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A prospective study of substance use and housing stability in a homeless population

Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

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.

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Fig. 1

Notes

  1. 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.

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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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Correspondence to Carol S. North.

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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

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