Alcohol use disorder (AUD) is associated with severe alcohol-related harm, especially in vulnerable populations. People experiencing homelessness comprise one such population that is disproportionately affected by AUD and its sequelae. Although traditional abstinence-based treatment does not adequately reach or engage this population, a growing body of research has indicated that harm-reduction treatment may present an efficacious alternative. Harm-reduction treatment uses a compassionate and pragmatic approach to help people who use substances and their communities reduce substance-related harm and improve quality of life without requiring abstinence or even use reduction. Primary components of harm-reduction treatment for AUD can include medication-assisted treatment alongside counseling, in which interventionists assess and track harm-reduction metrics, help patients set harm-reduction goals, and discuss safer-use strategies. Studies that have implemented safer-use strategies, or means of staying safer and healthier even if patients are drinking, have shown efficacy in reducing alcohol-related harm. However, no studies to date have explored the associations between implementation of safer-use strategies and alcohol-related harm in people experiencing homelessness and AUD. This secondary study (N=213) was conducted in the context of a larger randomized controlled trial (N=308) of harm-reduction pharmacological and behavioral treatments with people experiencing homelessness and AUD. We aim to quantitatively and qualitatively describe treated patients’ engagement with safer-use strategies over the three-month treatment course and examine the longitudinal association between safer-use strategies and alcohol-related harm. We expect to see inverse associations between the application of safer-use strategies and alcohol-related harm. These findings may help clinicians and counselors better understand what kinds of safer-use strategies are most commonly endorsed by this population and their relative contribution to the reductions in alcohol-related harm and improvements in quality of life observed in the context of harm-reduction treatment with people experiencing homelessness and AUD.

For many years, the primary mode of treatment for people experiencing alcohol use disorder (AUD) has been abstinence-based treatment. Research has indicated, however, that abstinence-based treatment does not optimally engage or treat more severely affected populations, such as people experiencing AUD and homelessness. Instead, harm-reduction treatment approaches are more desirable for this population and can serve as an effective treatment alternative for people experiencing AUD and homelessness. Harm-reduction treatment entails a set of compassionate and pragmatic strategies to emphasize client autonomy, mitigate substance-related harm, and promote quality of life (QoL) without the need for abstinence or use-reduction. Specific components include assessment and tracking of harm-reduction metrics, harm-reduction goal-setting, and implementation of safer-use strategies. This secondary study (N = 213) served to qualitatively and quantitatively explore harm-reduction goals generated by participants in a larger, 4-arm randomized control trial of harm-reduction treatment for people experiencing homelessness and AUD. The three treatment groups included in this secondary study received: a) harm-reduction counseling only, b) harm-reduction counseling + medication assisted treatment (i.e., extended-release naltrexone), and c) harm-reduction counseling + placebo. Participant goals were recorded using the Safer Drinking and Harm Reduction Efforts (SHaRE) scale at baseline assessments and weeks 4, 8, and 12. Qualitative analyses will be conducted to determine the kinds of goals participants generated throughout the 12-week treatment period. Additional descriptive, quantitative analyses will establish quantity of participant goals set at each time point. Finally, inferential statistics will be used to test harm-reduction goals as correlates of alcohol outcomes across the 12-week treatment period. It is expected that a) the combined pharmacotherapy group will generate, progress toward, and achieve more goals than other study conditions; and b) quality-of-life goals will be more strongly associated with reduced alcohol-related harm than drinking-related goals.