Homelessness predicts attrition but not alcohol abstinence in outpatients experiencing co-occurring alcohol dependence and serious mental illness

ABSTRACT

Background: Adults experiencing homelessness and serious mental illnesses (SMI) are at an increased risk of poor mental health and treatment outcomes compared with stably housed adults with SMI. The additional issue of alcohol misuse further complicates the difficulties of those living with homelessness and SMI. In this secondary data analysis, the authors investigated the impact of homelessness on attrition and alcohol use in a contingency management (CM) intervention that rewarded alcohol abstinence in outpatients with SMI. Methods: The associations between housing status and attrition and alcohol abstinence during treatment, as assessed by ethyl glucuronide (EtG) urine tests, were evaluated in 79 adults diagnosed with alcohol dependence and SMI. Results: Thirty-nine percent (n = 31) of participants reported being homeless at baseline. Individuals who were homeless were more likely to drop out of CM (n = 10, 62.5%) than those who were housed (n = 4, 16.7%), χ²(1) = 8.86, P < .05. Homelessness was not associated with attrition in the noncontingent control group. Accounting for treatment group and prerandomization EtG levels, neither the effect of housing status nor the interaction of housing status and group were associated with EtG-assessed alcohol abstinence during treatment. Conclusions: Individuals experiencing homelessness and co-occurring alcohol dependence and SMI receiving CM had higher rates of attrition, relative to those who were housed. Homelessness was not associated with differences in biologically assessed alcohol abstinence.

KEYWORDS:

• Addiction treatment
• alcohol use disorder
• contingency management
• homelessness
• serious mental illness
• substance use

Acknowledgments

The authors wish to acknowledge and thank the participants and the community mental health and addiction treatment agencies that cooperated and participated in the parent study.

The authors declare that they have no conflicts of interest.

Funding

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) provided funding for this study (grant R01 AA AA020248; Principal Investigator: M. G. McDonell). The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author contributions

Emily Leickly and Jordan Skalisky wrote the manuscript and contributed significantly to data collection, data analysis, and interpretation. Dr. Oluwoye provided critical revisions of the manuscript and data analyses. Drs. McPherson, Srebnik, Roll, and Ries contributed to the revision of the final submission and research conception and design. Dr. McDonell oversaw manuscript writing, including final submission, and provided significant support for data analyses and interpretation.