The lived experience of navigating entry into residential treatment for alcohol use disorder while experiencing homelessness: A qualitative study.

INTRODUCTION: Alcohol use disorder (AUD) is highly prevalent among people experiencing homelessness with an estimated 29 %-63 % impacted by this disease. As the effects of alcohol further perpetuate cycles of homelessness, treatment of AUD among this population is an important area of research. Although treatment facilities and outpatient services exist, many unhoused individuals underutilize or lack engagement with these programs. To date, only a few studies have explored the lived experiences of individuals navigating pathways toward treatment for AUD from the streets. Therefore, a patient-centered understanding through the lens of individuals with lived experiences may help those embedded within addiction treatment networks better engage and care for people experiencing homelessness.

METHODS: This study consisted of in-depth semi-structured interviews with people experiencing homelessness being treated at a residential treatment facility for AUD (N = 19). Thematic analysis was used to understand their perspectives regarding the intricacies of navigating into a residential treatment facility for AUD from the streets. Interview transcripts were analyzed using Nvivo software, and an open codebook which guided the analysis.

RESULTS: Frequently described barriers to AUD treatment initiation, navigation, and maintenance were compiled into themes such as, "alcohol as a method of escapism", "burden of navigation lies on the participant", and "gaps in knowledge and function of community resources." Facilitators to AUD treatment included, "need for housing," "linkage by good samaritans," "internal faith," and "being a role model and productive citizen." Attitudes that influenced engagement within the treatment network included "self-efficacy," "recognition of AUD risks," and "medical mistrust."

DISCUSSION: This study unveiled perceived internal and external structural barriers and facilitators that guide AUD treatment initiation, navigation, and maintenance from the streets. More so, it generated common attitudes that facilitate various levels of engagement within the AUD treatment network among people experiencing homelessness. Through the generosity of participants in sharing their stories, this study can aid in informing the development and implementation of effective treatment models focused on guiding people experiencing homelessness toward treatment and recovery.