A new approach to treating alcohol use disorder in people experiencing homelessness

In the response to homelessness in North America and Europe, alcohol use disorder receives less attention than it should when compared with drugs. This imbalance is likely to reflect the toll of deaths attributable to opioids in North America. However, the current prevalence of alcohol use among homeless people is high, at 38%, compared with an average prevalence of 24% for drug use disorders in this population. 1 Fazel S Khosla V Doll H et al. The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med. 2008; 5: e225 Crossref PubMed Scopus (665) Google Scholar Unremitting alcohol use contributes to mortality and to poisoning events (ie, overdose). In one survey of over 5000 US veterans who had experienced homelessness in the preceding 30 months, published in 2020, 192 (3·7%) had had an overdose event with alcohol that required medical attention. 2 Riggs KR Hoge AE DeRussy AJ et al. Prevalence of and risk factors associated with nonfatal overdose among veterans who have experienced homelessness. JAMA Netw Open. 2020; 3e201190 Crossref PubMed Scopus (15) Google Scholar Combining behavioral harm-reduction treatment and extended-release naltrexone for people experiencing homelessness and alcohol use disorder in the USA: a randomised clinical trialCompared with existing services, combined pharmacological and behavioural harm-reduction treatment resulted in decreased alcohol use and alcohol-related harm and improved physical health-related quality of life during the 12-week treatment period for people experiencing homelessness and alcohol use disorder. Although not as consistent, there were also positive findings for behavioural harm-reduction treatment alone. Considering the non-significant differences between participants receiving HaRT-A plus placebo and HaRT-A plus XR-NTX, the combined pharmacological and behavioural treatment effect cannot be attributed to XR-NTX alone. Full-Text PDF