title: Qualitatively and quantitatively evaluating harm-reduction goal setting among chronically homeless individuals with alcohol dependence.
abstract: BACKGROUND
  Most treatment programs for alcohol dependence have prioritized alcohol abstinence as the primary treatment goal. However, abstinence-based goals are not always considered desirable or attainable by more severely affected populations, such as chronically homeless people with alcohol dependence. Because these individuals comprise a multimorbid and high-utilizing population, they are in need of more focused research attention that elucidates their preferred treatment goals. The aim of this secondary study was therefore to qualitatively and quantitatively document participant-generated treatment goals
  
  
  METHODS
  Participants were currently or formerly chronically homeless individuals (N=31) with alcohol dependence who participated in a pilot of extended-release naltrexone and harm-reduction counseling. Throughout the treatment period, study interventionists elicited participants' goals and recorded them on an open-ended grid. In subsequent weeks, progress towards and achievement of goals was obtained via self-report and recorded by study interventionists. Conventional content analysis was performed to classify participant-generated treatment goals
  
  
  RESULTS
  Representation of the three top categories remained stable over the course of treatment. In the order of their frequency, they included drinking-related goals, quality-of-life goals and health-related goals. Within the category of drinking-related goals, participants consistently endorsed reducing drinking and alcohol-related consequences ahead of abstinence-based goals. Quantitative analyses indicated participants generated an increasing number of goals over the course of treatment. Proportions of goals achieved and progressed towards kept pace with this increase
  
  
  CONCLUSIONS
  Findings confirmed hypotheses that chronically homeless people with alcohol dependence can independently generate and achieve treatment goals towards alcohol harm reduction and quality-of-life improvement.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA. Electronic address: collinss@uw.edu.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Collins
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Véronique S
authors.initials: VS
authors.lastname: Grazioli
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Nicole I
authors.initials: NI
authors.lastname: Torres
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Taylor
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Connor B
authors.initials: CB
authors.lastname: Jones
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Gail E
authors.initials: GE
authors.lastname: Hoffman
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Haelsig
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Mengdan D
authors.initials: MD
authors.lastname: Zhu
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Alyssa S
authors.initials: AS
authors.lastname: Hatsukami
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Molly J
authors.initials: MJ
authors.lastname: Koker
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Herndon
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Shawna M
authors.initials: SM
authors.lastname: Greenleaf
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA.
authors.forename: Parker E
authors.initials: PE
authors.lastname: Dean
mesh_terms: D000328:Adult; D064829:Alcohol Abstinence / Q000523:psychology; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation*; D015331:Cohort Studies; D003376:Counseling / Q000379:methods; D005260:Female; D006040:Goals; D040261:Harm Reduction; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D018802:Patient-Centered Care; D010865:Pilot Projects; D011446:Prospective Studies; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology; D013695:Temperance / Q000523:psychology
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone
keywords: Alcohol dependence; Goals; Harm reduction; Homelessness; Qualitative analysis