Open AccessJail and Emergency Department Utilization in the Context of Harm Reduction Treatment for People Experiencing Homelessness and Alcohol Use Disorder
Author(s) -
Susan E. Collins,
Silvi C. Goldstein,
Bow Suprasert,
Samantha A M Doerr,
Joanne Gliane,
Clarissa Song,
Victoria E. Orfaly,
Rddhi Moodliar,
Emily Taylor,
Gail Hoffmann
Publication year - 2020
Publication title -
journal of urban health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.211
H-Index - 92
eISSN - 1468-2869
pISSN - 1099-3460
DOI - 10.1007/s11524-020-00452-8
Subject(s) - alcohol use disorder , abstinence , emergency department , harm reduction , context (archaeology) , psychiatry , medicine , population , randomized controlled trial , harm , alcohol dependence , psychology , alcohol , public health , environmental health , nursing , social psychology , paleontology , biochemistry , chemistry , surgery , biology
People experiencing homelessness are disproportionately affected by alcohol use disorder (AUD). Abstinence-based treatment, however, does not optimally engage or treat this population. Thus, Harm Reduction Treatment for Alcohol (HaRT-A) was developed together with people with the lived experience of homelessness and AUD and community-based agencies that serve them. HaRT-A is a compassionate and pragmatic approach that aims to help people reduce alcohol-related harm and improve quality of life (QoL) without requiring abstinence or use reduction. The parent RCT showed that HaRT-A precipitated statistically significant reductions in alcohol use, alcohol-related harm, AUD symptoms, and positive urine toxicology tests. This secondary study tested HaRT-A effects on more distal, 6-month pre-to-posttreatment changes on jail and emergency department (ED) utilization. People experiencing homelessness and AUD (N = 168; 24% women) were recruited in community-based clinical and social services settings. Participants were randomized to receive HaRT-A or services as usual. Over four sessions, HaRT-A interventionists delivered three components: (a) collaborative tracking of participant-preferred alcohol metrics, (b) elicitation of harm-reduction and QoL goals, and (c) discussion of safer-drinking strategies. Administrative data on jail and ED utilization were extracted for 6 months pre- and posttreatment. Findings indicated no statistically significant treatment group differences on 6-month changes in jail or ED utilization (ps > .23). Exploratory analyses showed that 2-week frequency of alcohol use was positively correlated with number of jail bookings in the 12 months surrounding their study participation. Additionally, self-reported alcohol-related harm, importance of reducing alcohol-related harm, and perceived physical functioning predicted more ED visits. Future studies are needed to further assess how harm-reduction treatment may be enhanced to move the needle in criminal justice and healthcare utilization in the context of larger samples, longer follow-up timeframes, and more intensive interventions.