Ryan P McCormack1, Lily F Hoffman2, Michael Norman3, Lewis R Goldfrank4, Elizabeth M Norman5. 1. Department of Emergency Medicine, New York University School of Medicine, New York, NY. Electronic address: ryan.mccormack@nyumc.org. 2. Department of Emergency Medicine, New York University School of Medicine, New York, NY; New York University Gallatin School of Individualized Study, New York, NY. 3. Department of Emergency Medicine, New York University School of Medicine, New York, NY; Arthur L. Carter Journalism Institute, New York University College of Arts and Sciences, New York, NY. 4. Department of Emergency Medicine, New York University School of Medicine, New York, NY. 5. Department of Emergency Medicine, New York University School of Medicine, New York, NY; Department of Humanities and Social Sciences and Interdepartmental Research Studies, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY.
Abstract
STUDY OBJECTIVE: We describe the evolution, environment, and psychosocial context of alcoholism from the perspective of chronically homeless, alcohol-dependent, frequent emergency department (ED) attendees. We use their words to explore how homelessness, health care, and other influences have contributed to the cause, progression, and management of their alcoholism. METHODS: We conducted detailed, semistructured, qualitative interviews, using a phenomenological approach with 20 chronically homeless, alcohol-dependent participants who had greater than 4 annual ED visits for 2 consecutive years at Bellevue Hospital in New York City. We used an administrative database and purposive sampling to obtain typical and atypical cases with diverse backgrounds. Interviews were audio recorded and transcribed verbatim. We triangulated interviews, field notes, and medical records. We used ATLAS.ti to code and determine themes, which we reviewed for agreement. We bracketed for researcher bias and maintained an audit trail. RESULTS: Interviews lasted an average of 50 minutes and yielded 800 pages of transcript. Fifty codes emerged, which were clustered into 4 broad themes: alcoholism, homelessness, health care, and the future. The participants' perspectives support a multifactorial process for the evolution of their alcoholism and its bidirectional reinforcing relationship with homelessness. Their self-efficacy and motivation for treatment is eroded by their progressive sense of hopelessness, which provides context for behaviors that reinforce stigma. CONCLUSION: Our study exposes concepts for further exploration in regard to the difficulty in engaging individuals who are incapable of envisioning a future. We hypothesize that a multidisciplinary harm reduction approach that integrates health and social services is achievable and would address their needs more effectively.
STUDY OBJECTIVE: We describe the evolution, environment, and psychosocial context of alcoholism from the perspective of chronically homeless, alcohol-dependent, frequent emergency department (ED) attendees. We use their words to explore how homelessness, health care, and other influences have contributed to the cause, progression, and management of their alcoholism. METHODS: We conducted detailed, semistructured, qualitative interviews, using a phenomenological approach with 20 chronically homeless, alcohol-dependent participants who had greater than 4 annual ED visits for 2 consecutive years at Bellevue Hospital in New York City. We used an administrative database and purposive sampling to obtain typical and atypical cases with diverse backgrounds. Interviews were audio recorded and transcribed verbatim. We triangulated interviews, field notes, and medical records. We used ATLAS.ti to code and determine themes, which we reviewed for agreement. We bracketed for researcher bias and maintained an audit trail. RESULTS: Interviews lasted an average of 50 minutes and yielded 800 pages of transcript. Fifty codes emerged, which were clustered into 4 broad themes: alcoholism, homelessness, health care, and the future. The participants' perspectives support a multifactorial process for the evolution of their alcoholism and its bidirectional reinforcing relationship with homelessness. Their self-efficacy and motivation for treatment is eroded by their progressive sense of hopelessness, which provides context for behaviors that reinforce stigma. CONCLUSION: Our study exposes concepts for further exploration in regard to the difficulty in engaging individuals who are incapable of envisioning a future. We hypothesize that a multidisciplinary harm reduction approach that integrates health and social services is achievable and would address their needs more effectively.
Authors: Hua Li; Alana Glecia; Kayla Arisman; Cindy Peternelj-Taylor; Lorraine Holtslander; Donald Leidl Journal: Community Ment Health J Date: 2021-06-01
Authors: Amanda Jurewicz; Deborah K Padgett; Ziwei Ran; Donna G Castelblanco; Ryan P McCormack; Lillian Gelberg; Donna Shelley; Kelly M Doran Journal: Subst Abus Date: 2021-09-29 Impact factor: 3.984