Barriers to and supports for tobacco and alcohol use disorder treatment among California’s homeless

ABSTRACT Recommendations for the treatment of tobacco and alcohol use disorders are plentiful. The literature is mixed, however, on the extent to which treatments for these disorders apply to people experiencing homelessness. We identified 12 community health centers from distinct counties across California that provide tobacco and alcohol use disorder treatments to people experiencing homelessness and conducted semi-structured interviews with each. We qualitatively analyzed transcripts using the NVivo 12 software. The following themes emerged: (1) the role of street outreach as the first step of service delivery, (2) the importance of patient choice and volition in the treatment decision-making process, (3) the need for explicit provider-patient trust-building, (4) acknowledging variability in access to and availability of resources at treatment sites, and (5) redefining successful outcomes. Findings have implications for dissemination and implementation research in tobacco and alcohol use disorders among people experiencing homelessness, both in California and broader North American settings.