Associations of alcohol use disorder, alcohol use, housing, and service use in a homeless sample of 255 individuals followed over 2 years

Abstract

Background: Homeless individuals with alcohol use disorders have multiple comorbidities and therefore various service needs. Despite need for services, homeless individuals face numerous barriers to treatment. Little is known about the associations of specific services in relation to homelessness in the context of alcohol problems. The current study analyzed 2-year prospective longitudinal data on a homeless sample, examining relationships between alcohol use disorder, alcohol use, housing status, and service use over time. Methods: Two hundred fifty-five of 400 individuals recruited systematically from shelters and street locations completed 3 annual assessments (69% completion). Data on lifetime and current psychiatric disorders, housing status, and past-year service use were obtained and merged with service use data gathered from local agencies. Generalized estimating equation (GEE) models were created to predict dependent outcome variables of stable housing, alcohol use, and service use in both follow-up years. Results: Lifetime alcohol use disorder was positively associated with substance and medical service use. Alcohol problems did not hinder attainment of stable housing, and placement in housing did not necessarily increase risk for alcohol use. Stable housing was negatively associated with psychiatric and substance service use. In the second year, when alcohol use was finally associated with receiving substance services, it appears that these services provided a gateway to psychiatric services. The psychiatric services in turn appeared to provide a gateway to medical services. Conclusions: Alcohol use behaved differently compared with lifetime alcohol use disorder in relation to service use. Lack of association between alcohol use and housing supports Housing First policy. Obtaining housing may have ameliorative effects on mental health, diminishing perceived need for psychiatric services. Services may also be more accessible during homelessness. Obtaining substance treatment may provide a gateway for those who use alcohol after becoming homeless to connect with psychiatric and medical services, informing policy and practice.

Keywords:

• Alcohol use
• homelessness
• Housing First
• service utilization

Additional information

Funding

The authors report no competing interests. This study was funded by grant R01 DA10713 from the National Institute on Drug Abuse and by grant R25 MH101078 from the National Institute of Mental Health of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. 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.

Notes on contributors

Emine R. Ayvaci

Emine R Ayvaci contributed to the research conception, data analysis, interpretation of the results, and writing and revision of the manuscript.

David E. Pollio

David E. Pollio contributed to the research conception and design, collection of data, analysis, interpretation of the results, and writing and revision of the manuscript.

Barry A. Hong

Barry A. Hong contributed to the research conception, data analysis, interpretation of the results, and writing and revision of the manuscript.

Carol S. North

Carol S. North contributed to the research conception and design, collection of data, analysis, interpretation of the results, and writing and revision of the manuscript.