Projects

Ongoing Research Projects (in alphabetical order)

Counseling for Harm Reduction and Retention in MOUD at Cherokee Nation (CHaRRM-CN) (PIs: Nelson, Collins & Lincoln). Scientists, clinicians, community leaders and people with lived experience at Cherokee Nation Health Services (CNHS), Washington State University, and the University of Washington started working together in 2019 to deepen our understanding of how to help patients with consistent access and adherence to OUD treatment. In the first phase of this NIDA-funded project, we talked to 30 patients, 15 community members, and 18 staff and management at CNHS. We asked them what they liked and disliked about OUD treatment they had experienced. Then, we asked them how to enhance OUD treatment to be more engaging and effective for patients moving forward. In Phase 2, we brought together a community advisory board made up of community members, researchers and CNHS staff and management to review the Phase 1 findings. We then collectively designed and implemented CHaRRM-CN programming that honored what patients and community members told us they wanted to see happen in the Phase 1 interviews. Community codesigned CHaRRM-CN components include 1) harm-reduction and culturally aligned counseling; 2) opportunities for telehealth and mailed medications to reduce barriers to medications; 3) caring contacts (phone, text) and regular monitoring of participant charts for outreach and additional support as needed; and 4) connection to community-based cultural events. In Phase 3, we are conducting a randomized controlled trial to test the effectiveness of the community-codesigned programming alongside the existing OUD treatment programming. To this end, we are recruiting up to 160 participants to measure whether this additional community-driven CHaRRM-CN programming builds cultural connectedness, boosts MOUD adherence, and reduces harm people experience due to opioids.

Doorway Project (Faculty Sponsor and Project Director: Clifasefi). The Doorway Project is a state-funded partnership between the University of Washington, youth and young adults experiencing homelessness, and organizations serving these individuals. Together with University District service providers and community stakeholders, the mission of the Doorway project is to empower and uplift the voices of youth and young adults experiencing homelessness to co-develop helpful and innovative solutions that create a more inclusive and supportive environment for all young people affected by homelessness. The Doorway project aims to expand and improve services through coordinated, comprehensive, and collaborative service delivery. Through our unwavering commitment to self-determination and community partnership, we aim to create a brighter future for young people where homelessness is replaced by stability, healing, and opportunity.

eHaRT-A Project (PI: Frohe). The eHaRT-A Project entails the codevelopment, implementation and evaluation of a therapist-guided structured digital treatment platform for people living in low-barrier, nonabstinence-based permanent supportive housing, called Housing First. The eHaRT-A represents an adaptation of the HaRRT Center’s harm reduction treatment for alcohol (HaRT-A). HaRT-A, which is an in-person harm reduction treatment for alcohol, was originally codeveloped and tested by the HaRRT Center codirectors, Drs. Collins and Clifasefi, and partnering community advisory board (CAB) members. In the present eHaRT-A Project, the in-person HaRT-A is being adapted into a therapist-guided digital treatment platform and implemented via “telehealth stations” that are set up at our partnering agency’s permanent supportive housing facilities (i.e. DESC) around Seattle. With the ongoing support of the HaRRT CAB, the eHaRT-A will be iteratively designed and tested (N=20) to ensure its acceptability and feasibility. The effectiveness of the eHaRT-A will then be tested in a 2-arm randomized controlled trial (N=160) comparing the eHaRT-A to supportive services as usual. The ultimate goal of eHaRT-A is to provide a new pathway for remote treatment delivery for alcohol use disorders (AUD) among marginalized populations who often have severely restricted personal access to digital health technology and may not present to abstinence-based and in-person treatment settings.

Harm-reduction treatment for smoking supported by tobacco-replacing electronic nicotine delivery systems (HaRTS-TRENDS; PI: Collins). The HaRTS-TRENDS study was the planned follow-up to the prior single-arm HaRT-S pilot (see below) and continues the prior study’s partnership between the UW, Washington State University and the Downtown Emergency Service Center (DESC). To build on the promising HaRT-S pilot findings, we planned a 12-month pilot RCT (N=102) to test the efficacy of HaRTS-TRENDS versus brief advice to quit among smokers receiving services at a community-based agency that provides supportive housing to single adults experiencing chronic homelessness. In HaRTS-TRENDS, interventionists embody a compassionate, advocacy-oriented “heart-set” and deliver manualized components: a) participant-led tracking of smoking-related outcomes, b) elicitation of harm-reduction goals and progress made toward them, c) discussion of relative risks of nicotine delivery systems, and d) distribution of electronic nicotine delivery systems (ENDS) as a means of community-preferred safer nicotine delivery. Starting in mid-2019, this study was set to recruit participants through 2020 and follow all participants through a 52-week follow-up. Due to COVID-19 pandemic-era site closures, however, we had to discontinue the study mid-recruitment and prior to most participants’ 52-week follow-up. Analyses are currently underway to represent the data we were able to collect prior to the study disruption. Specifically, we are testing treatment group differences on self-reported smoking and health-related quality of life outcomes as well as on biological measures of smoking-related harm, including levels of carbon monoxide in exhaled air and tobacco-specific nitrosamines (i.e., the primary group of cancer-causing chemicals in tobacco).

Life Enhancing Alcohol-management Program 2.0 (LEAP 2.0; PI: Clifasefi). The LEAP 2.0 Program builds on a longstanding partnership between the UW HaRRT Center and housing first residents, staff, and management of DESC. The pilot program was developed through our three-phase community based participatory research framework, and entails low-barrier, community-level, house-wide resident programming—including leadership opportunities, meaningful activities, and pathways to recovery. Results from the LEAP 1.0 pilot indicated that LEAP participants reported more engagement in meaningful activities than their control counterparts. Further, higher levels of engagement with the LEAP predicted significant reductions in alcohol use and alcohol-related harm. (See below for more information about LEAP 1.0 findings.)  To build on these promising pilot findings, the specific aims of LEAP 2.0 are to more definitively test LEAP effectiveness using a 2-arm, 12-month, cluster-randomized controlled trial at 10 Housing First sites (N=500). Sites will be randomized to the services-as-usual control or LEAP conditions. Quantitative analyses will test LEAP effectiveness in improving participants’ alcohol and QoL outcomes from baseline through the 3, 6-, and 12-month follow-up assessments.

mHealth app for HaRT-A (mHaRT-A; PI: Collins, Sponsor: HaRT3S). The evidence-based treatment, Harm Reduction Treatment for Alcohol or HaRT-A helps people reduce alcohol-related harm and improve quality of life, even if they are not ready, willing, or able to stop using. (See below for more information about HaRT-A.) This compassionate and pragmatic program comprises 3 primary components: 1) Collaborative tracking of alcohol-related harm metrics, 2) Elicitation of people’s own harm-reduction goals, and 3) Discussion of safer-use strategies. A new effort in this work brings together mHealth developers at the women-owned social purpose corporation, HaRT3S, and researchers at the University of Washington’s Harm Reduction Research and Treatment (HaRRT) Center. In order to reduce barriers to harm-reduction intervention even further, engineers at HaRT3S are adapting the HaRT-A approach for a mobile health application (mHaRT-A) so people won’t have to start treatment to start recovery. The UW HaRRT Center team is working on the research side of this project, using human-centered research to assess the app’s usability, feasibility, acceptability, and initial promise in impacting alcohol outcomes. Successful completion of these aims will build the foundation for a subsequent randomized clinical trial testing mHaRT-A’s efficacy in reducing alcohol-related harm and improving quality of life.

Staying in Touch and Engaged Project (Co-PIs: Clifasefi & Collins): The STEP project was a multiphase, COVID-era project funded by the University of Washington through a Population Health Initiative grant and the Psychiatry Department and Washington State University’s Arts & Humanities Minigrant Program. STEP was created when our other projects underway in permanent supportive housing had to be halted due to the COVID-19 pandemic. HaRRT Center CAB members who were residents in DESC’s permanent supportive housing voiced concerns at the very start of the pandemic that they and their neighbors would be left behind. In response, we decided to pivot and codevelop a way of helping residents stay engaged, connected, safe and healthy while physically distanced. During weekly Zoom meetings with CAB members, we created a 3-component intervention. First, we cocreated weekly 4-page, printed meaningful activities packet, featuring health messaging, COVID-19 information, activities to support creativity and self-reflection (e.g., creative writing prompts, visual art prompts). Second, we delivered art supplies and journals to participants housing program. Third, we created group art and wellness hours available via video and telephone conferencing. A 2-group randomized controlled pilot trial was conducted to compare substance use and health-related quality of life for people who received the STEP intervention immediately versus on a 4-week delay. Qualitative and quantitative analyses are currently underway and will be updated here when available.

Supporting Technology Use and Harm Reduction (STaHR) (PI: Frohe): This study entails a needs assessment to better understand technology use and harm reduction within DESC’s permanent, supportive housing facilities. Participants were 30 residents who reported engaging in non-prescription substance use and had lived experience of chronic homelessness. They completed a single interview which comprised open-ended questions about their substance use, current engagement with safer-use strategies, use of and access to technology, and interest in virtual harm-reduction services. Conventional content analysis was conducted to understand the intersection of current substance use, technology use and receipt of services to identify barriers to or facilitators for accessing health care, harm reduction, and other social services. This study will lay the foundation for future programming aimed at supporting technology use and harm reduction within permanent, supportive housing.

Completed Projects

The Harm Reduction Talking Circles (HaRTC) project started when American Indian and Alaska Native community members asked researchers at Washington State University (WSU) and the University of Washington (UW) to offer substance-use recovery pathways that honored their Indigenous traditions. Most requested was the integration of the North American Indigenous practice of Talking Circles with harm reduction, a low-barrier approach to substance-use treatment that does not require sobriety. After a small but successful pilot project in 2015, a larger group came together to continue this effort, including researchers at WSU and UW; Indigenous community members who have lived experience of alcohol use disorder; and traditional health professionals, staff and management at the Seattle Indian Health Board (SIHB). A randomized controlled trial testing the impact of this intervention was poised to start in March 2020 and was upended when Seattle became the initial epicenter of the COVID-19 pandemic. This difficult time, however, provided an opportunity to reshape the study intervention for virtual delivery. Below we share the phases of this work and our subsequent findings for virtual HaRTC, and additional materials are available on the HaRTC site. We thank NIAAA for funding of earlier stages of this work and WSU for funding our subsequent pilot study.

Phase 1: WSU and UW researchers asked urban American Indian and Alaska Native people with alcohol use disorder how they experienced alcohol treatment in the past and how they would redesign it in their own vision (see below article).

We also asked participants more specifically how they would suggest tailoring Harm Reduction Talking Cirlces to be helpful to the community in increasing cultural connection, reducing alcohol-related harm and improving health-related quality of life (see below article).

Phase 2: We assembled a community advisory board comprised of Native community members who have lived experience as well as traditional health professionals, staff and management at SIHB to integrate findings from Phase 1 to refine the HaRTC procedures to best fit the needs, setting and values of Indigenous people.

Phase 3: This phase was set to start in March 2020. Because of the pandemic, however, we shifted our procedures to be administered remotely via videoconferencing. This necessary move required us to change our original RCT design to a single-arm pilot trial of the virtual HaRTC (N=50). Findings provided preliminary support for this approach as a feasible and acceptable as a way of helping Indigenous people who meet alcohol use disorder criteria to support their cultural practices, enhance their quality of life, and reduce their alcohol-related harm.

Check out our reports, articles, and posters here.

Harm Reduction with Pharmacotherapy (HaRP) study (PI: Collins). People experiencing homelessness and alcohol use disorder (AUD) have a high prevalence of alcohol-related mortality and need access to AUD treatment. Typical abstinence-based treatments, however, do not optimally engage this population. Research conducted by the HaRRT Center and other colleagues around the world has shown that lower-barrier approaches aiming to reduce alcohol-related harm and improve health-related quality of life (HR-QoL) are more acceptable to this population and can be efficacious, including the behavior harm-reduction treatment for alcohol (HaRT-A) that you can read about in this section. The HaRP study’s aim was to test the efficacy of combining pharmacotherapy with the efficacious behavioral HaRT-A approach. Participants were 308 adults experiencing homelessness and AUD who were randomized to 4 treatment arms: a) behavioral Harm-Reduction Treatment for AUD (HaRT-A) + extended-release naltrexone (XR-NTX), b) HaRT-A + placebo injections, c) HaRT-A only, and d) supportive services as usual (TAU). All participants attended assessments at baseline and weeks 4, 8, 12, 24 and 36. Primary outcomes were self-reported alcohol use  quantity (AQUA; standard drinks) and frequency (ASI), alcohol-related harm (SIP-2R), and physical and mental HR-QoL (SF-12). Using piecewise growth modeling and an intent-to-treat model, we tested the effects of the 3 active treatment arms compared to TAU and the active medication versus placebo, double-blinded arms over a 12-week treatment course and through the 24 weeks following treatment withdrawal. Compared to TAU, the HaRT-A+XR-NTX arm evinced statistically significant improvements from baseline to 12 weeks posttreatment across 5 of the 6 outcomes, including peak alcohol quantity, alcohol frequency, alcohol-related harm, and physical HR-QoL. In the absence of XR-NTX, participants who received HaRT-A likewise saw improvements across 3 of the 6 outcomes, indicating that behavioral HaRT-A alone is helpful in reducing alcohol-use and alcohol-related harm as well. There were no significant differences between XR-NTX and placebo groups or among the 3 active treatment groups. Participants who received HaRT-A After treatment discontinuation at 12 weeks, improvements were maintained through the 36-week follow-up.

You can read more about the protocol for this study here:

Collins SE, Saxon AJ, Duncan MH, Smart BF, Merrill JO, Malone DK, Jackson TR, Clifasefi SL, Joesch J, Ries RK. Harm reduction with pharmacotherapy for homeless people with alcohol dependence: Protocol for a randomized controlled trial. Contemporary Clinical Trials. 2014;38:221-234. doi:10.1016/j.cct.2014.05.008

And you can read the main article here:

Since the main article was published, we have conducted a host of secondary studies based on this project that have indicated additional support for harm reduction tools and components, which are available here:

  • In addition to improving alcohol outcomes, HaRT-A was associated with reduced frequency of cannabis and polysubstance use. (Read article here.)
  • SIP-2R is internally consistent, shows convergent validity, and has cross-group measurement equivalence for NAI, Black, and White adults experiencing homelessness with AUD. (Read article here.)
  • Participants were able to develop clinically relevant harm-reduction goals and safer use strategies, which were, in turn, associated with some improvement in alcohol and health-related quality of life outcomes.
  • Extended-release naltrexone is not associated with increased hepatotoxicity. (Read article here.)

The LEAP 1.0 project (PI: Clifasefi) was an NIH-funded project that entailed the community-based development and evaluation of harm-reduction programming for people with lived experience of chronic homelessness and severe alcohol use disorder who are living in a Housing First program that is owned operated by the Downtown Emergency Service Center (DESC). Currently under scientific review, findings indicated a statistically significant difference between the LEAP and services-as-usual control conditions on participants’ level of involvement in meaningful activities. Although there were no significant group differences on alcohol outcomes, we did find that people who participated in more LEAP programming showed significantly less heavy drinking and alcohol-related problems over the 6-month follow-up.

Following the end of the research project, this programming was successfully implemented on an ongoing basis with the support of an ITHS grant (PI: Clifasefi). This project involved working together with our LEAP community partners (i.e., DESC residents, staff and management) to: a) evaluate and strengthen our existing partnership, b) assess the impact of the LEAP process on the partnership, and c) build community capacity by developing and piloting a technical assistance package for others wishing to implement the LEAP.

Phase 1: Findings gleaned through naturalistic observations, resident interviews and focus groups with staff and management indicated 3 preferred areas for LEAP program development: (a) enhancing training and support for staff, (b) increasing residents’ access to meaningful activities, and (c) exploring alternate pathways to recovery. 

Clifasefi SL, Collins SE, Torres NI, Grazioli VS, Mackelprang JL. Housing First, but what comes second? A qualitative study of resident, staff and management perspectives on single-site Housing First program enhancement. Journal of Community Psychology. 2016;44(7):845-855. doi:10.1002/jcop.21812

Phase 2: We used our CBPR approach to codesign the LEAP with Housing First residents, staff and management.

Collins SE, Clifasefi SL, Stanton J, The LEAP Advisory Board, Straits KJE, Gil-Kashiwabara E, Rodriguez Espinosa P, Nicasio AV, Andrasik MP, Hawes SM, Miller KA, Nelson LA, Orfaly VE, Duran BM, Wallerstein N. Community-based participatory research (CBPR): Towards equitable involvement of community in psychology research. American Psychologist. 2018;73:884-898. doi:10.1037/amp0000167

Phase 3: Findings from the nonrandomized controlled trial (N=116) indicated that residents in the LEAP house showed greater engagement in meaningful activities than residents in the services-as-usual houses. There were no significant group differences in alcohol outcomes or health-related QoL outcomes; however, greater involvement in LEAP activities predicted significant reductions in alcohol use and alcohol-related harm.

Clifasefi SL, Collins SE, The LEAP Advisory Board. The Life Enhancing Alcohol-management Program (LEAP): Results from a 6-month nonrandomized controlled pilot study assessing a community based participatory research program in Housing First. Journal of Community Psychology. 2020;48:763-776. doi:10.1002/jcop.22291

Follow-up analyses also indicated that 86% of participants attended at least one LEAP activity, but that employed residents attended 88% fewer LEAP activities than unemployed residents. Participants who sought out more pathways to recovery activities were more likely daily drinkers and more impacted by alcohol-related harm. Those engaging in administrative leadership opportunities were overall less impacted by alcohol use and had a higher quality of life generally, and their alcohol outcomes further improved over time.

Collins, S. E., Goldstein, S. C., King, V. L., Orfaly, V. E., Gu, J., Clark, A., … & Braid, A. K. (2021). Characterizing components of and attendance at resident‐driven Housing First programming in the context of community‐based participatory research. Journal of Community Psychology, 49, 1376-1392

The HaRT-S study (PI: Collins) was developed using our typical 3-phase CBPR framework together with clients, staff and management at the Downtown Emergency Service Center (DESC). The goal was to create an innovative, empirically informed and client-driven alternative to traditional smoking cessation interventions.

Phase 1: Participants (N=25) were smokers experiencing homelessness who responded to semi-structured qualitative interviews. Findings indicated participants appreciated providers’ initiation of conversations about smoking but did not feel advice to quit was a helpful approach. They suggested providers use a nonjudgmental, compassionate style, offer more support, and discuss a broader menu of options, including nonabstinence-based ways to reduce smoking-related harm and improve health-related quality of life. Most participants preferred engaging in their own self-defined, alternative smoking interventions, including obtaining nicotine more safely (e.g., vaping, using smokeless tobacco) and using behavioral (e.g., engaging in creative activities and hobbies) and cognitive strategies (e.g., reminding themselves about the positive aspects of not smoking and the negative consequences of smoking).

Collins SE, Orfaly VE, Wu T, Chang S, Hardy RV, Nash A, Jones MB, Mares L, Taylor EM, Nelson LA, Clifasefi SL. Content analysis of homeless smokers’ perspectives on established and alternative smoking interventions. International Journal of Drug Policy. 2018;51:10-17.

Phase 2 entailed the assembly of a shelter-based community advisory board comprising researchers at UW and WSU as well as staff, managment and clients at DESC. Together, we cocreated the HaRT-S intervention, which comprised an initial group gathering to introduce safer nicotine products followed by individual appointments for elicitation of participants’ goals for their smoking, discussion of safer nicotine use strategies, and provision of e-cigarettes and nicotine replacement therapy. The CAB also cocreated key materials to inform the community about safer use strategies, including our study flyer, information sheet and brochure.

Phase 3: Findings of our initial, single-arm pilot trial (N=44) with individuals with the lived experience of homelessness and smoking indicated 18% increase in odds of reporting 7-day, biochemically validated, point-prevalence abstinence. All participants who achieved abstinence reported using e-cigarettes. Participants also evinced reductions in cigarette dependence (-45%), frequency (-29%), and intensity (-78%; all ps<.05). Participants who used e-cigarettes during the study experienced an additional 44% reduction in smoking intensity and a 1.2-point reduction in dependence compared to participants who did not use e-cigarettes.

Collins, S. E., Nelson, L.A., Stanton, J., Mayberry, N., Ubay, T., Taylor, E.M.,…& the HaRT-S Community Advisory Board. (2019). Harm reduction treatment for smoking (HaRT-S): Findings from a single-arm pilot study with smokers experiencing chronic homelessness. Substance Abuse, 40, 229-239.

The aim of the Harm Reduction Treatment for Alcohol (HaRT-A) study (PI: Collins) was to codevelop and evaluate a harm-reduction alternative to abstinence-based alcohol treatment together with people experiencing homelessness and AUD. We used our 3-phase model of treatment codevelopment to this end. This study was conducted from 2014-2018 in partnership with DESC, REACH and Harborview Medical Center’s Pioneer Square Clinic.

Phase 1: Participants (N = 50) had lived experience of homelessness and AUDs and participated in semi-structured interviews regarding their experiences of abstinence-based alcohol treatment and suggestions for its improvement. Findings indicated most participants did not attend abstinence-based alcohol treatment for long-term sobriety (e.g., needing a warm place to stay, complying with legally mandated treatment sentence). Participants preferred nonabstinence-based and more holistic pathways to recovery, including fulfilling basic needs (e.g., obtaining housing), using harm reduction approaches (e.g., switching from higher to lower alcohol content beverages), engaging in meaningful activities (e.g., art, outings, spiritual/cultural activities), and making positive social connections.

Collins, S. E., Jones, C. B., Hoffmann, G., Nelson, L. A., Hawes, S. M., Grazioli, V. S., … & Herndon, P. (2016). In their own words: Content analysis of pathways to recovery among individuals with the lived experience of homelessness and alcohol use disorders. International Journal of Drug Policy, 27, 89-96.

Phase 2: We used our CBPR approach to codesign HaRT-A with people with lived experience of homelessness and AUD and the staff and management at agencies that served them.

Collins SE, Clifasefi SL, Stanton J, The LEAP Advisory Board, Straits KJE, Gil-Kashiwabara E, Rodriguez Espinosa P, Nicasio AV, Andrasik MP, Hawes SM, Miller KA, Nelson LA, Orfaly VE, Duran BM, Wallerstein N. Community-based participatory research (CBPR): Towards equitable involvement of community in psychology research. American Psychologist. 2018;73:884-898. doi:10.1037/amp0000167

The resulting HaRT-A comprised a 4-session behavioral AUD intervention. Components included participant-led tracking of their preferred metrics, elicitation of participants’ harm-reduction goals, and discussion of safer drinking strategies using a nonjudgmental, empathetic stance, and acceptance of participants wherever they were along the spectrum of behavior change (see manual).

Phase 3: Findings from our randomized controlled trial (N=168) indicated statistically significant treatment effects. Compared to control participants, HaRT-A participants reported significantly greater a) increases in confidence to engage in harm reduction and b) decreases in peak alcohol use, alcohol-related harm, AUD symptoms, and positive urinary ethyl glucuronide tests (ps < .05). There were, however, no significant treatment effects for health-related QoL (ps > .12).

Collins, S. E., Clifasefi, S. L., Lonnie, N.A., Stanton, J, Goldstein, S.C., Taylor, E.M.,… & Jackson, T.R. (2019). Randomized controlled trial of harm reduction treatment for alcohol (HaRT-A) for people experiencing homelessness and alcohol use disorder. International Journal of Drug Policy, 67, 24-33. doi.org/10.1016/j.drugpo.2019.01.002 

A follow-up study indicated that these positive treatment effects were not observed for more distal systems utilization outcomes, including jail bookings and days and emergency department use. Exploratory analyses showed that 2-week frequency of alcohol use was positively correlated with number of jail bookings in the 12 months surrounding their study participation. Additionally, self-reported alcohol-related harm, importance of reducing alcohol-related harm, and perceived physical functioning predicted more ED visits.

Collins, S. E., Goldstein, S. C., Suprasert, B., Doerr, S. A., Gliane, J., Song, C., … & Hoffmann, G. (2020). Jail and Emergency Department Utilization in the Context of Harm Reduction Treatment for People Experiencing Homelessness and Alcohol Use Disorder. Journal of Urban Health, 1-8.

Part 1 (July 2017-February 2018) entailed qualitative interviews and focus groups to document and analyze stakeholders’ (i.e., Center guests; DESC, REACH and SPD onsite and outreach staff and management; and City partners) experiences with and perceptions of the Center as well as potential points for improvement of the Center’s policies, procedures, amenities, services, and community-building efforts.

Click here to view our report.

Click here for the slide presentation.

Click here for the panel discussion.

Part 2 (November 2017-August 2018) entailed a single-arm assessment of self-reported changes in guests’ housing, substance use, mental health, physical health, and quality of life prior and subsequent to their entry into the Center. Findings indicated participants were 23% less likely to report any alcohol or drug use for each month after their move-in date through the 120-day follow-up. Participants’ experience of substance-related harm, including overdose, did not change in a statistically significant way; however, for each month after move-in, participants were 22% more likely to report having access to naloxone, 12% more likely to use clean injection equipment, and 20% more likely to report giving clean equipment to someone they know. Participants also reported significantly better “general health” over the follow-up.

Click here to view our report.

We were contracted by the Department of Social and Health Services (DSHS) to conduct a process evaluation of King County’s Regional Mental Health and Veterans Courts  (Co-PIs: Clifasefi and Collins). In this work, we documented the Courts’ current operations and services and compared these with their stated missions and national standards using qualitative data analysis methods. Our findings yielded recommendations for future planning, development and program enhancement.

Click here to view our report.

Contrasting with the criminal justice system as usual, Seattle’s Law Enforcement Assisted Diversion (LEAD) program is a pre-booking diversion program that entails a) a one-time diversion from booking and prosecution for a low-level drug or prostitution offense, b) referral to harm-reduction case management, and c) legal assistance. This program was developed by the King County Prosecuting Attorney’s Office, the Seattle City Attorney’s Office, the Seattle Police Department, the King County Sheriff’s Office, the King County Executive, the Mayor’s Office, the Washington State Department of Corrections, The Defender Association, the ACLU of Washington, REACH, and community members. Compared to the system-as-usual control participants, LEAD participants were less likely to recidivate and placed less strain and cost on the legal and criminal justice systems. More contact with LEAD case managers was associated with incrementally higher likelihood of obtaining shelter, housing, vocational services, jobs, and income and benefits. In turn, housing and jobs were associated with reduced recidivism.

Click here for a video that features LEAD.

For more information and to read about our findings please visit https://www.leadbureau.org/.

Project Vivitrol® (PI: Collins) was a single-arm pilot study of extended-release naltrexone as medication support for harm reduction counseling among currently and formerly chronically homeless individuals with alcohol dependence. Participants in this study were able to define their own goals—abstinence and use reduction were not required. Findings indicated significant and biochemically verified decreases on alcohol use and alcohol-related harm among participants. Our partners on Project Vivitrol include DESC, ETS’s REACH, King County, and the Dutch Shisler Sobering Center.

Collins, S. E., Duncan, M. H., Smart, B. F., Saxon, A. J., Malone, D. K., Jackson, T. R., & Ries, R. K. (2015). Extended-release naltrexone and harm reduction counseling for chronically homeless people with alcohol dependence. Substance Abuse, 36(1), 21-33.

Additional, secondary studies were the first to explore the content of harm-reduction goal-setting and safer-use strategies. Of note, only a minority of participants were interested in abstinence-oriented goals and reduced drinking as a safer-use strategy; however, all participants were able to generate and commit to clinically important goals and safer-use strategies.

Collins, S. E., Grazioli, V. S., Torres, N. I., Taylor, E. M., Jones, C. B., Hoffman, G. E., … & Herndon, P. (2015). Qualitatively and quantitatively evaluating harm-reduction goal setting among chronically homeless individuals with alcohol dependence. Addictive behaviors, 45, 184-190.

Grazioli VS, Hicks J, Kaese G, Lenert J, Collins SE. Safer-drinking strategies used by chronically homeless individuals with alcohol dependence. J Subst Abus Treat. 2015;54:63-68. doi:10.1016/j.jsat.2015.01.010

Project M2M (PI: Collins) was a three-year, NIH-funded randomized controlled trial testing the efficacy of two web-based motivational enhancement interventions for college drinkers. One intervention encouraged participants to weigh the pros and cons of their drinking, and the other provided personalized normative feedback about drinking. Findings indicated that web-based personalized normative feedback was associated with reductions in drinking quantity and frequency up to 6 months after exposure to the intervention. Weighing the pros and cons of their drinking helped participants decrease their drinking and alcohol-related harm.

Collins, S. E., Kirouac, M., Lewis, M. A., Witkiewitz, K., & Carey, K. B. (2014). Randomized controlled trial of web-based decisional balance feedback and personalized normative feedback for college drinkers. Journal of studies on alcohol and drugs, 75(6), 982-992.

Collins, S. E., Kirouac, M., Taylor, E., Spelman, P., Grazioli, V., Hoffman, G., Haelsig, L., Holttum, J., Kanagawa, A., Nehru, M., and Hicks, J. (2014). Advantages and disadvantages of college drinking in students’ own words: Content analysis of the decisional balance worksheet. Psychology of Addictive Behaviors, 28(3), 727.