Heavy drinking is clearly problematic for homeless populations, but is the best way to tackle it to aim for abstinence, or to accept the reality of life on the streets and aim to reduce harm and improve lives in ways which make sense to the patient? This US study supports the latter, but without conclusively deciding the issue.

Key points from summary and commentary
• This US study tested the efficacy of a harm reduction-based intervention for homeless people with (mostly severe) drinking problems.
• Compared to usual services only, the harm reduction intervention was associated with significantly greater increases in confidence to engage in harm reduction, as well as significantly greater decreases in peak drinking, alcohol-related harm, symptoms of alcohol use disorder, and urine samples testing positive for recent drinking.
• The findings suggest that a low-barrier, low-intensity, patient-driven, harm reduction approach has at least short-term efficacy in improving drinking outcomes in this population.