Abstract
Objectives
This study examined self-report and urine test data about homeless substance use over time, prospectively comparing substance use with attainment of stable housing.
Methods
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.
Results
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.
Conclusions
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.
Notes
Analysis of missing data across different time points was reconstructed using pairwise comparisons to include cases with missing data on only one time point to minimize effects of missing data in McNemar tests, and using the logit link function for GEE with time-varying independent variables to predict housing at 1 and 2 years. In these analyses, the findings were nearly identical to the analyses limited to only complete data cases, with no differences in statistical significance patterns. Therefore, it was decided to present the more straightforward analysis that does not account for missing data, for clarity and parsimony of presentation.
References
Appel PW, Hoffman JH, Blane HT, Frank B, Oldak R, Burke M (2001) Comparison of self-report and hair analysis in detecting cocaine use in a homeless/transient sample. J Psychoact Drugs 33:47–55
Booth BM, Sullivan G, Koegel P, Burnam A (2002) Vulnerability factors for homelessness associated with substance dependence in a community sample of homeless adults. Am J Drug Alcohol Abuse 28:429–452
Caton CLM, Wilkins C, Anderson J (2007) People who experience long-term homelessness: characteristics and interventions (Conference paper). In: Dennis D, Locke G, Khadduri J (eds) Toward understanding homelessness: The 2007 National Symposium on Homelessness Research. Department of Health and Human Services and U.S. Department of Housing and Urban Development, Washington, DC
Collins JJ, Hubbard RL, Rachal JV (1985) Expensive drug use and illegal income: a test of explanatory hypotheses. Criminology 23:743–764
Cottler LB, Compton WC (1993) Advantages of the CIDI family of instruments in epidemiological research of substance use disorders. Int J Meth Psychiat Res 3:109–119
Degenhardt L, Day C, Hall W, Conroy E, Gilmour S (2005) Was an increase in cocaine use among injecting drug users in New South Wales, Australia, accompanied by an increase in violent crime? BMC Public Health 5:40
Eyrich-Garg KM, Cacciola JS, Carise D, Lynch KG, McLellan AT (2008) Individual characteristics of the literally homeless, marginally housed, and impoverished in a US substance abuse treatment-seeking sample. Soc Psychiatry Psychiatr Epidemiol 43:831–842
Falck RS, Wang J, Carlson RG (2007) Crack cocaine trajectories among users in a midwestern American city. Addiction 102:1421–1431
Fischer PJ, Breakey WR (1991) The epidemiology of alcohol, drug, and mental disorders among homeless persons. Am Psychol 46(11):1115–1128
Haugland G, Siegel C, Hopper K, Alexander MJ (1997) Mental illness among homeless individuals in a suburban county. Psychiatr Serv 48:504–509
Heffron WA, Skipper BJ, Lambert L (1997) Health and lifestyle issues as risk factors for homelessness. J Am Board Fam Pract 10:6–12
Inciardi JA (1990). The crack-violence connection within a population of hard-core adolescent offenders. In De La Rosa M, Lambert EY, Gropper B (eds) National Institute on Drug Abuse Research Monograph, vol. 103. Government Printing Office (DHHS Pub. No. (ADM) 91-1721), Rockville, MD, pp 91–111
Jencks C (1994) The homeless. Harvard University Press, Cambridge, Massachusetts
Kertesz SG, Crouch K, Milby JB, Cusimano RE, Schumacher JE (2009) Housing first for homeless persons with active addiction: are we overreaching? Milbank Q 87:495–534
Kertesz SG, Weiner SJ (2009) Housing the chronically homeless: high hopes, complex realities. JAMA 301:1822–1824
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshelman S, Wittchen H-U, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiat 51:8–19
Kramar R (1998) Flexibility in Australia: implications for employees and managers. Employ Relat 20:453–460
Kushel MB, Vittinghoff E, Haas JS (2001) Factors associated with the health care utilization of homeless persons. JAMA 285:200–206
Lambert EY, Caces MF (1995) Correlates of drug abuse among homeless and transient people in the Washington, DC, metropolitan area in 1991. Pub Health Rep 110:455–461
Lee TC, Hanlon JG, Ben David J, Booth GL, Cantor WJ, Connelly PW, Hwang SW (2005) Risk factors for cardiovascular disease in homeless adults. Circulation 111:2629–2635
Milby JB, Schumacher JE, McNamara C, Wallace D, Usdan S, McGill T, Michael M (2000) Initiating abstinence in cocaine abusing dually diagnosed homeless persons. Drug Alcohol Depend 60:55–67
Milby JB, Schumacher JE, Vuchinich R, Kertesz SG, Mennemeyer ST, Wallace D (2009) Sustained abstinence for treated substance abusing homeless persons leads to stable housing and employment. Am J Publ Health (in press)
North CS, Eyrich KM, Pollio DE, Spitznagel EL (2004) Are rates of psychiatric disorders in the homeless population changing? Am J Publ Health 94:103–108
North CS, Pollio DE, Smith EM, Spitznagel EL (1998) Correlates of early onset and chronicity of homelessness in a large urban homeless population. J Nerv Ment Dis 186:393–400
O’Toole TP, Conde-Martel A, Gibbon JL, Hanusa BH, Freyder PJ, Fine MJ (2004) Substance-abusing urban homeless in the late 1990s: how do they differ from non-substance-abusing homeless persons? J Urban Health 81:606–617
Orwin RG, Scott CK, Arieira C (2005) Transitions through homelessness and factors that predict them: three-year treatment outcomes. J Subst Abuse Treat 28(Suppl 1):S23–S39
Parrott DJ, Drobes DJ, Saladin ME, Coffey SF, Dansky BS (2003) Perpetration of partner violence: effects of cocaine and alcohol dependence and posttraumatic stress disorder. Addict Behav 28:1587–1602
Petry NM (2001) The effects of housing costs on polydrug abuse patterns: a comparison of heroin, cocaine, and alcohol abusers. Exp Clin Psychopharmacol 9:47–58
Podymow T, Turnbull J, Coyle D, Yetisir E, Wells G (2006) Shelter-based managed alcohol administration to chronically homeless people addicted to alcohol. CMAJ 174:45–49
Robins LN, Cottler LB, Compton WM, Bucholz K, North CS, Rourke KM (2000) Diagnostic interview schedule for the DSM-IV (DIS-IV). Washington University, St. Louis
Schilling RF, Bidassie B, El Bassel N (1999) Detecting cocaine and opiates in urine: comparing three commercial assays. J Psychoact Drugs 31:305–313
Shaner A, Eckman TA, Roberts LJ, Wilkins JN, Tucker DE, Tsuang JW, Mintz J (1995) Disability income, cocaine use, and repeated hospitalization among schizophrenic cocaine abusers—a government-sponsored revolving door? N Engl J Med 333:777–783
Smith EM, North CS (1989) The homeless supplement to the diagnostic interview schedule (DIS/HS). Washington University, St. Louis
Smith EM, North CS, Spitznagel EL (1992) A systematic study of mental illness, substance abuse, and treatment in 600 homeless men. Ann Clin Psychiat 4:111–120
Smith EM, North CS, Spitznagel EL (1993) Alcohol, drugs, and psychiatric comorbidity among homeless women: an epidemiologic study. J Clin Psychiat 54:82–87
Stahler GJ, Shipley TE Jr, Kirby KC, Godboldte C, Kerwin ME, Shandler I, Simons L (2005) Development and initial demonstration of a community-based intervention for homeless, cocaine-using, African–American Women. J Sub Abuse Treat 28:171–179
Sullivan G, Burnam A, Koegel P (2000) Pathways to homelessness among the mentally ill. Soc Psychiatry Psychiatr Epidemiol 35:444–450
Susser E, Struening EL, Conover S (1989) Psychiatric problems in homeless men. Arch Gen Psychiat 46:845–850
Tsemberis S, Gulcur L, Nakae M (2004) Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. Am J Public Health 94:651–656
Winkleby MA, Rockhill B, Jatulis D, Fortmann SP (1992) The medical origins of homelessness. Am J Publ Health 82(10):1394–1398
Acknowledgments
This research was supported by National Institute on Drug Abuse (NIDA) Grant #10713 to Dr. North and the VA North Texas Health Care System. Points of view in this document are those of the authors and do not necessarily represent the official position of NIDA, the Department of Veterans Affairs, or the US Government.
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North, C.S., Eyrich-Garg, K.M., Pollio, D.E. et al. A prospective study of substance use and housing stability in a homeless population. Soc Psychiat Epidemiol 45, 1055–1062 (2010). https://doi.org/10.1007/s00127-009-0144-z
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DOI: https://doi.org/10.1007/s00127-009-0144-z