A Prospective Study of Substance Abuse and Housing Stability in a Homeless Population

VA North Texas Health Care System, 4500 S. Lancaster Rd., Dallas, TX 75216, USA.
Social Psychiatry (Impact Factor: 2.54). 10/2009; 45(11):1055-62. DOI: 10.1007/s00127-009-0144-z
Source: PubMed


This study examined self-report and urine test data about homeless substance use over time, prospectively comparing substance use with attainment of stable housing.
400 homeless people systematically sampled from shelters and streets in St. Louis, Missouri were assessed with structured diagnostic interviews and urine substance testing annually over 2 years. Nearly two-thirds (n = 255) completed all three assessments, constituting the sample for this prospective study.
More than half (55%) of this homeless sample had detectable cocaine use during the study. Most cocaine users continued using during the next 2 years and failed to achieve and maintain stable housing. Cocaine use in the first follow-up year predicted housing patterns over the next 2 years, independent of lifetime diagnosis of cocaine use disorder. Alcohol abuse/dependence in the 2-year follow-up period did not predict housing outcomes.
The course of cocaine use and abuse/dependence, but not continuing alcohol addiction, was associated with subsequent attainment of stable housing, especially cocaine use in the first prospective year. Replication of these findings in other locations to determine generalizability may have implications for designing housing service models.

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Available from: David E Pollio, Feb 05, 2014
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    • "Substances such as cocaine have become extremely popular and found to be used by 29–49% of homeless (Appel et al., 2001; Haugland et al., 1997; Lambert and Caces, 1995; Lee et al., 2005) with a SUD prevalence rate of about 49–53% (Haugland et al., 1997; O'Toole T et al., 2004). Crack cocaine in particular has experienced a remarkable rise in use among homeless populations over the last two decades (Fischer and Breakey, 1991; North et al., 2004), attributed at least in part to greater availability and affordability of the drug (North et al., 2010). "
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    ABSTRACT: Homeless individuals are an extremely vulnerable and underserved population characterized by overlapping problems of mental illness and substance use. Given the fact that mood disorders are frequently associated with substance use disorders, we wanted to further highlight the role of excitement in substance abuse. Patterns of substance abuse among homeless suffering from unipolar and bipolar depression were compared. The "self-medication hypothesis" which would predict no-differences in substance preference by unipolar (UP) and bipolar (BP) depressed homeless was tested. Homeless individuals from the Vancouver At Home/Chez Soi study were selected for lifetime UP and lifetime BP depression and patterns of substances abused in the previous 12 months were identified with the Mini-International Neuropsychiatric Interview. Differences in substance use between BP-depressed homeless and UP-depressed homeless were tested using Chi-square and logistic regression techniques. No significant differences were observed between UP and BP homeless demographics. The bipolar depressed homeless (BDH) group displayed a higher percentage of Central Nervous System (CNS) Stimulants (χ 8.66, p=0.004) and Opiates (χ 6.41, p=0.013) as compared to the unipolar depressed homeless (UDH) group. CSN Stimulant was the only predictor within the BDH Group (χ(2) 8.74 df 1 p<0.003). Data collected are self-reported and no urinalyses were performed. The results support the hypothesis that beyond the self-medication hypothesis, bipolarity is strictly correlated to substance use; this correlation is also verified in a homeless population. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Feb 2015 · Journal of Affective Disorders
    • "The simplest measure of housing stability in the literature is a dichotomous measure of the presence or absence of housing; housing is stable, homelessness is unstable. Bebout, Drake, Xie, McHugo, and Harris (1997), for example, defined individuals as stably housed if they had uninterrupted housing for the 6 months prior to the interview (also see Bolton, 2005; Cook-Craig & Koehly, 2011; Dickson-Gomez, Convey, Hilario, Corbett, & Weeks, 2008; North, Eyrich-Garg, Pollio, & Thirthalli, 2010). Single housing measures may be appropriate for some program evaluations if the outcome of interest is simply the presence or absence of housing, but such measures do not provide much insight into levels of stability within the broader category of " housed. "
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    ABSTRACT: Despite housing stability being a key concept in housing and homelessness policy, research, and service provision, it remains poorly defined and conceptualized, and to date there are no standard measures. We use in-depth qualitative interviews with 51 young people transitioning away homelessness over the course of a year to examine the core dimensions of housing stability. Due to the potential for sudden change, we define housing stability as the extent to which an individual's customary access to housing of reasonable quality is secure. We define housing security among 8 main dimensions: housing type, recent housing history, current housing tenure, financial status, standing in the legal system, education and employment status, harmful substance use, and subjective assessments of housing satisfaction and stability. Based on these dimensions, we suggest a brief 13-question scale that measures housing security.
    No preview · Article · Nov 2014 · Journal of Community Psychology
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    • "Interestingly, participants with diagnosis of alcohol or substance abuse or dependence had greater improvement in quality of life and greater reductions in both mental health symptom severity and substance use problems from baseline to 6-months, compared to participants without these diagnoses. These observations are novel and important because to date there is limited evidence that HF programs can improve substance use or related symptoms [11,64]. These observations may have resulted from compromised quality of life at baseline among individuals with a substance use disorder. "
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    ABSTRACT: Housing first has become a popular treatment model for homeless adults with mental illness, yet little is known about program participants' early experiences or trajectories. This study used a mixed methods design to examine participant changes in selected domains 6 months after enrolment in a Canadian field trial of Housing First. The study sample included 301 participants receiving the Housing First intervention at the Toronto site of the At Home/Chez Soi project. This study used a pre-post design to compare quantitative 6-month outcome data to baseline values in key domains and multivariate regression to identify baseline demographic, clinical or service use variables associated with observed changes in these domains. In addition, qualitative data exploring participant and service provider perspectives and experiences was collected via stakeholder interviews and focus groups, and analyzed using thematic analysis. The majority (60 to 72%) of participants followed the expected trajectory of improvement, with the remaining experiencing difficulties in community integration, mental health symptom severity, substance use, community functioning and quality of life 6 months after program enrolment. Diagnosis of psychotic disorder was associated with a reduction in quality of life from baseline to 6-months, while substance use disorders were associated with reduced mental illness symptoms and substance use related problems and an improvement in quality of life. Participants housed in independent housing at 6-months had greater improvements in community integration and quality of life, and greater reduction in mental illness symptoms, compared to those not independently housed. The quality of the working alliance was positively associated with improvements in physical and psychological community integration and quality of life. Qualitative data provided a unique window into the loneliness and isolation experienced by Housing First participants, as well as problems related to substance use and a need for life skills training and support. Additional strategies can help support Housing First participants in the early stages of program participation and address potential causes of early difficulties, including lack of life skills and social isolation. This study highlights the importance of early and ongoing evaluation, monitoring and program adaptations to address consumer support needs.Trial registration: Current Controlled Trials ISRCTN42520374.
    Full-text · Article · Apr 2014 · BMC Health Services Research
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