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In this secondary analysis, we tested race, ethnicity and sex assigned at birth as predictors and moderators of these effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary study of a four\u2010arm RCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Community settings serving people experiencing homelessness in the US Pacific Northwest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults aged 21\u201365 (N\u2009=\u2009308) with alcohol use disorder (AUD) who experienced past\u2010year homelessness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>In the parent RCT, participants were randomized to brief behavioral harm\u2010reduction treatment for AUD\u2009+\u2009extended\u2010release naltrexone (HaRT\u2010A\u2009+\u2009XR\u2010NTX); HaRT\u2010A\u2009+\u2009placebo; HaRT\u2010A alone, or services\u2010as\u2010usual control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurement<\/jats:title>\n                    <jats:p>We tested whether baseline outcomes, trial inclusion, data missingness, treatment adherence, side effects, and treatment effects on alcohol frequency, quantity, alcohol\u2010related harm, urinary ethyl glucuronide, and PH\u2010QoL differed by race, ethnicity, and sex assigned at birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Race, ethnicity and sex assigned at birth were not associated with differential trial inclusion, missingness, treatment adherence or side effects with one exception: the Multiracial\/other people of color (POC) group attended fewer HaRT\u2010A sessions than the white group (odds ratio [\n                      <jats:italic>OR<\/jats:italic>\n                      ]\u2009=\u20090.49,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03, 95% confidence interval [CI] [0.25, 0.95]). There were no statistically significant moderators of the behavioral HaRT\u2010A effect; however, Multiracial\/other POC race (\n                      <jats:italic>B\u2009=<\/jats:italic>\n                      \u00a0\u20103.34,\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u00a00.03, 95% CI [\u22126.35, \u22120.34]) and sex assigned at birth (\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20092.43,\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u00a00.04, 95% CI [0.14, 4.73]) moderated the XR\u2010NTX versus placebo effect on one variable: PH\u2010QoL. Simple slope analysis indicated the Multiracial\/other POC group who received placebo showed improvement on PH\u2010QoL (\n                      <jats:italic>dy\/dx<\/jats:italic>\n                      \u2009=\u20092.61,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003, 95% CI [0.91, 4.31]); the XR\u2010NTX group did not (\n                      <jats:italic>dy\/dx\u2009=<\/jats:italic>\n                      \u2009\u22120.22,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.79, 95% CI [\u22121.90, 1.45]). Among XR\u2010NTX recipients, the female group (\n                      <jats:italic>dy\/dx\u2009=<\/jats:italic>\n                      \u00a02.89,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, 95% CI [1.53, 4.25]) showed faster improvement rates than the male group (\n                      <jats:italic>dy\/dx<\/jats:italic>\n                      \u2009=\u20091.19,\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u00a00.02, 95% CI [0.23, 2.16]) on PH\u2010QoL.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Race, ethnicity and sex assigned at birth were largely not associated with trial inclusion, data missingness, treatment adherence, side effects, or outcomes in a combined harm\u2010reduction treatment and extended\u2010release naltrexone randomised clinical trial for alcohol use disorder (AUD). Although Multiracial\/other people of color (POC) participants attended fewer brief behavioral harm\u2010reduction treatment for AUD sessions, they did not differ from white participants on alcohol and physical health\u2010related quality of life outcomes. Among participants receiving extended\u2010release naltrexone (XR\u2010NTX), women showed greater improvement than men on physical health\u2010related quality of life. Compared with white participants, Multiracial\/other POC participants who received XR\u2010NTX showed less improvement than those who received placebo. Given their post hoc nature and limited power, findings are hypothesis\u2010generating. They suggest the equitable utility of behavioral harm\u2010reduction treatment and the importance of assessing sociodemographic differences in AUD treatment response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70251","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:45:33Z","timestamp":1765604733000},"page":"790-803","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Secondary analysis of a combined harm\u2010reduction treatment and extended\u2010release naltrexone randomized clinical trial for alcohol use disorder: Differences across race, ethnicity and sex assigned at birth"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1460-9752","authenticated-orcid":false,"given":"Silvi C.","family":"Goldstein","sequence":"first","affiliation":[{"name":"Department of Psychology University of Rhode Island  Kingston RI 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