Dose-Response in Harm Reduction Treatment With and Without Pharmacotherapy for People Experiencing Homelessness and Alcohol-Use Disorder

Abstract

People who experience homelessness are at an elevated risk for having alcohol-use disorder (AUD), which places them at up to 10 times greater risk of mortality than the general population. Abstinence-based treatments continue to be considered the gold standard for treating AUD, but fail to adequately engage people experiencing homelessness and AUD. The current study aims to investigate retention in a lower-barrier, community-based treatment that combines harm-reduction counseling and injectable, extended-release naltrexone (XR-NTX). Participants (N = 231) were adults aged 21 to 65 years old with AUD who experienced homelessness in the past year and participated in one of the three active harm-reduction treatment groups in the larger parent randomized controlled trial (RCT). Attendance at treatment sessions and the number of injections were tracked for each participant. Alcohol outcomes were measured using the Alcohol Quantity Use Assessment, the Short Inventory of Problems (SIP-2R), and the Alcohol and Substance-use Frequency Assessment questions adapted from the Addiction Severity Index. Health-related quality of life was measured using the Short Form – 12. There were significant time × number of injection interactions for both alcohol use (y/n) and alcohol-related harm in the past month, such that a greater number of injections was associated with less use and harm over time. There was also a significant time × number of treatment session interaction for alcohol use (y/n) in the past month, which indicated initial benefits of harm-reduction counseling that attenuated after the third session. This study emphasizes the importance of retention in a combined XR-NTX and harm-reduction counseling program to optimally support reduction in alcohol-related harm.