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May 25, 2021
by Patricia Tomasi

Can Medication And Counseling Help Homeless With Alcohol-Use Disorder?

May 25, 2021 08:00 by Patricia Tomasi  [About the Author]

A new study published in Lancet Psychiatry looked at combining behavioral harm-reduction treatment and extended-release naltrexone for people experiencing homelessness and alcohol use disorder in the United States.

“We tested whether combined medication and counseling harm-reduction treatment would help people experiencing homelessness and alcohol use disorder improve on alcohol and health outcomes,” study author Susan E. Collins told us. “We believed that combined medication and counseling harm-reduction treatment would be engaging and helpful for participants in reducing their alcohol-related harm and improving their health-related quality of life.”

Collins is a licensed clinical psychologist and codirector of the Harm Reduction Research and Treatment (HaRRT) Center. She’s also a professor in the Department of Psychology at Washington State University and an affiliate professor at the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine.
“As a substance-use treatment provider and researcher, it is my job to be sure we can serve the broadest spectrum of patients and community members we can,” Collins told us. “Meeting people where they are at – in their communities and in their readiness for change – and helping them achieve their goals is my job as a substance-use treatment professional.”

Collins and her research team used a randomized controlled trial for the study.

“We found that participants who received the combined medication and counseling harm-reduction treatment improved across five of six alcohol use, alcohol-related harm and health outcomes compared to a group receiving community-based services as usual (i.e., housing, nursing services, case management),” Collins told us. “Participants who received only the harm-reduction counseling did better across three of the six alcohol and health outcomes. And unlike abstinence-based treatment, which engages just about 10% of people with substance use disorder, this treatment engaged 96% of people we encountered.”

The researchers weren’t surprised with the results but say others might be.
“In the field of substance-use treatment, many of us have been trained to believe that if we insist on sobriety from our patients, we are enabling them,” Collins told us. “However, over the past 13 years, my colleagues and I have chipped away at this ‘enabling hypothesis’. We now have over a half dozen program evaluations and research studies showing that harm-reduction treatment and interventions are associated with reduced substance use and substance-related harm.”
Maybe more important, added Collins, is that in this study, 96% of people approached in their shelters said they wanted to participate, so harm reduction engages people that might not show up at treatment clinics. So, the enabling hypothesis just does not hold true. Given the chance, most people want to keep themselves, their families and their communities safer and healthier, even if they continue using substances. And harm-reduction treatment doesn’t make people use more, it helps them use less and use safer.

“We need to continue to develop and test the efficacy of interventions and treatments that help reduce substance related harm and improve quality of life for people who use substances—especially for those who are not ready, willing or able to stop using,” Collins told us. “As someone with my own lived experience with addictive behaviors and my families’ intergenerational experience of addictive behaviors, I believe in the real benefits of 12-step programs and abstinence-based treatment. They help a lot of people. But we need to be able to reach a broader spectrum of people, including people who might feel turned off by 12-step or sobriety programs. For those folks and anyone who uses substances, harm reduction is a good way to keep ourselves, our families and our communities safer and healthier.”



About the Author

Patricia Tomasi

Patricia Tomasi is a mom, maternal mental health advocate, journalist, and speaker. She writes regularly for the Huffington Post Canada, focusing primarily on maternal mental health after suffering from severe postpartum anxiety twice. You can find her Huffington Post biography here. Patricia is also a Patient Expert Advisor for the North American-based, Maternal Mental Health Research Collective and is the founder of the online peer support group - Facebook Postpartum Depression & Anxiety Support Group - with over 1500 members worldwide. Blog:

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