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Harm reduction treatment helped people with homelessness and alcohol use disorders drink less and improve their health – even if they had not stopped drinking alcohol.
In a randomized clinical trial, a research team led by Washington State University psychology professor Susan Collins studied more than 300 people from three Seattle homeless shelters and programs. Participants were randomly assigned to four groups that received different benefits: the first group received behavioral harm reduction treatment, which is a form of collaborative counseling that does not require sobriety or alcohol reduction, and an anti-craving drug called naltrexone. the second had the counseling and a placebo; the third the counseling alone; and the fourth served as a control group who received regular services.
All three groups that received the behavioral harm reduction treatment over a three-month period showed greater improvement than the control group – with the greatest improvement in the group that received both the counseling and the anti-craving medication.
“We found that participants didn’t have to stop drinking to recover,” said Collins, lead author of the study, which was published March 10 in The Lancet Psychiatry. “We didn’t ask participants to change their alcohol consumption in any particular way, but looking at the averages generated in our statistical models, we found that people who received the combined counseling and medication saw a decrease in number during their treatment 59% recorded drinks consumed on their heaviest drinking day. “
Other improvements over the three months of treatment included a 43% reduction in total alcohol-related harm, a 29% reduction in drinking frequency, and a 10% improvement in people’s self-assessment of physical health.
All participants were asked to complete surveys on alcohol consumption, health and quality of life at different intervals. While the group with counseling and medication showed a statistically significant improvement in five out of six measures, the other two groups who had counseling on harm reduction but no active medication showed a statistically significant improvement in three out of six measures.
The researchers also tested urine samples. Participants who received combined treatment and medication were almost three times more likely to have undetectable levels of an alcohol biomarker than participants in the control group, which means that their alcohol consumption had decreased significantly.
For over a decade, Collins and her co-authors from the University of Washington and the VA Puget Sound Health Care System have worked with people using substances and community agencies to develop evidence-based treatment to reduce behavioral harm in alcohol use disorder.
Treatment includes three strategies to reduce the negative effects of alcohol consumption. First, instead of dictating that they stop, interventionists help patients set their own treatment goals. Second, interventionists and patients discuss ways to stay safer and healthier while drinking as well. Third, instead of just tracking sobriety, interventionists work with patients to collectively measure and track different types of alcohol-related harm that may be important to patients.
Collins said that traditional alcohol treatment programs that encourage abstinence cannot help many people suffering from homelessness and alcohol use disorders. According to some estimates, people with chronic homelessness and alcohol use disorder have had alcohol treatment an average of 16 times in their lifetime.
“Often these people are referred to as ‘medical malpractice’, but after many years of this work we realized that it is us, the treatment system that fails them more than the other way around,” said Collins. “What we do with harm reduction treatment is try to meet people where they are. Instead of falling into that paternalistic, advisory approach that puts people off, we try to guide them in achieving their own goals support.”
Many of the study participants had multiple goals, only a few of which were to reduce alcohol consumption. As would be expected, the most common goal was to find more stable shelter. Other goals, however, included reconnecting with family, finding work, and pursuing hobbies they once enjoyed.
While this study included people with homelessness, the results also hold potential for other people with alcohol use disorder, Collins said.
“This approach has the potential to help anyone who wants to change their drinking but may not be ready or able to stop altogether,” said Collins. “We can take treatment gradually, which is potentially more enduring and less demoralizing than going through those cycles where people feel like they can’t stop drinking, can’t start recovery, or aren’t good enough for ours Treatment system. Instead, our definition of recovery and our treatment system must change. ”
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The Lancet Psychiatry (2021). DOI: 10.1016 / S2215-0366 (20) 30489-2 Provided by Washington State University
Quote: Clinical Study Shows Recovery From Alcohol Use Disorders Can Begin Without Sobriety (2021, March 10), Retrieved March 10, 2021 from https://medicalxpress.com/news/2021-03-clinical-trial-alcohol-disorder -recovery.html
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