Combining behavioral harm-reduction treatment and extended-release naltrexone for people experiencing homelessness and alcohol use disorder in the USA: a randomised clinical trial

Collins, Susan E.; Duncan, Mark; Saxon, Andrew J.; Taylor, Emily; Mayberry, Nigel; Merrill, Joseph O.; Hoffmann, Gail; Clifasefi, Seema L.; Ries, Richard K.

doi:10.1016/s2215-0366(20)30489-2

Cited by 41 publications

(72 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This connects with the literature gathered since the 1990s highlighting community-based harm reduction outreach as providing an essential first point of contact for people who use substances [ 59 , 60 , 61 , 62 ]. More generally, alcohol-specific harm reduction approaches for people experiencing homelessness are also increasing in a number of countries, including the US, in recognition of the need for such programmes, independently of COVID-19 [ 23 , 24 , 63 ]. These services could also be important providers of alcohol harm reduction education, such as the safer drinking guidelines developed during COVID-19 [ 40 ] and described by Grazioli et al [ 64 ] on providing alcohol harm reduction within drop-in programmes.…”

Section: Discussionmentioning

confidence: 99%

“…This has led to calls for tailored interventions for this group, such as safer use, in order to reduce adverse effects of alcohol without requiring abstinence [ 11 ]. Research is increasing in this area, with positive results concerning alcohol management programmes and the combining of behavioural harm reduction and pharmacological approaches [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Parkes

Carver

Masterton

et al. 2021

IJERPH

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Parkes

Carver

Masterton

et al. 2021

IJERPH

View full text Add to dashboard Cite

show abstract

“…We should also counsel patients to eat food when drinking to decrease alcohol-related harms. 19 Patients experiencing food insecurity should be linked to food resources through inpatient nutritional and social work consultations.…”

Section: What We Should Do Insteadmentioning

confidence: 99%

Things We Do for No Reason™: Prescribing Thiamine, Folate and Multivitamins on Discharge for Patients With Alcohol Use Disorder

DeFries

Leyde

Haber

et al. 2021

Journal of Hospital Medicine

View full text Add to dashboard Cite

Inspired by the ABIM Foundation's Choosing Wisely ® campaign, the "Things We Do for No Reason ™ " (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent clear-cut conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion. CLINICAL SCENARIOA 56-year-old man with alcohol use disorder (AUD) is admitted with decompensated heart failure and experiences alcohol withdrawal during the hospitalization. He improves with guideline-directed heart failure therapy and benzodiazepines for alcohol withdrawal. Discharge medications are metoprolol succinate, lisinopril, furosemide, aspirin, atorvastatin, thiamine, folic acid, and a multivitamin. No medications were offered for AUD treatment. At follow-up a week later, he presents with dyspnea and reports poor medication adherence and a return to heavy drinking.

show abstract

“…Much of the research to date has focused on community-level strategies—including low-barrier, non-abstinence-based housing, meaningful activities programming, and managed alcohol programs—which have shown promise in diminishing both individual- and community-level alcohol-related harms (Clifasefi et al, 2020; Collins, Malone, et al, 2012; Pauly et al, 2018; Stockwell et al, 2018). More recent research has provided empirical support for an additional family of individual-level interventions, called harm-reduction treatment for AUD, and its ability to reduce alcohol use, ameliorate alcohol-related harm and improve health-related QoL (Collins, Duncan, et al, 2015; Collins et al, 2019, Collins et al, 2021).…”

mentioning

confidence: 99%

“…Instead, interventionists used only strengths-based reflections and affirmations to support patients’ own unique harm-reduction goal-setting and safer-use strategies. Specific harm-reduction treatment components include (a) collaborative tracking of participant-preferred harm-reduction metrics, (b) elicitation of harm-reduction and QoL goals, and (c) discussion of safer-drinking strategies (Collins, Duncan, et al, 2015; Collins et al, 2019, Collins et al, 2021). An initial pilot study and two randomized controlled trials have shown harm-reduction treatment for AUD to be both highly engaging and associated with reduced alcohol use and alcohol-related harm and improved QoL in people experiencing homelessness (Collins, Duncan, et al, 2015; Collins et al, 2019, Collins et al, 2021).…”

mentioning

confidence: 99%

Dual study describing patient-driven harm reduction goal-setting among people experiencing homelessness and alcohol use disorder.

Fentress¹,

Wald²,

Brah³

et al. 2021

Experimental and Clinical Psychopharmacology

View full text Add to dashboard Cite

Two recent randomized controlled efficacy trials showed that harm-reduction treatment for alcohol use disorder (AUD)—or patient-driven treatment that does not require abstinence and instead supports decreased alcohol-related harm and improved quality of life (QoL)—is efficacious for adults experiencing homelessness and AUD. The present study provides qualitative and quantitative analysis of one component of harm-reduction treatment, participants’ harm-reduction goal-setting, within these two trials. Aims of this secondary, dual-trial study (Trial 1 N = 208, Trial 2 N = 86) were to describe participant-generated harm-reduction goals and determine whether aspects of harm-reduction goal-setting predict treatment outcomes. Across both trials, qualitative findings indicated improving QoL, meeting basic needs, improving physical and mental health, and changing drinking behavior were participants’ top four goals. Only 2%–6% of goals centered on attaining alcohol abstinence. Regarding quantitative findings, Trial 1 showed statistically significant increases in goals generation over the course of treatment, while proportion of achieved goals stayed constant. In Trial 2, number of goals generated remained constant, while proportion of goals achieved increased. Trial 2 findings showed greater goal generation over time was associated with better physical health-related QoL, and drinking-related goals predicted improved alcohol outcomes. Overall, this secondary, dual-trial study suggests patient-driven goal-setting in harm-reduction treatment is feasible: Participants generated diverse, personalized, and clinically relevant goals. This study built on positive efficacy trial findings, indicating participants’ generation of goals was associated with improved treatment outcomes. More research is needed to further understand more nuanced relationships between harm-reduction goal-setting and treatment outcomes.

show abstract

Combining behavioral harm-reduction treatment and extended-release naltrexone for people experiencing homelessness and alcohol use disorder in the USA: a randomised clinical trial

Cited by 41 publications

References 48 publications

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

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

Things We Do for No Reason™: Prescribing Thiamine, Folate and Multivitamins on Discharge for Patients With Alcohol Use Disorder

Dual study describing patient-driven harm reduction goal-setting among people experiencing homelessness and alcohol use disorder.

Contact Info

Product

Resources

About