(WITHDRAWN) Defining Harm Reduction Goal-Setting Among Individuals Experiencing Homelessness and Alcohol Use Disorder

Background and Purpose: The gold standard treatments for people with alcohol use disorders (AUD) are abstinence-based approaches. However, abstinence-based approaches fail to engage more severely affected populations, such as people experiencing homelessness and AUD. This population, which experiences multimorbidity and uses high levels of publicly funded services, is in need of more focused research attention that illuminates their preferred treatment goals. To this end, a prior community-based participatory research study was conducted to develop, implement and evaluate the efficacy of participant-driven harm-reduction treatment for alcohol in people experiencing homelessness and AUD. The randomized controlled trial within that parent study, which did not require a desire for abstinence, indicated that harm-reduction treatment resulted in statistically significantly decreased alcohol use and related harm compared to services as usual. The present secondary study qualitatively and quantitatively documents goal-setting from participants (N=86) randomized to the harm-reduction treatment arm in the parent randomized controlled trial.

Methods: The data in this secondary analysis was collected from participants in a two-arm randomized control trial comparing alcohol and QoL outcomes following client-directed goal-setting in harm-reduction counseling versus a “services-as-usual”. Participants (N = 86; 20% assigned female at birth) were people experiencing homelessness and AUD. The alcohol and substance-use frequency assessment questions were adapted from the Addiction Severity Index (ASI) and were used to assess frequency of alcohol use in the past 30 days. The Alcohol Quantity of Use Assessment (AQUA) was used to assess participants’ peak and typical alcohol quantity in the past 30 days. The Short Inventory of Problems (SIP-2R), a 15 item Likert- scale questionnaire, measures participants’ experience of social, occupational and psychological forms of alcohol-related harm. The resulting variables were used in the sample description. The Safer-drinking and Harm Reduction Efforts (SHaRE) form is an open-ended grid created for use in the harm-reduction counseling sessions. It was administered at intervention sessions at weeks 0, 1, 2, and 6 to elicit and record participant-generated harm-reduction goals. Directed content analysis was performed to classify participant-generated treatment goals transcribed from the ShaRE. Descriptive and inferential statistics were used to describe the number of goals generated at each point and over time.

Results: Results indicated that participants’ stated goals were focused on increasing quality of life, meeting basic needs, improving health, and changing alcohol use, in descending order of frequency. Only 2.4% of participants mentioned abstinence-based goals. Further, an increasing number of goals was generated by participants over the course of treatment, while the percentage of goals progressed towards and achieved kept pace with this increase.

Conclusions and Implications: Taken together, results suggest that client-driven goal setting in harm-reduction treatment is feasible and helps people generate personally and clinically meaningful goals. Client-driven goal-setting in AUD treatment thus offers clinicians a tool to work with individuals whom abstinence-based treatments fail to engage. Future studies involving larger sample sizes could explore the association of specific harm-reduction goals with longitudinal changes in alcohol outcomes.