Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories

Addictive Behaviors Research Center, University of Washington, Seattle, WA 98104, USA.
American Journal of Public Health (Impact Factor: 4.55). 03/2012; 102(3):511-9. DOI: 10.2105/AJPH.2011.300403
Source: PubMed


Two-year alcohol use trajectories were documented among residents in a project-based Housing First program. Project-based Housing First provides immediate, low-barrier, nonabstinence-based, permanent supportive housing to chronically homeless individuals within a single housing project. The study aim was to address concerns that nonabstinence-based housing may enable alcohol use.
A 2-year, within-subjects analysis was conducted among 95 chronically homeless individuals with alcohol problems who were allocated to project-based Housing First. Alcohol variables were assessed through self-report. Data on intervention exposure were extracted from agency records.
Multilevel growth models indicated significant within-subjects decreases across alcohol use outcomes over the study period. Intervention exposure, represented by months spent in housing, consistently predicted additional decreases in alcohol use outcomes.
Findings did not support the enabling hypothesis. Although the project-based Housing First program did not require abstinence or treatment attendance, participants decreased their alcohol use and alcohol-related problems as a function of time and intervention exposure.

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    • "A different type of problem is the use of a single group design of participants who entered Housing First with high rates of alcohol problems. Here, the improvements noted over time could be due to regression to the mean or ceiling effects (e.g., Collins, et al., 2012). Finally, Kertesz et al. (2009) questioned the appropriateness of some of the " usual care " comparison conditions, many of which were unspecified aggregate conditions, limited by underfunding, and lacking evidence based interventions. "
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    • "Another study assessing differences in substance use outcomes between HF and Treatment First (i.e., temporary congregate housing with prerequisite of detoxification/sobriety and 'housing readiness') participants using qualitative data, found that participants who received treatment first were more likely to use drugs and/or abuse alcohol 12 months after program entry than HF participants (Padgett et al., 2011). Studies based on an HF program in Seattle serving chronically homeless persons with severe alcohol problems found steady decreases in daily alcohol use, reductions in median number of drinks and number of days intoxicated among the intervention group (Collins et al., 2012; Larimer et al., 2009). "
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