - Joey Stanton
- University of Washington, United States; Downtown Emergency Service Center, United States
| | | | | | | | | | | | | | | | | | | | - T Ron Jackson
- University of Washington, United States; Evergreen Treatment Services - REACH
| |
Collapse
|
11
|
Collins SE, Nelson LA, Stanton J, Mayberry N, Ubay T, Taylor EM, Hoffmann G, Goldstein SC, Saxon AJ, Malone DK, Clifasefi SL, Okuyemi K. Harm reduction treatment for smoking (HaRT-S): findings from a single-arm pilot study with smokers experiencing chronic homelessness. Subst Abus 2019; 40:229-239. [PMID: 30924732 DOI: 10.1080/08897077.2019.1572049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Smoking prevalence and mortality is 5 times higher for the chronically homeless versus general population. Unfortunately, traditional smoking cessation treatment does not optimally engage this population. In a preliminary study, smokers experiencing chronic homelessness suggested providers avoid giving advice to quit and instead use a more compassionate, nonjudgmental style to discuss a broader menu of patient-driven options, including safer nicotine use. Most had negative perceptions of smoking cessation medications; however, 76% expressed interest in a switchover to electronic nicotine delivery systems (ENDS). Methods: Using a community-based participatory research approach, we codeveloped harm-reduction treatment for smoking (HaRT-S) together with people with lived experience of chronic homelessness and smoking and a community-based agency that serves them. In HaRT-S, interventionists embody a compassionate, advocacy-oriented "heart-set" and deliver manualized components: a) participant-led tracking of smoking-related outcomes, b) elicitation of harm-reduction goals and progress made toward them, c) discussion of relative risks of nicotine delivery systems, and d) distribution and instructions on use of safer nicotine products. We then conducted a single-arm, 14-week pilot of HaRT-S (N = 44). Results: Participants rated procedures "totally acceptable/effective," which was reflected in 26% overrecruitment within a 4-month period and 70% retention at the 14-week follow-up. For each week in the study, participants experienced an 18% increase in odds of reporting 7-day, biochemically verified, point-prevalence abstinence. All participants reporting abstinence used ENDS. Participants evinced reductions in cigarette dependence (-45%), frequency (-29%), and intensity (-78%; ps < .05). Participants who used ENDS experienced an additional 44% reduction in smoking intensity and a 1.2-point reduction in dependence compared to participants who did not. Conclusions: Harm-reduction counseling plus ENDS shows promise for smokers experiencing chronic homelessness. Randomized controlled trials are needed to establish the efficacy of this approach in decreasing smoking-related harm and improving health-related quality of life for this marginalized and disproportionately affected population.
Collapse
Affiliation(s)
- Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Lonnie A Nelson
- Washington State University West Campus , Seattle , Washington , USA
| | - Joey Stanton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Nigel Mayberry
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Tatiana Ubay
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Emily M Taylor
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Gail Hoffmann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Silvi C Goldstein
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA.,Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System , Seattle , Washington , USA
| | - Daniel K Malone
- Downtown Emergency Service Center , Seattle , Washington , USA
| | - Seema L Clifasefi
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | | | -
- Downtown Emergency Service Center , Seattle , Washington , USA
| |
Collapse
|
12
|
Watkins KE, Ober A, McCullough C, Setodji C, Lamp K, Lind M, Hunter SB, Chan Osilla K. Predictors of treatment initiation for alcohol use disorders in primary care. Drug Alcohol Depend 2018; 191:56-62. [PMID: 30081338 PMCID: PMC6141324 DOI: 10.1016/j.drugalcdep.2018.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND We identified predictors of receiving treatment (brief therapy [BT] and/or extended-release injectable naltrexone [XR-NTX]) for the treatment of alcohol use disorders (AUDs) in primary care. We also examined the relationship between receiving BT and XR-NTX. METHODS Secondary data analysis of SUMMIT, a randomized controlled trial of collaborative care. Participants were 290 individuals with AUDs who reported no past 30-day opioid use and who were receiving primary care at a multi-site Federally Qualified Health Center. Bivariate and multivariate analyses examined predictors of BT and/or XR-NTX. RESULTS Thirty-two percent (N = 93) received either BT or XR-NTX, 28% (N = 82) received BT and 13% (N = 37) received XR-NTX; 9% (N = 26) received both BT and XR-NTX. Older age, white race, talking with a professional about alcohol use and having more negative consequences all predicted receipt of evidence-based treatment; being homeless was a negative predictor. The predictors of receiving BT included not being homeless and previously talking with a professional; the predictors of receiving XR-NTX included older age, white race and experiencing more negative consequences. In 80% of those who received both BT and XR-NTX, receipt of BT preceded XR-NTX. CONCLUSIONS Patient factors were important predictors of receiving primary-care based AUD treatment and differed by type of treatment received. Receiving BT was associated with subsequent use of XR-NTX and may be associated with a longer duration of XR-NTX treatment. Providers should consider these findings when considering ways to increase primary-care based AUD treatment.
Collapse
Affiliation(s)
| | - Allison Ober
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | | | - Claude Setodji
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA.
| | - Karen Lamp
- Venice Family Clinic, 604 Rose Avenue, Venice, CA, 90291, USA.
| | - Mimi Lind
- Venice Family Clinic, 604 Rose Avenue, Venice, CA, 90291, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | | |
Collapse
|
13
|
Crabtree A, Latham N, Morgan R, Pauly B, Bungay V, Buxton JA. Perceived harms and harm reduction strategies among people who drink non-beverage alcohol: Community-based qualitative research in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:85-93. [PMID: 30071398 DOI: 10.1016/j.drugpo.2018.06.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There has been increasing interest in harm reduction initiatives for street-involved people who drink alcohol, including non-beverage alcohol such as mouthwash and hand sanitizer. Limited evidence exists to guide these initiatives, and a particular gap is in research that prioritizes the experiences and perspectives of drinkers themselves. This research was conducted to explore the harms of what participants termed "illicit drinking" as perceived by people who engage in it, to characterize the steps this population takes to reduce harms, and to identify additional interventions that may be of benefit. METHODS This participatory qualitative research drew on ethnographic approaches including a series of 14″town hall"-style meetings facilitatied and attended by people who self identify as drinking illicit or non-beverage alcohol (n = 60) in Vancouver, British Columbia. This fieldwork was supplemented with four focus groups to explore emerging issues. RESULTS Participants in the meetings described the harms they experienced as including unintentional injury; harms to physical health; withdrawal; violence, theft, and being taken advantage of; harms to mental health; reduced access to services; and interactions with police. Current harm reduction strategies involved balancing the risks and benefits of drinking in groups and adopting techniques to avoid withdrawal. Proposed future initiatives included non-residential managed alcohol programs and peer-based supports. CONCLUSIONS Illicit drinkers describe harms and harm reductions strategies that have much in common with those of other illicit substances, and can be interpreted as examples of and responses to structural and everyday violence. Understanding the perceived harms of alcohol use by socially marginalized drinkers and their ideas about harm reduction will help tailor programs to meet their needs.
Collapse
Affiliation(s)
- Alexis Crabtree
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada; British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada.
| | - Nicole Latham
- Eastside Illicit Drinkers Group for Education, 380 E Hastings St, Vancouver, BC, V6A 1P4, Canada
| | - Rob Morgan
- Eastside Illicit Drinkers Group for Education, 380 E Hastings St, Vancouver, BC, V6A 1P4, Canada
| | - Bernadette Pauly
- Centre for Addiction Research of British Columbia, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Victoria Bungay
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada; British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| |
Collapse
|
14
|
Smith-Bernardin S, Rowe C, Behar E, Geier M, Washington S, Santos GM, Euren J, Martin J, Gleghorn A, Coffin PO. Low-threshold extended-release naltrexone for high utilizers of public services with severe alcohol use disorder: A pilot study. J Subst Abuse Treat 2018; 85:109-115. [DOI: 10.1016/j.jsat.2017.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 08/18/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
|
15
|
Grazioli VS, Collins SE, Paroz S, Graap C, Daeppen JB. Six-month outcomes among socially marginalized alcohol and drug users attending a drop-in center allowing alcohol consumption. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 41:65-73. [PMID: 28104548 DOI: 10.1016/j.drugpo.2016.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 11/24/2016] [Accepted: 12/19/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite their experience of substance-related harm, few socially marginalized alcohol and other drug (AOD) users access substance use treatment. Thus, identifying alternative approaches for this population is important. This program evaluation documented substance use and health-related quality of life (QoL) following exposure to such an alternative approach: a harm-reduction drop-in center allowing alcohol consumption onsite. METHODS Participants (N=85) were socially marginalized AOD users (e.g., alcohol, heroin) attending a harm-reduction drop-in center in the French-speaking part of Switzerland. Time and drop-in center attendance were predictors of substance-use outcomes and mental and physical health-related QoL, which were measured at baseline, 1- and 6-month follow-ups. RESULTS Findings indicated that, for each month of the evaluation, participants' alcohol use and related problems decreased by 5% and 7%, respectively. Drop-in center attendance predicted additional decreases in drug-related problem severity and improvements in mental health-related QoL. CONCLUSION Participants' alcohol use and related problems decreased over time. Additionally, participants evinced improved mental health-related QoL and decreased drug-related problem severity with greater drop-in center attendance. Harm-reduction drop-in centers allowing alcohol consumption onsite are promising interventions for socially marginalized AOD users.
Collapse
Affiliation(s)
- Véronique S Grazioli
- University of Lausanne, Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland; University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
| | - Susan E Collins
- University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Sophie Paroz
- University of Lausanne, Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Caroline Graap
- University of Lausanne, Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- University of Lausanne, Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne, Switzerland
| |
Collapse
|
16
|
Zaaijer ER, Goudriaan AE, Koeter MWJ, Booij J, van den Brink W. Acceptability of Extended-Release Naltrexone by Heroin-Dependent Patients and Addiction Treatment Providers in the Netherlands. Subst Use Misuse 2016; 51:1905-11. [PMID: 27613150 DOI: 10.1080/10826084.2016.1201117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Extended-release naltrexone (XRNT) was developed to overcome poor treatment compliance with oral naltrexone in alcohol and opioid-dependent patients. XRNT injections are registered in the United States and Russia, but not in The Netherlands. However, XRNT can be obtained for individual patients, but it is expensive and not reimbursed by the health insurance. OBJECTIVES This study evaluates the support for abstinence oriented treatment among heroin-dependent patients and the acceptability of XRNT injections by heroin-dependent patients and treatment providers in The Netherlands. METHODS A sample of 261 patients in methadone maintenance treatment or heroin assisted treatment and a sample of 188 addiction treatment providers completed specially designed questionnaires. RESULTS The current study shows that many patients in opioid maintenance treatment (58%) report a desire to become abstinent from opioids and that 83% of the patients with a desire for abstinence are interested in XRNT. The majority of treatment providers (81%) are willing to support the prescription of XRNT injections in opioid-dependent patients to prevent relapse after detoxification. CONCLUSIONS The current practice of automatic and indefinite continuation of opioid substitution should therefore be reconsidered. However, XRNT injections are very expensive and currently not reimbursed by the health insurance agencies in The Netherlands and thus not really available to most patients.
Collapse
Affiliation(s)
- Eline R Zaaijer
- a Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Anna E Goudriaan
- a Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Maarten W J Koeter
- a Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Jan Booij
- a Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Wim van den Brink
- a Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| |
Collapse
|
17
|
Stringfellow EJ, Kim TW, Gordon AJ, Pollio DE, Grucza RA, Austin EL, Johnson NK, Kertesz SG. Substance use among persons with homeless experience in primary care. Subst Abus 2016; 37:534-541. [PMID: 26914448 PMCID: PMC4999348 DOI: 10.1080/08897077.2016.1145616] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Community survey data suggest high prevalence of substance use disorders among currently homeless individuals. There are less data regarding illicit drug and alcohol use problems of homeless-experienced persons engaged in primary care. They may have less severe use and require different care responses from primary care teams. METHODS The authors surveyed currently and formerly homeless, i.e., homeless-experienced, persons engaged in primary care at five federally funded programs in the United States, administering the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST definitions of lower, moderate, and high risk were used to assess a spectrum of lifetime and recent substance use, from any use to likely dependence, and to identify sociodemographic and health status characteristics associated with severity of use. RESULTS Almost one half of the sample (N = 601) had recently (within the past three months) used alcohol, and one third had recently used an illicit drug. The most commonly used illicit drugs in the past three months were cannabis (19%), cocaine (16%), and opioids (7.5%). Over one half (59%) of respondents had ASSIST-defined moderate- or high-risk substance use. A significant proportion (31%) of those identified as at moderate risk had no recent substance use, but did report past problematic use. Ten percent of the lower-risk group had past problematic use of alcohol. Severity of use was associated with worse health status, but not with housing status or type of homelessness experienced. CONCLUSIONS Less severe (moderate-risk) use and past problematic use, potentially indicative of remitted substance use disorders, were more common than high-risk use in this primary care, homeless-experienced sample. These findings highlight the urgency of identifying effective ways to reduce risky substance use and prevent relapse in homeless-experienced persons.
Collapse
Affiliation(s)
- Erin J. Stringfellow
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Theresa W. Kim
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Adam J. Gordon
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David E. Pollio
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard A. Grucza
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | | | - Stefan G. Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA
- School of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
18
|
Clifasefi SL, Collins SE, Torres NI, Grazioli VS, Mackelprang JL. Housing First, but What Comes Second? A Qualitative Study of Resident, Staff and Management Perspectives on Single-Site Housing First Program Enhancement. JOURNAL OF COMMUNITY PSYCHOLOGY 2016; 44:845-855. [PMID: 28579653 PMCID: PMC5451125 DOI: 10.1002/jcop.21812] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Single-site Housing First (HF) is associated with reduced publicly funded service utilization and costs and alcohol-related harm for chronically homeless individuals with severe alcohol problems. Many residents, however, continue to experience alcohol-related problems after their move into single-site HF. Thus, it is necessary to explore areas for program enhancement after individuals move into single-site HF. To this end, we collected qualitative data via 30 hours of naturalistic observation, staff focus groups (n = 3), and one-on-one interviews with single-site HF residents (n = 44), program staff (n = 7), and agency management (n = 4). Qualitative analyses were used to construct a conceptual or thematic description of residents', staff's, and management's suggestions for program enhancement, which comprised 3 areas: (a) enhancing training and support for staff, (b) increasing residents' access to meaningful activities, and (c) exploring alternate pathways to recovery. Development of programming addressing these areas may help residents continue to reduce alcohol-related harm and improve health and quality of life after their move into single-site HF.
Collapse
|
19
|
|
20
|
Collins SE, Grazioli VS, Torres NI, Taylor EM, Jones CB, Hoffman GE, Haelsig L, Zhu MD, Hatsukami AS, Koker MJ, Herndon P, Greenleaf SM, Dean PE. Qualitatively and quantitatively evaluating harm-reduction goal setting among chronically homeless individuals with alcohol dependence. Addict Behav 2015; 45:184-90. [PMID: 25697724 PMCID: PMC4452113 DOI: 10.1016/j.addbeh.2015.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 01/26/2015] [Accepted: 02/02/2015] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Most treatment programs for alcohol dependence have prioritized alcohol abstinence as the primary treatment goal. However, abstinence-based goals are not always considered desirable or attainable by more severely affected populations, such as chronically homeless people with alcohol dependence. Because these individuals comprise a multimorbid and high-utilizing population, they are in need of more focused research attention that elucidates their preferred treatment goals. The aim of this secondary study was therefore to qualitatively and quantitatively document participant-generated treatment goals METHODS Participants were currently or formerly chronically homeless individuals (N=31) with alcohol dependence who participated in a pilot of extended-release naltrexone and harm-reduction counseling. Throughout the treatment period, study interventionists elicited participants' goals and recorded them on an open-ended grid. In subsequent weeks, progress towards and achievement of goals was obtained via self-report and recorded by study interventionists. Conventional content analysis was performed to classify participant-generated treatment goals RESULTS Representation of the three top categories remained stable over the course of treatment. In the order of their frequency, they included drinking-related goals, quality-of-life goals and health-related goals. Within the category of drinking-related goals, participants consistently endorsed reducing drinking and alcohol-related consequences ahead of abstinence-based goals. Quantitative analyses indicated participants generated an increasing number of goals over the course of treatment. Proportions of goals achieved and progressed towards kept pace with this increase CONCLUSIONS Findings confirmed hypotheses that chronically homeless people with alcohol dependence can independently generate and achieve treatment goals towards alcohol harm reduction and quality-of-life improvement.
Collapse
Affiliation(s)
- Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
| | - Véronique S Grazioli
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Nicole I Torres
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Emily M Taylor
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Connor B Jones
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Gail E Hoffman
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Laura Haelsig
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Mengdan D Zhu
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Alyssa S Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Molly J Koker
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Patrick Herndon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Shawna M Greenleaf
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Parker E Dean
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| |
Collapse
|
21
|
Grazioli VS, Hicks J, Kaese G, Lenert J, Collins SE. Safer-drinking strategies used by chronically homeless individuals with alcohol dependence. J Subst Abuse Treat 2015; 54:63-8. [PMID: 25690515 DOI: 10.1016/j.jsat.2015.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/16/2014] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
Chronically homeless individuals with alcohol dependence experience severe alcohol-related consequences. It is therefore important to identify factors that might be associated with reduced alcohol-related harm, such as the use of safer-drinking strategies. Whereas effectiveness of safer-drinking strategies has been well-documented among young adults, no studies have explored this topic among more severely affected populations, such as chronically homeless individuals with alcohol dependence. The aims of this study were thus to qualitatively and quantitatively document safer-drinking strategies used in this population. Participants (N=31) were currently or formerly chronically homeless individuals with alcohol dependence participating in a pilot study of extended-release naltrexone and harm-reduction counseling. At weeks 0 and 8, research staff provided a list of safer-drinking strategies for participants to endorse. Implementation of endorsed safer-drinking strategies was recorded at the next appointment. At both time points, strategies to buffer the effects of alcohol on the body (e.g., eating prior to and during drinking) were most highly endorsed, followed by changing the manner in which one drinks (e.g., spacing drinks), and reducing alcohol consumption. Quantitative analyses indicated that all participants endorsed safer-drinking strategies, and nearly all strategies were implemented (80-90% at weeks 0 and 8, respectively). These preliminary findings indicate that chronically homeless people with alcohol dependence use strategies to reduce harm associated with their drinking. Larger randomized controlled trials are needed to test whether interventions that teach safer-drinking strategies may reduce overall alcohol-related harm in this population.
Collapse
Affiliation(s)
- Véronique S Grazioli
- Lausanne University Hospital, Alcohol Treatment Center, Av. de Beaumont 21 bis, 1011 Lausanne, Switzerland; University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
| | - Jennifer Hicks
- University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
| | - Greta Kaese
- University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
| | - James Lenert
- University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
| | - Susan E Collins
- University of Washington-Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
| |
Collapse
|
22
|
Jenkins JA, Gordon AJ. Substance Use Disorder Prevention and Treatment in Stigmatized Patient Populations: Ripe for Innovation. Subst Abus 2015; 36:1-2. [DOI: 10.1080/08897077.2015.1009266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
23
|
Collins SE, Saxon AJ, Duncan MH, Smart BF, Merrill JO, Malone DK, Jackson TR, Clifasefi SL, Joesch J, Ries RK. Harm reduction with pharmacotherapy for homeless people with alcohol dependence: protocol for a randomized controlled trial. Contemp Clin Trials 2014; 38:221-34. [PMID: 24846619 PMCID: PMC4104260 DOI: 10.1016/j.cct.2014.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/05/2014] [Accepted: 05/10/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Interventions requiring abstinence from alcohol are neither preferred by nor shown to be highly effective with many homeless individuals with alcohol dependence. It is therefore important to develop lower-threshold, patient-centered interventions for this multimorbid and high-utilizing population. Harm-reduction counseling requires neither abstinence nor use reduction and pairs a compassionate style with patient-driven goal-setting. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving and may support achievement of harm-reduction goals. Together, harm-reduction counseling and XR-NTX may support alcohol harm reduction and quality-of-life improvement. AIMS Study aims include testing: a) the relative efficacy of XR-NTX and harm-reduction counseling compared to a community-based, supportive-services-as-usual control, b) theory-based mediators of treatment effects, and c) treatment effects on publicly funded service costs. METHODS This RCT involves four arms: a) XR-NTX+harm-reduction counseling, b) placebo+harm-reduction counseling, c) harm-reduction counseling only, and d) community-based, supportive-services-as-usual control conditions. Participants are currently/formerly homeless, alcohol dependent individuals (N=300). Outcomes include alcohol variables (i.e., craving, quantity/frequency, problems and biomarkers), health-related quality of life, and publicly funded service utilization and associated costs. Mediators include 10-point motivation rulers and the Penn Alcohol Craving Scale. XR-NTX and harm-reduction counseling are administered every 4weeks over the 12-week treatment course. Follow-up assessments are conducted at weeks 24 and 36. DISCUSSION If found efficacious, XR-NTX and harm-reduction counseling will be well-positioned to support reductions in alcohol-related harm, decreases in costs associated with publicly funded service utilization, and increases in quality of life among homeless, alcohol-dependent individuals.
Collapse
Affiliation(s)
- Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| | - Andrew J Saxon
- VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 45th St. Box 354944, Seattle, WA 98195, USA.
| | - Mark H Duncan
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| | - Brian F Smart
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| | - Joseph O Merrill
- Department of Medicine, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359780, Seattle, WA 98195, USA.
| | - Daniel K Malone
- Downtown Emergency Service Center (DESC), 515 Third Ave, Seattle, WA 98104, USA.
| | - T Ron Jackson
- Evergreen Treatment Services - REACH, 1700 Airport Way S, Seattle, WA 98134, USA.
| | - Seema L Clifasefi
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 45th St. Box 354944, Seattle, WA 98195, USA.
| | - Jutta Joesch
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave Box 359911, Seattle, WA 98195, USA.
| |
Collapse
|