Background: People experiencing homelessness are disproportionately affected by alcohol use disorder (AUD). Abstinence-based treatment, however, does not optimally engage or treat this population. Thus, Harm Reduction Treatment for Alcohol (HaRT-A) was developed together with people with lived experience of homelessness and AUD and community-based agencies that serve them. HaRT-A is a compassionate and pragmatic approach that aims to help people reduce alcohol-related harm and improve quality of life (QoL) without requiring abstinence or use reduction. A three-month, two-arm randomized controlled trial was conducted to test the initial efficacy of HaRT-A compared to a services-as-usual control condition. Methods: People experiencing homelessness and AUD (N = 168; 24% women) were recruited in community-based clinical and social services settings. Self-reported alcohol use, alcohol-related harm, motivation, and QoL as well as urinary ethyl glucuronide were assessed over a 3-month follow-up. Participants were randomized to receive HaRT-or services as usual. Over four sessions, HaRT-A interventionists delivered three components: a) collaborative tracking of participantpreferred alcohol metrics, b) elicitation of harm-reduction and QoL goals, and c) discussion of safer-drinking strategies. Results: Compared to control participants, HaRT-A participants reported significantly greater increases in confidence to engage in harm reduction and decreases in peak alcohol use, alcoholrelated harm, AUD symptoms, and positive urinary ethyl glucuronide tests (ps < .05). Findings were inconclusive regarding group differences on QoL (ps > .12). Conclusion: A low-barrier, low-intensity, patient-driven, harm-reduction approach has at least short-term efficacy in improving AUD outcomes in this population. Future studies are needed to establish its longer-term efficacy. Keywords drinking; alcohol-related harm; alcohol treatment; harm reduction; homelessness; quality of life Based on 2017 estimates, 549,928 people in the US are homeless on any given night (US Department of Housing and Urban Development, 2017), and over 1.4 million people-or 1 in 230 Americans-spent at least one night in a shelter in 2017 (US Department of Housing Collins et al.

Indigenous youth are at increased risk of initiating substance use at early ages and suffer greater negative consequences related to substance use as compared to non-Indigenous youth. The present study aimed to investigate risk and protective factors associated with substance use in one group of First Nation adolescents. Using a modified grounded theory approach, the present study conducted qualitative focus groups and individual interviews assessing categories of risk and protective factors based upon Behavioral Theories of Choice. Behavioral Theories of Choice suggests that substance use is contingent on the availability of substances and the availability of alternatives to substance use. Fifteen reserve-dwelling (75% female, M age = 15.2 years) First Nation adolescents identified peer influences, parental/family influences, and community influences and issues as risk and protective factors associated with substance use. Results highlight possible targets of culturally appropriate prevention strategies for Indigenous populations.

No abstract

Purpose: North American Indigenous (NAI) communities often cite substance misuse as problematic in their communities. The Competing Life Reinforcers (CLRs) model suggests that when reinforcers are valued, important, and incompatible with substance use, they will be associated with less substance misuse. Three categories of CLRs were identified in our formative work and include the following: cultural, social, and extracurricular activities. The aims of the current study were to test the associations among valuing and availability of CLRs and NAI adolescent alcohol and marijuana use. Methods: Adolescents living in rural First Nation reserve communities (N = 106, 50.0% female) reported their substance use and perceived availability and valuing of CLRs (e.g., smudging and after school activities). Findings: Greater value placed on cultural reinforcers was significantly associated with reduced likelihood of past 3-month drinking to get drunk (OR = 0.85, 95% CI[0.73, 0.98]). Greater value placed on social reinforcers was associated with lower likelihood of past 3-month drinking (OR = 0.94, 95% CI[0.89, 0.995]) and past-3 month drinking to get drunk (OR = 0.94, 95% CI[0.88, 0.99]). Greater valuing extracurricular activities were associated with lower likelihood of past month marijuana use (OR = 0.84, 95% CI[0.72, 098]), past 3-month drinking (OR = 0.77, 95% CI[0.64, 0.92]), and past 3-month drinking to get drunk (OR = 0.76, 95% CI[0.63, 0.92]). Conclusions: CLRs may be protective against NAI adolescent substance use and may be useful targets for prevention and treatment for NAI adolescent substance use. Public Policy Relevance StatementIt is of utmost importance to incorporate important cultural activities and to include trusted supportive people in interventions targeting NAI youth substance use. Prevention approaches for adolescents should make efforts to decrease access to substances and increase access to and importance/value of enjoyable substance-free cultural, social, and extracurricular alternatives. aaa A dolescent substance use is of significant public health concern, as earlier initiation of substance use is associated with higher rates of use, dependence, and a number of negative substance-related consequences later in life (Griffin & Botvin, 2010). This is of particular concern for North American Indigenous (NAI) adolescents (e.g., American Indians [AIs] and Alaska Natives [NAs] in the United States and First Nations people in Canada) who are at disproportionately increased risk for substance use disorders compared to non-Indigenous adolescents (Stanley & Swaim, 2015;Whitbeck et al., 2006;Whitbeck, Sittner Hartshorn, et al., 2014). Research indicates that NAI adolescents are more likely to have used cigarettes (Spillane, Treloar This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

This study is the first to document suicidality among chronically homeless people with alcohol problems (N = 134) and examine its trajectory following exposure to immediate, permanent, low-barrier housing (i.e., Housing First). Suicidal ideation, intent, plans, and prior attempts were assessed at baseline and during a 2-year follow-up. Baseline suicidal ideation was over four times higher than in the general population. Two-year, within-subjects, longitudinal analyses indicated severity of suicidal ideation decreased by 43% from baseline to follow-up. Significant decreases were also found for intent and clinical significance of ideation. No participants died by suicide during the 2-year follow-up.