Alcohol use disorders (AUDs) are more prevalent among
homeless individuals than in the general population, and homeless individuals
are disproportionately affected by alcohol-related morbidity and mortality.
Unfortunately, abstinence-based approaches are neither desirable to nor highly
effective for most members of this population. Recent research has indicated
that homeless people aspire to clinically significant recovery goals beyond
alcohol abstinence, including alcohol harm reduction and quality-of-life
improvement. However, no research has documented this population's preferred
pathways toward self-defined recovery. Considering principles of
patient-centred care, a richer understanding of this population's desired
pathways to recovery may help providers better engage and support them.
Participants (N=50) had lived experience of homelessness and
AUDs and participated in semi-structured interviews regarding histories of
homelessness, alcohol use, and abstinence-based treatment as well as
suggestions for improving alcohol treatment. Conventional content analysis was
used to ascertain participants' perceptions of abstinence-based treatment and
mutual-help modalities, while it additionally revealed alternative pathways to
recovery.
Most participants reported involvement in abstinence-based
modalities for reasons other than the goal of achieving long-term abstinence
from alcohol (e.g., having shelter in winter months, "taking a break"
from alcohol use, being among "like-minded people"). In contrast,
most participants preferred alternative pathways to recovery, including
fulfilling basic needs (e.g., obtaining housing), using harm reduction
approaches (e.g., switching from higher to lower alcohol content beverages),
engaging in meaningful activities (e.g., art, outings, spiritual/cultural
activities), and making positive social connections.
Most people with the lived experience of homelessness and
AUDs we interviewed were uninterested in abstinence-based modalities as a means
of attaining long-term alcohol abstinence. These individuals do, however, have
creative ideas about alternative pathways to recovery that treatment providers
may support to reduce alcohol-related harm and enhance quality of life.
Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
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