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Substance Use Outcomes for Chronically Homeless in Low-Demand Housing

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In Session With Ellen Lockard Edens, MD, MPE:

Substance Use Outcomes for Chronically Homeless in Low-Demand Housing

 

April 11, 2011

Ellen Lockard Edens, MD, MPE

 

US Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center; the National Center on Homelessness Among Veterans

First published in Psychiatry Weekly, Volume 6, Issue 8, on April 11, 2011

 

Q: Does low-demand housing affect high substance-use rates for the chronically homeless?

A: Housing the chronically homeless (ie, individuals who have been homeless for either 1 continuous year or have had 4 episodes of homelessness within the past 3 years) has been a popular public initiative for the past decade, with low-demand housing becoming a favored approach. This model seeks to improve housing access by easing the requirements and conditions upon which housing is received. Key components include: (1) a simple application process, and (2) no conditions of tenancy that exceed normal leaseholder responsibilities. As such, participants may or may not be adherent to a medication regimen, have a money-manager, or maintain sobriety.

Proponents of the low-demand housing model have indeed shown impressive results with regard to housing outcomes. It has been less clear, however, whether participants who are actively using alcohol or drugs (excluding nicotine) have similar or worse housing outcomes than other chronically homeless individuals. Our study sought to answer this question. The Collaborative Initiative on Chronic Homelessness was a federally funded, multi-site demonstration program begun to provide permanent housing, case management, and primary and mental health services to persons experiencing chronic homelessness, using a low-demand model. Over a 2-year follow-up period we compared participants who reported past 30 days abstinence at the time of receiving housing (N=290) to those who reported more than 15 days of using alcohol or 15 days of using marijuana or any other illicit drug (N=120). We found both groups dramatically improved in their average number of days housed in the past 90 days without significant group difference. That is, active alcohol or drug use at housing entry had no effect on ability to maintain housing 24 months later. With regard to substance use, individuals actively using substances at housing entry continued to report high levels of use throughout the 2-year follow-up period—with slight though significant decline—compared to those abstaining at housing entry.


Q: How did placement in housing affect service use in this study?

A: Over time, the average number of mental health and substance abuse outpatient visits declined for both groups. Total health costs also diminished over time as well, although this cannot be causally attributed to receiving housing, as there was no control group not receiving housing and supportive services.


Disclosure: This work was supported by the Mental Illness Research, Education, and Clinical Center at the VA Connecticut Healthcare System, West Haven, Connecticut.

Reference:

1. Edens EL, Mares AS, Tsai J, Rosenheck RA. Does active substance use at housing entry impair outcomes in supported housing for chronically homeless persons? Psychiatr Serv. 2011;62:171-178.