Harm reduction through housing first: an assessment of the Emergency Warming Centre in Inuvik, Canada

Purpose Recently, Managed Alcohol Programs (MAPs have emerged as an alcohol harm reduction model for those living with severe alcohol use disorder (AUD) and experiencing homelessness. There is still a lack of clarity about the role of these programs in relation to Housing First (HF) discourse. The authors examine the role of MAPs within a policy environment that has become dominated by a focus on HF approaches to addressing homelessness. This examination includes a focus on Canadian policy contexts where MAPs originated and are still predominately located. The purpose of this paper is to trace the development of MAPs as a novel response to homelessness among people experiencing severe AUD and to describe the place of MAPs within a HF context. Design/methodology/approach This conceptual paper outlines the development of discourses related to persons experiencing severe AUD and homelessness, with a focus on HF and MAPs as responses to these challenges. The authors compare the key characteristics of MAPs with “core principles” and values as outlined in various definitions of HF. Findings MAPs incorporate many of the core values or principles of HF as outlined in some definitions, although not all. MAPs (and other housing/treatment models) provide critical housing and support services for populations who might not fit well with or who might not prefer HF models. Originality/value The “silver bullet” discourse surrounding HF (and harm reduction) can obscure the importance of programs (such as MAPs) that do not fully align with all HF principles and program models. This is despite the fact that MAPs (and other models) provide critical housing and support services for populations who might fall between the cracks of HF models. There is the potential for MAPs to help fill a gap in the application of harm reduction in HF programs. The authors also suggest a need to move beyond HF discourse, to embrace complexity and move toward examining what mixture of different housing and harm reduction supports are needed to provide a complete or comprehensive array of services and supports for people who use substances and are experiencing homelessness.

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Qualitative findings from a Housing First evaluation project for homeless Veterans in Canada

Journal of Military Veteran and Family Health ◽

10.3138/jmvfh-2021-0052 ◽

2021 ◽

Author(s):

Cheryl Forchuk ◽

Jan Richardson ◽

Heather Atyeo ◽

Jonathan Serratoa

Keyword(s):

Harm Reduction ◽

Peer Support ◽

Housing First ◽

New Approach ◽

Housing Stability ◽

Homeless Veterans ◽

Permanent Housing ◽

Personal Experiences ◽

Housing Services ◽

Mental Health Support

LAY SUMMARY This two-year study implemented a Housing First approach among homelessness services for Veterans in four cities across Canada (Victoria, Calgary, London, and Toronto). This approach included peer support and harm reduction resources for Veterans. To obtain a detailed evaluation of personal experiences and opinions, focus groups were held with Veterans, housing staff, and stakeholders at three time points during the study: July-September 2012, May-June 2013, and January 2014. Harm reduction and peer support were regarded as positive aspects of this new approach to housing and homelessness. It was suggested that greater mental health support, support from peers with military experience, and issues regarding roommates should be considered in future implementations of housing services for Veterans. It was also noted that to support personal stabilization, permanent housing is preferred over transitional or temporary housing. Future housing programs serving Veterans experiencing homelessness should consider the addition of harm reduction and peer support to further enhance services and help maintain housing stability.

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From Controlled Drinking to Housing First: Marlatt's Impact on Harm Reduction Research and Practice

PsycEXTRA Dataset ◽

10.1037/e637482012-001 ◽

2012 ◽

Author(s):

Mary Larimer

Keyword(s):

Harm Reduction ◽

Housing First ◽

Research And Practice ◽

Controlled Drinking

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Harm reduction in a Norwegian housing first project: a qualitative study of the treatment providers’ practice

Advances in Dual Diagnosis ◽

10.1108/add-08-2017-0015 ◽

2018 ◽

Vol 11 (1) ◽

pp. 4-15 ◽

Cited By ~ 3

Author(s):

Ellen Sofie Andvig ◽

Knut Tore Sælør ◽

Esther Ogundipe

Keyword(s):

Substance Use ◽

Qualitative Study ◽

Harm Reduction ◽

Local Community ◽

Mental Health Problems ◽

Housing First ◽

Professional Judgment ◽

Content Type ◽

Treatment Providers ◽

Reduction Approach

Purpose Little is known about how harm reduction is practiced in Norwegian housing first (HF) projects. The purpose of this paper is to explore, describe, and interpret how providers apply a harm reduction approach within a housing project focused on individuals who are homeless with co-morbid substance use and mental health problems. Design/methodology/approach This qualitative study was part of a larger evaluation study of a three-year HF project in a Norwegian municipality. Data were collected using four multi-stage focus groups with five providers working in the HF project. Focus group interviews were transcribed verbatim and analyzed using thematic analysis. Findings Analysis resulted in three main themes: “Letting the service user sit in the driver’s seat,” “We don’t follow service provision contracts, we do everything,” and “Collaborating with the local community.” Research limitations/implications There is a need to develop increased knowledge about service users’ experiences within the harm reduction approach. Practical implications To practice effective harm reduction, treatment providers must have open authorizations and the opportunity to exercise professional judgment. Harm reduction practice must also focus on social, political, and economic factors influencing users’ everyday lives. Originality/value The paper contributes to the knowledge base on harm reduction within HF practice that differs from a traditional model wherein clients are expected to abstain from substance use. It highlights important preconditions for challenges practitioners might encounter at both individual and service system levels.

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Where harm reduction meets housing first: Exploring alcohol's role in a project-based housing first setting

International Journal of Drug Policy ◽

10.1016/j.drugpo.2011.07.010 ◽

2012 ◽

Vol 23 (2) ◽

pp. 111-119 ◽

Cited By ~ 52

Author(s):

Susan E. Collins ◽

Seema L. Clifasefi ◽

Elizabeth A. Dana ◽

Michele P. Andrasik ◽

Natalie Stahl ◽

...

Keyword(s):

Harm Reduction ◽

Housing First

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Harm Reduction Outcomes and Practices in Housing First: A Mixed-Methods Systematic Review

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2021.109052 ◽

2021 ◽

pp. 109052

Author(s):

Nick Kerman ◽

Alexia Polillo ◽

Geoff Bardwell ◽

Sophia Gran-Ruaz ◽

Cathi Savage ◽

...

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Harm Reduction ◽

Housing First

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Unknown and Under-Researched: The Anatomy of Drinking Under Control Programs

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/0939-5911/a000504 ◽

2017 ◽

Vol 63 (5) ◽

pp. 277-288

Author(s):

Harald Klingemann ◽

Justyna Klingemann

Keyword(s):

Quality Of Life ◽

Harm Reduction ◽

Evaluation Studies ◽

Mission Statements ◽

Community Response ◽

Limited Resources ◽

Admission Criteria ◽

Control Programs ◽

Institutional Order

Abstract. Introduction: While alcohol treatment predominantly focuses on abstinence, drug treatment objectives include a variety of outcomes related to consumption and quality of life. Consequently harm reduction programs tackling psychoactive substances are well documented and accepted by practitioners, whereas harm reduction programs tackling alcohol are under-researched and met with resistance. Method: The paper is mainly based on key-person interviews with eight program providers conducted in Switzerland in 2009 and up-dated in 2015, and the analysis of reports and mission statements to establish an inventory and description of drinking under control programs (DUCPs). A recent twin program in Amsterdam and Essen was included to exemplify conditions impeding their implementation. Firstly, a typology based on the type of alcohol management, the provided support and admission criteria is developed, complemented by a detailed description of their functioning in practice. Secondly, the case studies are analyzed in terms of factors promoting and impeding the implementation of DUCPs and efforts of legitimize them and assess their success. Results: Residential and non-residential DUCPs show high diversity and pursue individualized approaches as the detailed case descriptions exemplify. Different modalities of proactively providing and including alcohol consumption are conceptualized in a wider framework of program objectives, including among others, quality of life and harm reduction. Typically DUCPs represent an effort to achieve public or institutional order. Their implementation and success are contingent upon their location, media response, type of alcohol management and the response of other substance-oriented stake holders in the treatment system. The legitimization of DUCPs is hampered by the lack of evaluation studies. DUCPs rely mostly – also because of limited resources – on rudimentary self-evaluations and attribute little importance to data collection exercises. Conclusions: Challenges for participants are underestimated and standard evaluation methodologies tend to be incompatible with the rationale and operational objectives of DUCPs. Program-sensitive multimethod approaches enabled by sufficient financing for monitoring and accompanying research is needed to improve the practice-oriented implementation of DUCPs. Barriers for these programs include assumptions that ‘alcohol-assisted’ help abandons hope for recovery and community response to DUCPs as locally unwanted institutions (‘not in my backyard’) fuelled by stigmatization.

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Motivational Interviewing: Ein Literaturüberblick

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/suc.2001.47.3.171 ◽

2001 ◽

Vol 47 (3) ◽

pp. 171-188 ◽

Cited By ~ 6

Author(s):

Ralf Demmel

Keyword(s):

Motivational Interviewing ◽

Harm Reduction ◽

Motivational Enhancement Therapy ◽

Motivational Enhancement ◽

Motivationale Interventionen

Der dysfunktionale Konsum psychotroper Substanzen geht in der Regel mit einem Zwiespalt zwischen Abstinenzvorsatz bzw. der Absicht, den Konsum zu reduzieren, einerseits und dem Wunsch oder Zwang, den Konsum fortzusetzen, andererseits einher. Das von Miller und Rollnick (1991) beschriebene Motivational Interviewing (MI) ist ein zugleich klientenzentrierter und direktiver Behandlungsstil, der dieser Ambivalenz Rechnung tragen und somit Veränderungsbereitschaft erhöhen soll. Miller und Rollnick (1991) nennen fünf Prinzipien motivationaler Gesprächsführung: <OL><LI>Empathie, <LI>Widersprüche aufzeigen, <LI>Wortgefechte vermeiden, <LI>Nachgiebig auf Widerstand reagieren und <LI>Selbstwirksamkeit fördern.</OL> Diese Prinzipien stimmen mit den Annahmen (sozial-) psychologischer Modelle der Einstellungs- und Verhaltensänderung überein. Seit Ende der achtziger Jahre wurden vorwiegend in den angelsächsischen Ländern verschiedene motivationale Interventionen zur Sekundärprävention und Behandlung von Substanzabhängigkeit und -missbrauch entwickelt, die den von Miller und Rollnick (1991) formulierten Behandlungsprinzipien entsprechen (der Drinkers Checkup, Motivational Enhancement Therapy, das Harm-Reduction-Programm BASICS, Brief Motivational Interviewing, Brief Negotiation sowie eine Reihe weiterer motivationaler Kurzinterventionen). Vor dem Hintergrund der bislang vorliegenden Literatur erscheint insbesondere die Durchführung standardisierter motivationaler Interventionen zur Reduktion dysfunktionalen Alkoholkonsums bzw. der negativen Konsequenzen eines fortgesetzten Alkoholmissbrauchs gerechtfertigt. Voraussetzungen einer Optimierung des Behandlungserfolgs sind neben der Identifikation zentraler Wirkmechanismen u.a. eine fortlaufende Prozess-Evaluation der Implementierung motivationaler Interventionen sowie eine evidenzbasierte Ausbildung.

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