Longitudinal cost of services in a homeless sample with cocaine use disorder

ABSTRACT

Homeless people with cocaine use disorder have multiple comorbidities and costly service needs. This study examined service costs associated with cocaine use and substance service use in substance, psychiatric, and medical service sectors. 127 homeless participants with cocaine use disorder were interviewed annually. Self-report and agency-report service use and cost data were combined. Pairwise comparisons were made with cocaine abstinence and substance service use in relation to mean and yearly proportional service costs in 3 service sectors. Among substance service users, the achievement of abstinence was not associated with decreased substance service costs. Cocaine abstinence was associated with proportional reduction of substance service costs over time. Substance service use was associated with proportional reduction of psychiatric service costs over time among the abstinent subgroup. Conversely, substance service use was associated with continuing higher medical service expenditures in the abstinent subgroup and higher psychiatric service expenditures in those not abstinent. Homeless individuals who achieved cocaine abstinence after using substance services had decreased substance service expenditures. Individuals with continued substance service use had greater medical and psychiatric service costs. Policy-based on maximizing benefits while minimizing costs appears insufficiently complex to incorporate the multiple needs and associated with the costs of treating homeless populations.

KEYWORDS:

• Cocaine use
• homelessness
• substance service use
• service utilization
• cost of health services

Acknowledgements

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health.

Disclosure statement

No potential conflict of interest was reported by the authors.

Availability of data and materials

Because the dataset includes identifiable patient information and relevant privacy regulations prohibit dissemination, data utilized in this study is not available for sharing.

Notes on contributors

Emine R. Ayvaci, MD, works as a clinical faculty at the University of Texas Southwestern Medical Center, Department of Psychiatry. Dr. Ayvaci graduated from Hacettepe University Medical School in Ankara, Turkey, and completed the psychiatry residency at the University of Texas Southwestern Medical Center. As part of her residency education, Dr. Ayvaci completed the research track funded by an NIH R25 grant. Her current academic interests are epidemiology of psychiatric diseases, specifically underserved populations such as homeless or incarcerated populations.

David E. Pollio, PhD, Distinguished Professor of Social Work and Department Chair, has long focused his work on making a difference in the real world. His practice career dates back more than 30 years and includes working with adolescents with behavioral issues, persons, and families coping with mental illness and addiction, runaway youth and adult homeless; and persons experiencing disaster. His research focuses on developing services for these and other populations and ranges from evaluating organizations, to developing new interventions, to using cutting edge technologies such as on-line social communities and virtual reality. His work has been multi-disciplinary by nature, as is seen through his secondary appointments in the School of Public Health and the African American Studies program, and his longstanding affiliation with the Center for AIDS Research. His work and research has taken him under bridges to the halls of Congress, from the rubble of disaster sites to destinations local and all across this country.

Barry A. Hong, Ph.D., is a Professor of Psychiatry at Washington University School of Medicine. He holds joint appointments in the Department of Medicine and in the Department of Psychology. He is the Vice-Chairman for Clinical Affairs in Psychiatry and the Chief Psychologist for Barnes-Jewish Hospital. Dr. Hong has been a consultant with the United Network of Organ Sharing (UNOS) and the Division of Transplantation (HRSA). Presently, he is working with the National Living Donor Assistance Program (NLDAC), a federally sponsored project which has facilitated over 3,500 living kidney transplants. He has studied live donors, organ procurement professionals, the circumstances of donation and follow-up studies of live donors and an NIH follow-up study on living lung donors together with five other universities. His work with Dr. North focuses on underserved populations such as homeless populations and their health service needs.

Carol S. North, MD, MPE, holds The Nancy and Ray L. Hunt Chair in Crisis Psychiatry and is Professor in the Departments of Psychiatry and Emergency Medicine at The University of Texas Southwestern Medical Center in Dallas. She is also Director of the Division of Trauma and Disaster in the Department of Psychiatry. For more than a quarter of a century, Dr. North has continuously conducted federally funded research into disaster mental health, psychiatric aspects of medical illness, and psychiatric problems of homeless populations, and has developed specialized education programs for professionals, patients, and families, while providing direct patient care and directing clinical services for homeless and seriously psychiatrically ill patients. Dr. North has authored more than 200 peer-reviewed scientific published articles, served on scientific editorial boards, and chaired and served on committees for federal grant review and for development of terrorism policy for the Institute of Medicine.

ORCID

Emine R. Ayvaci http://orcid.org/0000-0002-0421-591X

Additional information

Funding

This study was funded by grant number R01 DA10713 from the National Institute on Drug Abuse (US), by grant number R25 MH101078 from the National Institute of Mental Health, and by grant number UL1TR001105 from the National Center for Advancing Translational Sciences.