‘Everywhere I call, there's nothing available’: Understanding the alcohol treatment landscape and needs among unstably housed people who use alcohol in Rhode Island

Alexandra B. Collins*, Michael Tan, Megan Smith, Sara J. Becker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Alcohol is a leading cause of morbidity and mortality in the United States and people who are unstably housed are disproportionately impacted by adverse alcohol-related health outcomes. Addressing the needs of unstably housed people with high-intensity alcohol use (i.e., heavy episodic use or binge drinking), including those whose goal is not abstinence, is critical to reducing harms among this population. This study explores the alcohol-related treatment and support needs among unstably housed people who use alcohol. Methods: Data collection included participant observation and semi-structured interviews (n = 25) with unstably housed people with high-intensity alcohol use. Data were analysed thematically, with attention to structural vulnerability and social-structural forces at shaping perceptions of and experiences with alcohol treatment. Results: Participants underscored how housing instability was critical in precipitating and maintaining heavy alcohol use, with alcohol often used to manage the stress and anxiety related to housing instability. While participants regularly engaged with alcohol treatment programs, program design and barriers to access undermined the effectiveness of these services for participants. Participants described the need for a range of program and service options across a continuum of care to be implemented to support participants in meeting their diverse needs and identified goals regarding alcohol use. Discussion and Conclusions: Alcohol treatment and supports need to be modified so that they include a range of harm reduction and abstinence-based models to better meet people's diverse needs. Furthermore, treatment must be paired with permanent and affordable housing to address underlying drivers of alcohol-related harm for unstably housed people.

Original languageEnglish (US)
Pages (from-to)1235-1246
Number of pages12
JournalDrug and Alcohol Review
Volume43
Issue number5
DOIs
StatePublished - Jul 2024

Keywords

  • alcohol
  • alcohol treatment
  • alcohol use disorder
  • housing instability
  • qualitative

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health(social science)

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