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

Area of Science:

• Social Science
• Public Health
• Addiction Studies

Background:

• Housing First (HF) programs provide permanent housing to chronically homeless individuals with co-occurring disorders.
• Project-based HF offers individual units within a larger housing development.
• Previous studies show HF is associated with reduced service use and alcohol consumption, but the role of alcohol use in residents' lives remains unexplored.

Purpose of the Study:

• To qualitatively explore the role of alcohol use in the lives of residents in project-based Housing First programs.
• To understand residents' motivations for alcohol use and the effectiveness of different approaches.

Main Methods:

• Naturalistic observation of staff-resident interactions.
• Field notes from staff rounds.
• Audio-recorded staff focus groups and resident interviews.
• Grounded theory methodology with constant comparative analysis.

Main Results:

• Residents' motivations for alcohol use, including perceived consequences, are crucial.
• A harm reduction approach facilitates housing attainment and maintenance.
• Abstinence-based models are perceived as ineffective and undesirable by residents and staff.
• The moral model of alcohol dependence influences self-perception and community views.

Conclusions:

• Traditional alcohol use models and approaches need re-evaluation for this population.
• Tailored, alcohol-specific harm reduction interventions can enhance project-based HF programs.
• Understanding residents' needs and perspectives is key to improving HF program effectiveness.