Where harm reduction meets housing first: Exploring alcohol's role in a project-based housing first setting
Where harm reduction meets housing first: Exploring alcohol's role in a project-based housing first setting
复制标题
DOI：
10.1016/j.drugpo.2011.07.010
复制
发表时间：
2012-03-01
影响因子：
4.4
通讯作者：
Malone, Daniel K.
中科院分区：
文献类型：
--
作者：
Collins, Susan E.;Clifasefi, Seema L.;Malone, Daniel K.
背景：住房优先（HF）计划提供低门槛、非禁欲、即时的服务。为经常同时患有药物滥用和/或精神疾病的长期无家可归者提供支持性和永久住房。基于项目的 HF 计划在较大的住房项目中以单独单元的形式提供住房。最近在一个基于特定项目的 HF 计划中进行的研究发现，住房供应与公共资助服务利用率的减少、酒精使用量的减少和大量成本抵消有关。然而，迄今为止，还没有研究定性地探讨了酒精使用在基于项目的心力衰竭居民生活中的作用。方法：我们通过对工作人员和居民之间的言语交流的自然观察、工作人员查房期间的现场笔记以及录音的工作人员焦点小组和居民访谈会议，在基于项目的心力衰竭环境中收集数据。使用与扎根理论方法一致的持续比较过程来管理和编码定性数据。分析的目的是对酒精在居民生活中的作用进行概念/主题描述。结果：研究结果表明，考虑居民饮酒的动机很重要，其中可能包括感知到的积极和消极后果。此外，据报告采取了减少危害的方法，以促进住房的获得和维护。居民和工作人员报告说，传统的禁欲方法对于这一特定人群来说既不理想也不有效。最后，酒精依赖道德模式的要素继续渗透到居民对自己的看法和社区对他们的看法中。结论：研究结果表明，有必要抛开传统的饮酒模式和方法，以更好地理解、适应和满足这一人群的需求。在此过程中，我们可能会进一步了解如何通过应用更有针对性的、针对酒精的、减少危害的干预措施来增强现有的基于项目的 HF 方法。 (C) 2011 Elsevier B.V. 保留所有权利。
Background: Housing first (HF) programmes provide low-barrier, nonabstinence-based, immediate. supportive and permanent housing to chronically homeless people who often have co-occurring substance-use and/or psychiatric disorders. Project-based HF programmes offer housing in the form of individual units within a larger housing project. Recent studies conducted at a specific project-based HF programme that serves chronically homeless individuals with alcohol problems found housing provision was associated with reduced publicly funded service utilisation, decreased alcohol use, and sizable cost offsets. No studies to date, however, have qualitatively explored the role of alcohol use in the lives of residents in project-based HF.Methods: We collected data in a project-based HF setting via naturalistic observation of verbal exchanges between staff and residents, field notes taken during staff rounds, and audio recorded staff focus groups and resident interview sessions. Qualitative data were managed and coded using a constant comparative process consistent with grounded theory methodology. The goal of the analysis was to generate a conceptual/thematic description of alcohol's role in residents' lives.Results: Findings suggest it is important to take into account residents' motivations for alcohol use, which may include perceived positive and negative consequences. Further, a harm reduction approach was reported to facilitate housing attainment and maintenance. Residents and staff reported that traditional, abstinence-based approaches are neither desirable nor effective for this specific population. Finally, elements of the moral model of alcohol dependence continue to pervade both residents' views of themselves and the community's perceptions of them.Conclusions: Findings suggest it is necessary to set aside traditional models of alcohol use and approaches to better understand, align with, and address this population's needs. In doing so, we might gain further insights into how to enhance the existing project-based HF approach by applying more tailored, alcohol-specific, harm reduction interventions. (C) 2011 Elsevier B.V. All rights reserved.