Long-Term Housing and Work Outcomes Among Treated Cocaine-Dependent Homeless Persons

Abstract

Communities across the United States have initiated plans to end chronic homelessness. In many of these communities, addiction treatment programs remain the default point of entry to housing and services. This study examined the percentage of cocaine-using homeless persons (all with psychiatric distress) attaining stable housing and employment 12 months after entering a randomized trial of intensive behavioral day treatment, plus one of the following for 6 months: no housing; housing contingent on drug abstinence; housing not contingent on abstinence. Of 138 participants, the percentages with stable housing and employment at 12 months were 34.1% and 33.3%, respectively. Analyses suggested superior outcomes in trial arms that offered housing as part of the behavioral treatment. The majority of participants, however, did not achieve housing or employment, in part because of the limited capacity of the local housing programs to accommodate persons who had not achieved perfect abstinence. The findings demonstrate a helpful role for addiction treatment, and suggest a role for services to support housing of persons who reduce but do not eliminate all substance use.

The Role of Recovery Housing: Prioritizing Choice in Homeless Services

“…Participants were able to maintain independent housing without exacerbating psychiatric or substance use symptoms (Tsemberis et al, 2004); many experienced fewer episodes of homelessness compared with participants receiving standard care, day treatment with no housing, or housing that was contingent on treatment and sobriety (Greenwood, Schaefer-McDaniel, Winkel, & Tsemberis, 2005;Gulcur et al, 2003;Kertesz et al, 2007;Milby, Schumacher, Wallace, Freedman, & Vuchinich, 2005;Padgett, Gulcur, & Tsemberis, 2006;Tsemberis et al, 2004). Some also experienced decreased service use, resulting in lower costs (Gulcur et al, 2003).…”

Toward cost-effective initial care for substance-abusing homeless

“…Among homeless persons who sought addiction treatment in 2004 (175,000 admissions), 17% reported cocaine as the primary substance of abuse (SAMSHA, 2006). Effective treatment for cocaine dependence among homeless persons has the potential to improve health and social functioning, and may assist with return to housed status (Kertesz et al, 2006).…”

‘Doing it Already?’: Stakeholder Perceptions of Housing First in the UK

“…It is now widely recognised that the demands of linear treatment first systems are such that homeless people with complex support needs rarely reach the final stage, that is, achieve independent living (Kertesz et al, 2006;Pearson et al, 2009). Further, recent evaluations note that staff working within treatment first programmes often find themselves, ironically, 'consumed with the pursuit of housing', that is, focusing more on assisting clients to manoeuvre through the housing system than addressing clinical concerns and/or overlooking mental health or substance misuse issues if making them explicit might jeopardise a client's chances of moving into more permanent accommodation .…”