Alcohol Use and Other Psychiatric Disorders in the Formerly Homeless and Never Homeless: Prevalence, Age of Onset, Comorbidity, Temporal Sequencing, and Service Utilization

Abstract

Interview survey data were collected on a large (n = 4730) general population sample of adults subsequently classified as “never homeless” (NH) or “formerly homeless” (FH), with the latter group consisting of persons who had past experience of at least a one-month period with no regular place to live. The objective was to analyze differences, as a function of this classification, in the prevalence, age of onset, comorbidity, temporal sequencing, and service utilization pertinent to alcohol-use and other psychiatric disorders. Almost half of the FH group were found to have a one-year DSM diagnosis, nearly twice the rate seen in the NH group. Moreover, at 15.1%, the prevalence of alcohol-use disorder (AUD) comorbid with one or more other psychiatric disorders was five times that reported by NH participants. Subsequent analyses addressed differences between the FH (n = 167) and NH (n = 1031) groups within the subset who met criteria for one or more psychiatric diagnoses. Focusing on drinking behavior, we found that among the FH, dual-diagnosis was associated with elevated rates of alcohol-use problem symptoms and with greater alcohol consumption than were evident in the FH with AUD alone. Also, among the FH with comorbid AUD, as well as among those with two or more psychiatric disorders unrelated to alcohol, there was an earlier onset of psychiatric disorders than in the NH. This earlier onset may have placed these individuals at greater risk for later homelessness and AUD, and may also be indicative of a more severe course of illness. Differences between the FH and the NH suggest the importance of devoting special attention to this unique sample.

• Homelessness
• Drinking problems
• Psychiatric disorders
• Treatment
• Relapse
• Chronicity

Notes

Each of these psychiatric illnesses was fully included in computations of epidemiology, including comorbidity, except that single substance-use disorders (e.g., non-comorbid Cocaine Dependence other than alcohol) were not considered. This omission reflects our focus on AUD and cognizance of the potential for significant overlap between alcohol and other substance-use disorders. The result was a relatively homogeneous sample of AUD participants. In the interest of complete reporting, however the following data are provided: A total of 124 participants (99 NH and 35 FH) were diagnosed with a non-AUD drug disorder; and over twice as many FH (21.1%) as NH (9.6%) had a nonalcohol substance use disorder, χ²(1) = 18.52, p<0.001. There were also significantly more males than females in both the FH and NH groups, χ²(1) = 4.77, p<0.05, and χ²(1) = 35.55, p<0.001. The relative proportions of males to females, however, did not differ across homelessness status groups, χ²(1) = 0.39, n.s.

In connection with other epidemiological research unrelated to the present study, the data were weighted to better reflect the actual demographic census of Colorado. Thus, in publications relevant to that work and focused specifically on epidemiological rates of disorders in the Colorado population, the data were analyzed using the weighting procedures.

As noted above, persons with non-AUD SUD were not considered in the formation of Comorbidity groups. In other words, the presence of a non-AUD substance use-related problem was not considered to be a comorbid condition with AUD (or another disorder) if that was the only other diagnosed disorder. We considered only non-AUD/non-SUD in our classification of participants into one of the two Comorbid groups (i.e., Comorbid/Non-Alcohol or Comorbid/Alcohol). Moreover, a participant diagnosed with AUD and non-AUD drug disorder, but no other psychiatric disorder, would be classified in the Non-Comorbid/Alcohol group. Non-AUD SUDs were represented in the following proportions among the FH: n = 3 or 10.3% of Non-Comorbid/Alcohol; n = 8 or 13.1% of Non-Comorbid/Non-Alcohol; n = 4 or 12.5% of Comorbid/Non-Alcohol; n = 13 or 40.6% of Comorbid/Alcohol. Non-AUD drug disorders were represented in the following proportions among the NH: n = 14 or 11.2% of Non-Comorbid/Alcohol; n = 16 or 2.8% of Non-Comorbid/Non-Alcohol; n = 5 or 2.9% of Comorbid/Non-Alcohol; n = 17 or 19.8% of Comorbid/Alcohol. Among individuals with an AUD, a higher percentage of FH than NH had an additional drug-abuse disorder (26.2% compared to 14.6%), χ²(1) = 4.6, p<0.05.

Additional information

Notes on contributors

Maureen Lyons Reardon

Maureen Lyons Reardon, M.S., is a doctoral candidate in Clinical Psychology at The Florida State University, currently specializing in the study of substance use and schizophrenia. Other research interests include: mechanisms underlying acute alcohol tolerance, substance use in forensic populations, predictors of psychotherapy outcome, and objective predictors of psychiatric chronicity. Ms. Reardon received her Bachelor of Science Degree in Psychology, Summa Cum Laude, from the University of Connecticut, and her Masters Degree in Clinical Psychology from The Florida State University.

Andrea B. Burns

Andrea B. Burns, B.A., is a graduate student in the Doctoral Program in Clinical Psychology at Florida State University. She graduated from Williams College with a Bachelor of Arts with Honors in Psychology in 1998. Her primary research interests are gender issues, depression, and eating disorders.

Robyn Preist

Robyn Priest received her Masters Degree in Counseling Psychology from the School of Education at Boston College. She is currently a Training Specialist for the Higher Education Center for Alcohol and Other Drug Prevention. She assists change agents from institutions of higher education across the nation in implementing environmental change strategies to reduce illegal and high-risk alcohol-use on campus and in the community. Ms. Priest is an elected member of the directorate body of the national commission for Alcohol and Other Drug Issues (Commission XVIII) of the American College Personnel Association (ACPA).

Natalie Sachs-Ericsson

Natalie Sachs-Ericsson, Ph.D., is Professor of Psychology at Florida State University. She has worked extensively in the area of psychiatric epidemiology with a focus on social factors that are related to the prevalence of psychiatric illness. She has conducted studies on the epidemiology of psychiatric and medical problems among the homeless as well as on the service needs of the homeless. Her research has been used as a basis for the development of mental health, medical, and substance-user treatment programs for the homeless.

Alan R. Lang

Alan R. Lang, Ph.D., is a Professor of Psychology at Florida State University where he is a member and past Director of the Clinical Science program. His research, supported nearly continuously for 20 years by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), focuses on the antecedents and consequences of acute alcohol intoxication, including stress and social behavior. Recent work has emphasized cognitive mediation of the relationship between drinking and emotional response, using laboratory analogue experiments involving psychophysiological indices of the relevant affective and cognitive processes to investigate how alcohol can affect fear. Assessment of responses to addiction-relevant stimuli that evoke “craving” and/or inclinations to avoid use is another focus. Dr. Lang is past Associate Editor of the Journal of Abnormal Psychology and has served as both a regular and ad hoc member of numerous NIAAA grant review study sections. He is a fellow of the Division on Addictive Behaviors of the American Psychological Association.