Social Psychiatry and Psychiatric Epidemiology

, Volume 45, Issue 11, pp 1055–1062 | Cite as

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

  • Carol S. North
  • Karin M. Eyrich-Garg
  • David E. Pollio
  • Jagadisha Thirthalli
Original Paper



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.


Homeless Cocaine Drugs Substance use disorders Urine testing Housing stability 


  1. 1.
    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 33:47–55Google Scholar
  2. 2.
    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 28:429–452CrossRefPubMedGoogle Scholar
  3. 3.
    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, DCGoogle Scholar
  4. 4.
    Collins JJ, Hubbard RL, Rachal JV (1985) Expensive drug use and illegal income: a test of explanatory hypotheses. Criminology 23:743–764CrossRefGoogle Scholar
  5. 5.
    Cottler LB, Compton WC (1993) Advantages of the CIDI family of instruments in epidemiological research of substance use disorders. Int J Meth Psychiat Res 3:109–119Google Scholar
  6. 6.
    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 5:40CrossRefPubMedGoogle Scholar
  7. 7.
    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 43:831–842CrossRefPubMedGoogle Scholar
  8. 8.
    Falck RS, Wang J, Carlson RG (2007) Crack cocaine trajectories among users in a midwestern American city. Addiction 102:1421–1431CrossRefPubMedGoogle Scholar
  9. 9.
    Fischer PJ, Breakey WR (1991) The epidemiology of alcohol, drug, and mental disorders among homeless persons. Am Psychol 46(11):1115–1128CrossRefPubMedGoogle Scholar
  10. 10.
    Haugland G, Siegel C, Hopper K, Alexander MJ (1997) Mental illness among homeless individuals in a suburban county. Psychiatr Serv 48:504–509PubMedGoogle Scholar
  11. 11.
    Heffron WA, Skipper BJ, Lambert L (1997) Health and lifestyle issues as risk factors for homelessness. J Am Board Fam Pract 10:6–12PubMedGoogle Scholar
  12. 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 91–111Google Scholar
  13. 13.
    Jencks C (1994) The homeless. Harvard University Press, Cambridge, MassachusettsGoogle Scholar
  14. 14.
    Kertesz SG, Crouch K, Milby JB, Cusimano RE, Schumacher JE (2009) Housing first for homeless persons with active addiction: are we overreaching? Milbank Q 87:495–534CrossRefPubMedGoogle Scholar
  15. 15.
    Kertesz SG, Weiner SJ (2009) Housing the chronically homeless: high hopes, complex realities. JAMA 301:1822–1824CrossRefPubMedGoogle Scholar
  16. 16.
    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 51:8–19PubMedGoogle Scholar
  17. 17.
    Kramar R (1998) Flexibility in Australia: implications for employees and managers. Employ Relat 20:453–460CrossRefGoogle Scholar
  18. 18.
    Kushel MB, Vittinghoff E, Haas JS (2001) Factors associated with the health care utilization of homeless persons. JAMA 285:200–206CrossRefPubMedGoogle Scholar
  19. 19.
    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 110:455–461Google Scholar
  20. 20.
    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 111:2629–2635CrossRefPubMedGoogle Scholar
  21. 21.
    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 60:55–67CrossRefPubMedGoogle Scholar
  22. 22.
    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)Google Scholar
  23. 23.
    North CS, Eyrich KM, Pollio DE, Spitznagel EL (2004) Are rates of psychiatric disorders in the homeless population changing? Am J Publ Health 94:103–108CrossRefGoogle Scholar
  24. 24.
    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 186:393–400CrossRefPubMedGoogle Scholar
  25. 25.
    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 81:606–617PubMedGoogle Scholar
  26. 26.
    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–S39CrossRefPubMedGoogle Scholar
  27. 27.
    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 28:1587–1602CrossRefPubMedGoogle Scholar
  28. 28.
    Petry NM (2001) The effects of housing costs on polydrug abuse patterns: a comparison of heroin, cocaine, and alcohol abusers. Exp Clin Psychopharmacol 9:47–58CrossRefPubMedGoogle Scholar
  29. 29.
    Podymow T, Turnbull J, Coyle D, Yetisir E, Wells G (2006) Shelter-based managed alcohol administration to chronically homeless people addicted to alcohol. CMAJ 174:45–49PubMedGoogle Scholar
  30. 30.
    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. LouisGoogle Scholar
  31. 31.
    Schilling RF, Bidassie B, El Bassel N (1999) Detecting cocaine and opiates in urine: comparing three commercial assays. J Psychoact Drugs 31:305–313Google Scholar
  32. 32.
    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 333:777–783CrossRefPubMedGoogle Scholar
  33. 33.
    Smith EM, North CS (1989) The homeless supplement to the diagnostic interview schedule (DIS/HS). Washington University, St. LouisGoogle Scholar
  34. 34.
    Smith EM, North CS, Spitznagel EL (1992) A systematic study of mental illness, substance abuse, and treatment in 600 homeless men. Ann Clin Psychiat 4:111–120CrossRefGoogle Scholar
  35. 35.
    Smith EM, North CS, Spitznagel EL (1993) Alcohol, drugs, and psychiatric comorbidity among homeless women: an epidemiologic study. J Clin Psychiat 54:82–87Google Scholar
  36. 36.
    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 28:171–179CrossRefGoogle Scholar
  37. 37.
    Sullivan G, Burnam A, Koegel P (2000) Pathways to homelessness among the mentally ill. Soc Psychiatry Psychiatr Epidemiol 35:444–450CrossRefPubMedGoogle Scholar
  38. 38.
    Susser E, Struening EL, Conover S (1989) Psychiatric problems in homeless men. Arch Gen Psychiat 46:845–850PubMedGoogle Scholar
  39. 39.
    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 94:651–656CrossRefPubMedGoogle Scholar
  40. 40.
    Winkleby MA, Rockhill B, Jatulis D, Fortmann SP (1992) The medical origins of homelessness. Am J Publ Health 82(10):1394–1398CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Carol S. North
    • 1
    • 2
    • 3
  • Karin M. Eyrich-Garg
    • 4
    • 5
    • 6
  • David E. Pollio
    • 7
  • Jagadisha Thirthalli
    • 8
  1. 1.VA North Texas Health Care SystemDallasUSA
  2. 2.Department of PsychiatryThe University of Texas Southwestern Medical CenterDallasUSA
  3. 3. Division of Emergency Medicine, Department of SurgeryThe University of Texas Southwestern Medical CenterDallasUSA
  4. 4.The School of Social WorkTemple UniversityPhiladelphiaUSA
  5. 5.Department of Public Health, College of Health Professions and Social WorkTemple UniversityPhiladelphiaUSA
  6. 6.Department of Geography and Urban Studies of the College of Liberal ArtsTemple UniversityPhiladelphiaUSA
  7. 7.The University of Alabama School of Social WorkTuscaloosaUSA
  8. 8.National Institute of Mental Health and Neurosciences (NIMHANS)BangaloreIndia

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