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.