University of Washington, Seattle, WA 98104, USA.
Int J Drug Policy. 2012 Mar;23(2):111-9. doi: 10.1016/j.drugpo.2011.07.010. Epub 2011 Aug 17.
Housing first (HF) programmes provide low-barrier, nonabstinence-based, immediate, supportive and permanent housing to chronically homeless people who often have co-occurring substance-use and/or psychiatric disorders. Project-based HF programmes offer housing in the form of individual units within a larger housing project. Recent studies conducted at a specific project-based HF programme that serves chronically homeless individuals with alcohol problems found housing provision was associated with reduced publicly funded service utilisation, decreased alcohol use, and sizable cost offsets. No studies to date, however, have qualitatively explored the role of alcohol use in the lives of residents in project-based HF.
We collected data in a project-based HF setting via naturalistic observation of verbal exchanges between staff and residents, field notes taken during staff rounds, and audio recorded staff focus groups and resident interview sessions. Qualitative data were managed and coded using a constant comparative process consistent with grounded theory methodology. The goal of the analysis was to generate a conceptual/thematic description of alcohol's role in residents' lives.
Findings suggest it is important to take into account residents' motivations for alcohol use, which may include perceived positive and negative consequences. Further, a harm reduction approach was reported to facilitate housing attainment and maintenance. Residents and staff reported that traditional, abstinence-based approaches are neither desirable nor effective for this specific population. Finally, elements of the moral model of alcohol dependence continue to pervade both residents' views of themselves and the community's perceptions of them.
Findings suggest it is necessary to set aside traditional models of alcohol use and approaches to better understand, align with, and address this population's needs. In doing so, we might gain further insights into how to enhance the existing project-based HF approach by applying more tailored, alcohol-specific, harm reduction interventions.
住房优先（HF）计划为经常同时患有药物使用和/或精神疾病的慢性无家可归者提供低门槛、非禁欲、即时、支持性和永久性住房。基于项目的 HF 计划以较大住房项目内的单个单元形式提供住房。最近在一项专门为有酒精问题的慢性无家可归者提供服务的基于项目的 HF 计划中进行的研究发现，住房提供与减少公共资助服务的使用、减少酒精使用以及大量成本抵消有关。然而，迄今为止，尚无研究从定性角度探讨基于项目的 HF 居民中酒精使用的作用。
我们通过工作人员和居民之间的口头交流的自然观察、工作人员查房时的现场记录、工作人员焦点小组和居民访谈的录音，在基于项目的 HF 环境中收集数据。使用与扎根理论方法一致的恒定性比较过程来管理和编码定性数据。分析的目的是生成一个关于酒精在居民生活中作用的概念/主题描述。
研究结果表明，考虑居民饮酒的动机很重要，这些动机可能包括感知到的积极和消极后果。此外，据报道，减少伤害的方法有助于实现和维持住房。居民和工作人员报告说，传统的、禁欲的方法对这一特定人群既不可取也无效。最后，酒精依赖的道德模型的要素继续影响居民对自己的看法以及社区对他们的看法。
研究结果表明，有必要摒弃传统的酒精使用模式和方法，以更好地理解、符合并满足这一人群的需求。在这样做的过程中，我们可能会进一步了解如何通过应用更具针对性、专门针对酒精、减少伤害的干预措施来增强现有的基于项目的 HF 方法。
