Community Mental Health Journal

, Volume 50, Issue 5, pp 505–513 | Cite as

Risk Factors Associated with Recurrent Homelessness After a First Homeless Episode

  • Hunter L. McQuistion
  • Prakash Gorroochurn
  • Eustace Hsu
  • Carol L. M. Caton
Original Paper


Alcohol and drug use are commonly associated with the experience of homelessness. In order to better understand this, we explored the prevalence of drug and alcohol use as it related to successful re-housing within a sample of first-time single homeless adults at municipal shelters. From within this sample, we compared the features of recurrent homelessness with those of chronic homelessness and of being stably housed. We interviewed 344 subjects upon shelter entry and followed each one every six months for 18 months using standardized social and mental health measures. We analyzed baseline assessments relative to housing experiences during follow-up using Chi square and multinomial logistic regression. Eighty-one percent (N = 278) obtained housing over 18 months, of which 23.7 % (N = 66) experienced homelessness again. Recurrent homelessness was more common among those with a high school education and if initially re-housed with family. Bivariate analysis resulted in the observation of the highest rate of alcohol and other drug use among this recurrent group and multinomial logistic regression supported this only with the coupling of arrest history and diagnosed antisocial personality disorder. With relatively high rates of recurrent homelessness, there were differences between subjects who experienced recurrent homelessness compared to those who were stably housed and with chronic homelessness. That alcohol and other substance use disorders were associated with recurrent homelessness only if they were linked to other risk factors highlights the complexity of causes for homelessness and a resultant need to organize them into constellations of causal risk factors. Consistent with this, there should be initiatives that span bureaucratic boundaries so as to flexibly meet multiple complex service needs, thus improving outcomes concerning episodes of recurrent homelessness.


Chronic homelessness Recurrent homelessness First episode homelessness Chemical misuse Criminal justice 


  1. Caton, C. L. M. (1997). The community care schedule, modified version. New York: New York State Psychiatric Institute.Google Scholar
  2. Caton, C. L. M., Dominguez, B., Schanzer, B., Hasin, D. S., Shrout, P. E., Felix, A., et al. (2005). Risk factors for long-term homelessness: Findings from a longitudinal study of first-time homeless single adults. American Journal of Public Health, 95, 1753–1759.Google Scholar
  3. Culhane, D. P., Dejowski, E. F., Ibanez, J., Needham, E., & Macchia, I. (1994). Public shelter admission rates in Philadelphia and New York City: The implications of turnover for sheltered population counts. Housing Policy Debate, 5, 107–140.CrossRefGoogle Scholar
  4. Fazel, S., Khosla, V., Doll, H., & Geddes, J. (2008). The prevalence of mental disorders among the homeless in Western countries: Systematic review and meta-regression analysis. PLoS Medicine (, 5(12), 0001–0012.
  5. First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997a). User’s guide for the structured clinical interview for DSM-IV axis II personality disorders (SCID II). Washington, DC: American Psychiatric Press.Google Scholar
  6. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997b). Structured clinical interview for DSM-IV axis I: Disorders, research version, patient/non-patient edition. New York: Biometrics Research Division, New York State Psychiatric Institute.Google Scholar
  7. Fisk, D., Sells, D., & Rowe, M. (2007). Sober housing and motivational interviewing: The treatment access project. J Primary Prevention, 28, 281–293.CrossRefGoogle Scholar
  8. Forney, J. C., Lombardo, S., & Toro, P. A. (2007). Diagnostic and other correlates of HIV risk behaviors in a probability sample of homeless adults. Psychiatric Services, 58, 92–99.PubMedCrossRefGoogle Scholar
  9. Goldfinger, S. M., Schutt, R. K., Seidman, L. J., Turner, W. M., Penk, W. E., & Tolomiczenko, G. S. (1996). Self-report and observer measures of substance abuse among homeless mentally ill persons in the cross-section and over time. Journal of Nervous and Mental Disease, 184, 667–672.PubMedCrossRefGoogle Scholar
  10. Goldfinger, S. A., Schutt, R. K., Tolomiczenko, G. S., Seidman, L. J., Penk, W. E., Turner, W. M., et al. (1999). Housing placement and subsequent days homeless among formerly homeless adults with mental illness. Psychiatric Services, 50, 674–679.PubMedGoogle Scholar
  11. Hasin, D. S., Trautman, K. D., Miele, G. M., Samet, S., Smith, M., & Endicott, J. (1996). Psychiatric research interview for substance and mental disorders (PRISM): Reliability for substance abusers. American Journal of Psychiatry, 153, 1195–1201.PubMedGoogle Scholar
  12. Hurlburt, M. S., Hough, R. L., & Wood, P. A. (1996). Effects of substance abuse on housing stability of homeless mentally ill persons in supportive housing. Psychiatric Services, 47, 731–736.PubMedGoogle Scholar
  13. Johnson, T. P., Freels, S. A., Parsons, J. A., & Vangeest, J. B. (1997). Substance Abuse and homelessness: Social selection or adaptation. Addiction, 92, 437–445.PubMedCrossRefGoogle Scholar
  14. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Study Replication. Archives of General Psychiatry, 62, 593–602.PubMedCrossRefGoogle Scholar
  15. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005b). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62, 617–627.PubMedCentralPubMedCrossRefGoogle Scholar
  16. Lee, N., Robins, L. N., Helzer, J. E., Croughan, J., & Ratcliff, K. S. (1981). National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity. Archives of General Psychiatry, 38, 381–389.CrossRefGoogle Scholar
  17. Lee, S., Wong, Y.-L. I., & Rothbard, A. (2009). Factors associated with departure from supported independent living programs for persons with serious mental illness. Psychiatric Services, 60, 367–373.PubMedGoogle Scholar
  18. Lehman, A. F., & Cordray, D. S. (1993). Prevalence of alcohol, drug and mental disorders among the homeless: One more time. Contemporary Drug Problems, 20, 355–383.Google Scholar
  19. Link, B., Phelan, J., Bresnahan, M., Stueve, A., Moore, R., & Susser, E. (1995). Lifetime and five-year prevalence of homelessness in the United States: New evidence on an old debate. American Journal of Orthopsychiatry, 65, 347–354.PubMedCrossRefGoogle Scholar
  20. Link, B. G., Susser, E. S., Stueve, A., Phelan, J., Moore, R. E., & Struening, E. (1994). Lifetime and five-year prevalence of homelessness in the United States. American Journal of Public Health, 84, 1907–1912.PubMedCentralPubMedCrossRefGoogle Scholar
  21. Lipton, F. R., Siegel, C., Hannigan, A., Samuels, J., & Baker, S. (2000). Tenure in supportive housing for homeless persons with severe mental illness. Psychiatric Services, 51, 479–486.PubMedCrossRefGoogle Scholar
  22. Madras, B. K., Compton, W. S., Avula, D., Stegbauer, T., Stein, J. B., & Clark, H. W. (2009). Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and 6 months later. Drug and Alcohol Dependence, 99, 280–295.PubMedCentralPubMedCrossRefGoogle Scholar
  23. Mauer, M., & King, R. S. (2007). Uneven Justice: State rates of incarceration by race and ethnicity. Washington DC: The Sentencing Project.Google Scholar
  24. Milby, J. B., Schumacher, J. E., Wallace, D., et al. (2003). Day treatment with contingency management for cocaine abuse in homeless persons: 12-month follow-up. Journal of Consulting and Clinical Psychology, 71, 619–621.PubMedCrossRefGoogle Scholar
  25. Miller, W. R., & Rollnick, S. (2002). Motivational Interviewing: Preparing people for change (2nd ed.). New York NY: Guilford.Google Scholar
  26. Munetz, M. R., & Griffin, P. A. (2006). Use of the sequential intercept model as an approach to decriminalization of people with serious mental illness. Psychiatric Services, 57, 544–549.PubMedCrossRefGoogle Scholar
  27. Ng, A. T., & McQuistion, H. L. (2004). Outreach to the homeless: Craft, science, and future implications. Journal of Psychiatric Practice, 10(2), 95–105.PubMedCrossRefGoogle Scholar
  28. North, C. S., Eyrich, K. M., Pollio, D. E., & Spitznagel, E. L. (2004). Are rates of psychiatric disorders in the homeless population changing? American Journal of Public Health, 94, 103–108.PubMedCentralPubMedCrossRefGoogle Scholar
  29. O’Connell, M. J., Kasprow, W., & Rosenheck, R. A. (2008). Rates and risk factors for homelessness after successful housing in a sample of formerly homeless veterans. Psychiatric Services, 59, 268–2008.PubMedCrossRefGoogle Scholar
  30. O’Toole, T. P., Gibbon, J. L., Hanusa, B. H., Freyder, P. J., Conde, A. M., & Fine, M. J. (2004). Self-reported changes in drug and alcohol use after becoming homeless. American Journal of Public Health, 94, 830–835.PubMedCentralPubMedCrossRefGoogle Scholar
  31. Prochaska, J., DiClemente, C., & Norcross, J. (1992). In search of how people change: Applications to addictive behaviors. Am Psychologist, 47, 1102–1114.CrossRefGoogle Scholar
  32. Project Renewal, Inc. (2012). In Homes now. Accessed March 16, 2013.
  33. Rowe, M., Fisk, D., Frey, J., & Davidson, L. (2002). Engaging persons with substance use disorders: Lessons from homeless outreach. Admin Policy in Mental Health, 29, 263–273.CrossRefGoogle Scholar
  34. Snyder, H. N. (2012). Arrest in the United States, 1990–2010; Bureau of justice statistics, Office of Justice Programs, US Department of Justice. Available at Accessed February 17, 2013.
  35. Spitzer, R. L., Williams, J. B. W., Gibbon, M., & First, M. B. (1992). The structured clinical interview for DSM-III-R (SCID) I: History, rationale, and description. Archives of General Psychiatry, 49, 624–629.PubMedCrossRefGoogle Scholar
  36. Stafford, W., & Salas, D. (2005). The State of African American males in New York City women of color policy network. New York, NY: NYU Wagner School of Public Service.Google Scholar
  37. Substance Abuse and Mental Health Services Administration. (2011). Screening, brief intervention, referral, and treatment (SBIRT). US Department of Health and Human Services. Available at Accessed March 16, 2013.
  38. Sullivan, E., Mino, M., Nelson, K., & Pope, J. (2002). Families as a resource in recovery from drug abuse: An evaluation of La Bodega de la Familia. New York, NY: Vera Institute of Justice.Google Scholar
  39. Susser, E. S., Lin, S. P., Conover, S., & Struening, E. L. (1991). Childhood antecedents of homelessness in psychiatric patients. American Journal of Psychiatry, 148, 1026–1030.PubMedGoogle Scholar
  40. Susser, E., Valencia, E., Conover, S., Felix, A., Tsai, W.-Y., & Wyatt, R. J. (1997). Preventing recurrent homelessness among mentally ill men: A “critical time” intervention after discharge from a shelter. American Journal of Public Health, 87, 256–262.PubMedCentralPubMedCrossRefGoogle Scholar
  41. US Census Bureau. (2000). Accessed March 16, 2013.
  42. VanGeest, J. B., & Johnson, T. P. (2002). Substance abuse and homelessness: Direct or indirect effects? Annals of Epidemiology, 2, 455–461.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Hunter L. McQuistion
    • 1
    • 2
  • Prakash Gorroochurn
    • 4
  • Eustace Hsu
    • 5
  • Carol L. M. Caton
    • 2
    • 3
  1. 1.Division of Outpatient and Community Psychiatry, Department of Psychiatry and Behavioral HealthThe St. Luke’s and Roosevelt HospitalsNew YorkUSA
  2. 2.Department of Psychiatry, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  3. 3.c/o Mailman School of Public HealthNew YorkUSA
  4. 4.Department of BiostatisticsMailman School of Public Health, Columbia UniversityNew YorkUSA
  5. 5.Department of PsychologyUniversity of Southern CaliforniaLos AngelesUSA

Personalised recommendations