2. The experience of persons in homeless situation with alcohol related problems regarding a pharmacological harm reduction initiative

People in homeless situations are more likely to be affected by alcohol use disorder (AUD) and traditional treatment settings and goals fail to provide efficient care. During the COVID19 pandemic, this population was at additional risk of life-threatening deprivation syndrome for the lack of access to usual alcoholic beverages. In new emergency shelters (ES) created in Lisbon, an adapted harm-reduction (HR) pharmacological intervention. How was this initiative welcomed by users, and how it impacted on their individual trajectories?

As part of PLACE – a retrospective, mixed methods observational study – we performed a qualitative analysis adapted from Consolidated Framework for Implementation Research Constructs (CFIRC). This framework was applied to 19 individual telephonic interviews to persons in homeless situation with AUD that were admitted in new emergency shelters during 2020.

We interviewed 5 women and 14 men, with ages ranging from 31 to 60 years. They had different life trajectories, nationalities, time spent as homeless, life objectives and perceptions of the initiative. Some of the adapted Intervention Characteristics from CFIRC emerged from the interviews (Intervention Source, Relative Advantage, Evidence Strength and Quality, Design Quality and Packaging, Cost, Complexity). Despite the persistence of an abstinence-based philosophy, this initiative was found helpful, especially if associated with social responses, such us Housing First.

Under the auspice of HR initiatives, these fundamental actors are called upon an active participation in their own life decisions regarding their AUD and life goals. These results contribute to the wider understanding of HR policies and their local implications.