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HRB Drug and Alcohol Evidence Reviews HRB drug and alcohol evidence reviews 07 Evidence review of drug treatment services for people who are homeless and use drugs Evidence review of drug treatment services for people who are homeless and use drugs Joanna Miler, Hannah Carver, Wendy Masterton, Tessa Parkes (Salvation Army Centre for Addiction Services and Research (SACASR), University of Stirling) Lisa Jones, Michelle Maden, Harry Sumnall (Public Health Institute at Liverpool John Moores University) Dublin: Published by the Health Research Board Grattan House, 67-72 Lower Mount Street, Dublin 2, D02 H638 ISSN: 2009-793X Print ISSN: 2009-7948 Online © 2021 2 www.hrb.ie Citation information HRB National Drugs Library Miler J, Carver H, Masterton W, Parkes T, Jones The HRB National Drugs Library commissions the L, Maden M and Sumnall H (2021) Evidence review reviews in this series. The library’s website and of drug treatment services for people who are online repository (www.drugsandalcohol.ie) and our homeless and use drugs. HRB Drug and Alcohol library information services provide access to Irish Evidence Review 7. Dublin: Health Research Board. and international research literature in the area of drug and alcohol use and misuse, policy, treatment, An electronic copy is available at: prevention, rehabilitation, crime, and other drug- https://www.drugsandalcohol.ie/33910 and alcohol-related topics. It is a significant information resource for researchers, policy- makers, and people working in the areas of drug or alcohol use and addiction. The National Drugs HRB drug and alcohol evidence Strategy assigns the HRB the task of promoting and reviews enabling research-informed policy and practice for stakeholders through the dissemination of evidence. This review series is part of the library’s work in this The HRB Drug and Alcohol Review series supports area. drug and alcohol task forces, service providers and policy-makers in using research-based knowledge in their decision-making, particularly in regard to their assigned actions in the National Drugs Strategy. Health Research Board Topics for review are selected following consultation with stakeholders to identify particular information The Health Research Board (HRB) is the lead agency gaps and to establish how the review will contribute in Ireland supporting and funding health research. We to the selection and implementation of effective provide funding, maintain health information systems, responses. Each study examines a topic relevant to and conduct research linked to national health the work of responding to the situation in Ireland. priorities. Our aim is to improve people’s health, build health research capacity, and make a significant contribution to Ireland’s knowledge economy. The HRB is Ireland’s National Focal Point to the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA). The focal point monitors, reports on, and disseminates information on the drugs situation in Ireland and the responses to it, and promotes best practice and an evidence-based approach to work in this area. Evidence review of drug treatment services for people who are homeless and use drugs 3 Acknowledgements Murphy L, Farragher L, Keane M, Galvin B and Long J (2017) Drug-related intimidation. The Irish situation and international responses: an evidence review. The authors would like to thank Dr Austin O’Carroll, HRB Drug and Alcohol Evidence Review 4. Dublin: Tony Duffin, Dr Clíona Ní Cheallaigh, Dairearca Ni Health Research Board. Neill, and Marie Lynch for their participation in the stakeholder discussion with the authors at the early Bates G, Jones L, Maden M, Corchrane M, stages of the review. We also kindly acknowledge Pendlebury M and Sumnall H (2017) The effectiveness Nicola Singleton (formerly EMCDDA), Dr Austin of interventions related to the use of illicit drugs: O’Carroll, and Dr Anne Campbell (Queen’s University prevention, harm reduction, treatment and recovery. Belfast), who peer reviewed the report. We also wish A ‘review of reviews’. HRB Drug and Alcohol Evidence to thank Brenda O’Hanlon for editing services, and Dr Review 5. Dublin: Health Research Board. Camille Coyle (HRB) for her support in drafting the research brief. Minyard K, Manteuffel B, Smith CM, Attell BK, Landers G, Schlanger M and Dore E (2019) Treatment services for people with co-occurring substance use and mental health problems. A rapid realist synthesis. HRB drug and alcohol evidence HRB Drug and Alcohol Evidence Review 6. Dublin: reviews to date Health Research Board. Miler J, Carver H, Masterton W, Parkes T, Jones Munton T, Wedlock E and Gomersall A (2014) The L, Maden M and Sumnall H (2021) Evidence review role of social and human capital in recovery from of drug treatment services for people who are drug and alcohol addiction. HRB Drug and Alcohol homeless and use drugs. HRB Drug and Alcohol Evidence Review 1. Dublin: Health Research Board. Evidence Review 7. Dublin: Health Research Board. Munton T, Wedlock E and Gomersall A (2014) The efficacy and effectiveness of drug and alcohol abuse prevention programmes delivered outside of school settings. HRB Drug and Alcohol Evidence Review 2. Dublin: Health Research Board. Nic Gabhainn S, D’Eath M, Keane M and Sixsmith JA (2016) Scoping review of case management in the treatment of drug and alcohol misuse, 2003–2013. HRB Drug and Alcohol Evidence Review 3. Dublin: Health Research Board. 4 www.hrb.ie Table of contents List of acronyms 6 2 Methods 19 Glossary of terms 7 2.1 Chapter overview 19 Executive summary 9 2.2 Trend analysis and mapping of service provision Introduction 9 in Ireland 19 Trend analysis 9 2.3 Review of reviews 20 Overview of services in Ireland for people who are 2.3.1 Search strategy 20 homeless who use drugs 9 2.3.2 Inclusion criteria 23 Evidence review on effective interventions for 2.3.3 Data extraction/quality assessment and people who are homeless and use drugs 10 synthesis 23 Treatment engagement and retention 10 2.4 Chapter summary 23 Successful treatment completion 11 Treatment outcomes: substance use 11 3 Contextual background 24 Treatment outcomes: housing 11 3.1 Chapter overview 24 Treatment outcomes: other 11 3.2 Trend analysis 24 Policy and research recommendations 12 3.2.1 Prevalence and patterns of drug use 24 1 Introduction 13 3.2.2 Problem drug use 25 3.2.3 Drug-related deaths and mortality 27 1.1 Chapter overview 13 3.2.4 Drug-related infectious diseases 27 1.2 Scope and aims of the review 13 3.2.5 Treatment demand 28 1.3 Models of drug treatment for people who are 3.3 Mapping of existing drug services provided to homeless 13 meet the needs of people experiencing 1.4 People with complex and challenging lives 14 homelessness and who use drugs 29 1.4.1 Physical health, criminal justice involvement, 3.3.1 Wider health and social care services 29 and inclusion health approaches 14 3.3.2 Drug treatment services 30 1.4.2 Co-occurring serious mental health 3.3.3 Housing 32 problems and alcohol/drug use (COSMHAD) 16 3.3.4 Other services 32 1.4.3 Trauma-informed and psychologically informed approaches 16 3.4 Chapter summary 33 1.4.4 Life course approaches 17 4 Review of international evidence 34 1.5 Implications of COVID-19 17 4.1 Chapter overview 34 1.6 Chapter summary 18 4.2 Quality appraisal of included reviews 34 4.3 An overview of the included reviews 34 Evidence review of drug treatment services for people who are homeless and use drugs 5 4.4 Outcomes: treatment entry, engagement, References 64 and retention 39 Appendices 75 4.5 Outcomes: successful completion of treatment 41 Appendix 1. PICOS 75 4.6 Treatment outcomes 42 Appendix 2. Sources for trend analysis 76 4.6.1 Treatment outcomes: substance use 42 4.6.2 Treatment outcomes: housing 46 Appendix 3. Relevant data sources 77 4.6.3 Treatment outcomes: other 48 Appendix 4. Search strategy 78 4.7 Components of good practice 50 Appendix 5. Inclusion and exclusion criteria 87 4.8 Chapter summary 51 Appendix 6. Final inclusion decisions for identified papers 88 5 Discussion and conclusions 53 Appendix 7. Organisations included in search for 5.1 Chapter overview 53 grey literature 100 5.2 Key messages from all study components 53 Appendix 8. JBI Critical Appraisal Checklist for 5.3 Strengths and limitations 54 Systematic Reviews and Research Syntheses 109 5.4 Research and evidence gaps 55 Appendix 9. Quality appraisal final scores 110 5.5 Recommendations for policy and practice Appendix 10. Quality appraisal mediation 111 development 57 Appendix 11. Data extraction table 112 5.5.1 Intersection of homelessness and problem substance use 57 5.5.2 Lack of homogeneity 57 5.5.3 Tailored treatment versus ‘ingredients’ of success 57 5.5.4 Optimal length of treatment and stability 58 5.5.5 Importance of staff: compassionate and non-judgemental approach 58 5.5.6 Integration and partnership working 59 5.5.7 Harm reduction 59 5.5.8 Housing interventions 60 5.5.9 Interventions for people with COSMHAD 60 5.5.10 Case management 61 5.5.11 Peer-led or peer-involved interventions 61 5.6 Chapter summary 62 Key messages 63 6 www.hrb.ie List of acronyms ACE adverse childhood events NA Narcotics Anonymous ACMD Advisory Council on the Misuse of Drugs NACDA National Advisory Committee on Drugs and Alcohol ACT Assertive Community Treatment NDARC National Drug and Alcohol Research Centre (Australia) AIDS acquired immunodeficiency syndrome NDTRS National Drug Treatment Reporting System BBV blood-borne virus NIHR National Institute for Health Research CBT cognitive behavioural therapy NSP needle and syringe programme CD concurrent
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