Trial Summary
What is the purpose of this trial?People experiencing chronic homelessness comprise a small yet high-morbidity, high-cost subset of the larger homeless population and are disproportionately impacted by alcohol-related harm. Unfortunately, traditional abstinence-based treatment does not adequately reach or engage this population, and both firsthand (problems stemming from one's own alcohol use) and secondhand (problems stemming from others' alcohol use) alcohol-related harm persists even after housing attainment. There have therefore been calls for more flexible and client-centered approaches tailored to this population's needs. Housing First, which entails the provision of immediate, permanent, low-barrier, nonabstinence-based housing, is a response to this call. Research has shown that Housing First is associated with decreased alcohol use, alcohol-related harm, and publicly funded service utilization. Nonetheless, Housing First residents continue to experience both first- and secondhand alcohol-related harm. Thus, further community-based interventions are necessary. To this end, a pilot project was conducted in which researchers as well as Housing First residents, staff and management codeveloped, implemented, and initially evaluated the Life Enhancing Alcohol-management Program (LEAP). The LEAP entails low-barrier, community-level, house-wide resident programming-including leadership opportunities, activities, and pathways to recovery. At the 6-month follow up, LEAP participants reported significantly more engagement in meaningful activities than control participants (p \< .001). Moreover, high levels of LEAP program engagement (\>2 activities per month) predicted significant reductions in alcohol use and alcohol-related harm (ps \< .01). To build on these promising findings, we propose a larger, cluster-randomized controlled trial of LEAP (N=160) as an innovative, community-based, and client-driven adjunct to Housing First. Analyses will test LEAP effectiveness in increasing engagement in meaningful activities, decreasing alcohol use, ameliorating both first- and secondhand alcohol-related harm, and improving quality of life. Engagement in meaningful activities will also be tested as a mediator of the LEAP effect on alcohol and quality-of-life outcomes. Finally, we will assess whether LEAP is associated with reduced costs stemming from participants' use of emergency health-care and criminal justice services.
Eligibility Criteria
This trial is for current DESC clients living in certain Housing First sites who have a history of chronic homelessness and at-risk drinking. To join, men must score over 3 and women over 2 on the AUDIT-C screening. Participants must be able to consent to research and not pose a safety risk.Inclusion Criteria
At-risk drinking as established by the AUDIT-C at screening (cut-off scores: men >= 3, women >= 2)
Having a history of chronic homelessness according to the widely accepted federal definition (i.e., having a psychiatric, medical, or substance use disorder paired with being homeless for a year or more or having 4 or more episodes of homelessness in the past 3 years)
Being a current DESC client living in 1 of 10 participating Housing First sites
Exclusion Criteria
Constituting a risk to the safety and security of other clients or staff
I am unable or unwilling to give consent for research participation.
Participant Groups
The LEAP program is being tested as an adjunct to Housing First housing. It's a community-based initiative offering leadership opportunities, activities, and recovery pathways aimed at reducing alcohol use and related harm while improving engagement in meaningful activities.
2Treatment groups
Active Control
Group I: LEAPActive Control1 Intervention
Housing First plus LEAP
Group II: Service-As-UsualActive Control1 Intervention
Housing First
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
University of Washington - Harborview Medical CenterSeattle, WA
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Who Is Running the Clinical Trial?
University of WashingtonLead Sponsor
National Institute on Alcohol Abuse and Alcoholism (NIAAA)Collaborator
Washington State UniversityCollaborator