Home > What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography.

Carver, Hannah and Ring, Nicola and Miler, Joanna and Parkes, Tessa . (2020) What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography. Harm Reduction Journal, 17 (1) https://doi.org/10.1186/s12954-020-0356-9

URL: https://harmreductionjournal.biomedcentral.com/art...

BACKGROUND: People experiencing homelessness have higher rates of problematic substance use but difficulty engaging with treatment services. There is limited evidence regarding how problematic substance use treatment should be delivered for these individuals. Previous qualitative research has explored perceptions of effective treatment by people who are homeless, but these individual studies need to be synthesised to generate further practice-relevant insights from the perspective of this group.

METHODS: Meta-ethnography was conducted to synthesise research reporting views on substance use treatment by people experiencing homelessness. Studies were identified through systematic searching of electronic databases and websites and were quality appraised. Original participant quotes and author interpretations were extracted and coded thematically. Concepts identified were compared to determine similarities and differences between studies. Findings were translated (reciprocally and refutationally) across studies, enabling development of an original over-arching line-of-argument and conceptual model.

RESULTS: Twenty-three papers published since 2002 in three countries, involving 462 participants, were synthesised. Findings broadly related, through personal descriptions of, and views on, the particular intervention components considered effective to people experiencing homelessness. Participants of all types of interventions had a preference for harm reduction-oriented services. Participants considered treatment effective when it provided a facilitative service environment; compassionate and non-judgemental support; time; choices; and opportunities to (re)learn how to live. Interventions that were of longer duration and offered stability to service users were valued, especially by women. From the line-of-argument synthesis, a new model was developed highlighting critical components of effective substance use treatment from the service user's perspective, including a service context of good relationships, with person-centred care and an understanding of the complexity of people's lives.

CONCLUSION: This is the first meta-ethnography to examine the components of effective problematic substance use treatment from the perspective of those experiencing homelessness. Critical components of effective problematic substance use treatment are highlighted. The way in which services and treatment are delivered is more important than the type of treatment provided. Substance use interventions should address these components, including prioritising good relationships between staff and those using services, person-centred approaches, and a genuine understanding of individuals' complex lives.


Item Type:Evidence resource
Drug Type:Alcohol or other drugs in general
Intervention Type:AOD disorder, AOD disorder drug therapy, AOD disorder treatment method, AOD disorder harm reduction, Psychosocial treatment method, Rehabilitation/Recovery
Date:31 January 2020
Page Range:p. 10
Volume:17
Number:1
EndNote:View
Subjects:HJ Treatment method > Substance disorder treatment method
HJ Treatment method > Treatment outcome
J Health care, prevention and rehabilitation > Treatment and maintenance > Treatment factors
J Health care, prevention and rehabilitation > Treatment and maintenance > Patient attitude toward treatment
MA-ML Social science, culture and community > Social condition > Homelessness
MA-ML Social science, culture and community > Social condition > Homelessness > Homeless services
T Demographic characteristics > Homeless person

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