Date of Award

2023

Degree Type

Dissertation

Degree Name

Doctor of Philosophy in Psychology

Specialization

Clinical Psychology

Department

Psychology

First Advisor

Nicole H. Weiss

Abstract

Among populations experiencing homelessness, alcohol use disorder (AUD) precipitates high rates of alcohol-related mortality and morbidity. Within this population, minoritized race, ethnicity, and sex assigned at birth populations experience disproportionate alcohol-related harm. A four-arm randomized control trial (RCT) of Harm Reduction Treatment with Pharmacotherapy (HaRP) tested the efficacy of harm reduction treatment with extended-release naltrexone (XR-NTX; VIVITROL®) among urban-dwelling adults experiencing homelessness and AUD. The HaRP study included three treatment arms (harm reduction counseling [HRC], XR-NTX + HRC, Placebo + HRC) and a services-as-usual control group. The present secondary study 1) used a mixed methods approach to assess perceptions and acceptability of the HaRP treatment across race, ethnicity, and sex assigned at birth groups and 2) assessed moderation effects by race, ethnicity, and sex assigned at birth for the three treatment arms compared to the services-as-usual control group. Participants who qualified to be randomized to the study were adults aged 21-65 years old (Mage = 48.17 years, SD = 9.21) with AUD who were, or had been, homeless in the past year. Participants included North American Indigenous (NAI; 15.9%; n = 49), Black (30.8%; n = 95), white (31.2%; n = 96), other people of color (6.5%; n = 20). 16.2% of participants (n = 50) reported that they were female and 83.8% (n = 258) that they were male and 22.1%. Approximately 1 in 10 participants reported Hispanic/Latine ethnicity (11.1%; n = 34) compared to 88.9% who reported non-Hispanic/Latine ethnicity (n = 273). Participants were randomized to one of the four groups: HRC, XR-NTX + HRC, Placebo + HRC, and a services-as-usual control group. The study featured a 12-week active treatment trial; participants attended a baseline session, three intervention or assessment appointments over 12 weeks, and a week 36 follow up assessment. Participants who had attended the week 36 follow-up assessment (N = 125) were included in the mixed methods portion of the study (assessment of perceptions and acceptability of the HaRP). Conventional content analysis revealed that a majority of participants had positive experiences with general intervention procedures (89.2%), the harm reduction counseling component of the treatment (76.0%); however, pharmacotherapy had less acceptability (32.9%). Further, in general, results suggested the acceptability of the HaRP across the race, ethnicity, and sex assigned at birth groups in this population of adults experiencing homelessness with AUD. Next, growth curve modeling indicated that the efficacy of HaRP, compared to the services-as-usual control group, was not moderated by race, ethnicity, or sex assigned at birth on study outcomes of alcohol frequency, alcohol peak quantity, alcohol-related harm, and physical-related quality of life. Overall, our results provide preliminary indication that harm reduction treatment is acceptable and efficacious across race, ethnicity, and sex assigned at birth groups. Our findings can be used to inform more equitable treatment approaches for individuals from who are at greater risk for substance-related harm, as well as underscore the potential utility of harm reduction intervention for minoritized race, ethnicity, and sex assigned at birth populations.

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