Guest Editorial: Interventions for Homeless Individuals With Co-Occurring Mental Health and Addictive Disorders (original) (raw)
Related papers
Journal of Social Distress and the Homeless, 2015
Communities throughout the U.S. are struggling to find solutions for serious and persistent homelessness. Alcohol and drug problems can be causes and consequences of homelessness, as well as cooccurring problems that complicate efforts to succeed in finding stable housing. Two prominent service models exist, one known as "Housing First" takes a harm reduction approach and the other known as the "linear" model typically supports a goal of abstinence from alcohol and drugs. Despite their popularity, the research supporting these models suffers from methodological problems and inconsistent findings. One purpose of this paper is to describe systematic reviews of the homelessness services literature, which illustrate weaknesses in research designs and inconsistent conclusions about the effectiveness of current models. Problems among some of the seminal studies on homelessness include poorly defined inclusion and exclusion criteria, inadequate measures of alcohol and drug use, unspecified or poorly implemented comparison conditions, and lack of procedures documenting adherence to service models. Several recent papers have suggested broader based approaches for homeless services that integrate alternatives and respond better to consumer needs. Practical considerations for implementing a broader system of services are described and peer-managed recovery homes are presented as examples of services that address some of the gaps in current approaches. Three issues are identified that need more attention from researchers: (1) improving upon the methodological limitations in current studies, (2) assessing the impact of broader based, integrated services on outcome, and (3) assessing approaches to the service needs of homeless persons involved in the criminal justice system.
Journal of Health Care for the Poor and Underserved, 1994
Alcohol and other drug problems are widespread among homeless persons. Although precise estimates of prevalence are difficult to obtain, a recent review indicates that alcohol problems affect between 40 and 50 percent of all homeless persons, and that other drug problems affect between 28 and 37 percent.1 Taking into account distinctions among symptoms and diagnoses in previous prevalence studies, an estimated 40 to 45 percent of homeless persons suffer from Axis I mental disorders, while undifferentiated mental health problems afflict between 45 and 50 percent. Thus, whatever the total number of homeless persons in the United States, alcohol and other drug addiction, as well as mental illness, are among this population's most pressing problems. In July 1987, Section 613 of the Stewart B. McKinney Homeless Assistance Act (Public Law 100-77) authorized funds for a new demonstration program for homeless persons with alcohol and other drug-related problems. In May 1988, through this authority, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in consultation with the National Institute on Drug Abuse, initiated the Community Demonstration Projects for Alcohol and Drug Abuse Treatment of Homeless Individuals (hereinafter referred to as the Community Demonstration Program). The program awarded two-year grants on a competitive basis to nine community-based projects to implement and evaluate a variety of interventions. The projects were located in eight cities: Anchorage
Assertive Community Treatment (ACT) and the Comprehensive, Continuous, Integrated System of Care (CCISC) are two models for delivering services to homeless persons with complex behavioral health needs. This quasi-experimental study presents preliminary data comparing these two programs. The first program was based out of a community mental health center and utilized the ACT model of care with supported housing (ACT-SH), and the second program was based out of a substance abuse treatment agency and used the CCISC model of care in a residential treatment facility (CCISC-RT). Participants completed clinical assessment interviews at baseline before being admitted to the programs and then 6 months later. Measures included the Brief Symptom Inventory (BSI) to measure mental health symptoms; the Treatment Services Needed and Received (TSNR) to assess service needs, utilization, and levels of unmet needs; and a tool assessing employment, housing, and past-month substance use. Results indicated that participants in both interventions reported significant reductions in substance use and mental health symptoms, although the CCISC-RT program was associated with slightly greater reductions in mental health symptoms. Both programs were also associated with significant improvements in residential stability, although participants in the ACT-SH program were more likely to own or rent their own residence 6 months following program enrollment. This study indicates that both the ACT and CCISC models of care can be successfully implemented to serve homeless individuals with behavioral health needs. Although the CCISC-RT program was based in a residential treatment facility and delivered a greater intensity of behavioral health services than the ACT-SH program, results indicate that either approach can successfully be used to assist homeless individuals in obtaining a variety of needed services, reducing their substance use and mental health symptoms, and attaining a stable residence.
Homelessness and Addiction: Causes, Consequences and Interventions
Current Treatment Options in Psychiatry, 2016
Homeless individuals suffer from poverty, disaffiliation, personal vulnerability and often poor health. The main concerns from a public health point of view are poor health and barriers to health care. Reviews have identified substance use disorders as a priority among these disorders. Substance use disorders are under-treated and can constitute a barrier to treatment. The current review summarizes recent findings and up-to-date evidence on substance use disorders in this marginalized population. Focusing on treatment-relevant factors, the review will summarize the current evidence for substance use as a risk factor for homelessness, and on homelessness as a risk factor for substance use. The review will further focus on the impact of these findings have on interventions and the current best practices to treat homeless individuals with substance use disorders. Motivation to initiate and retention are major issues in addiction treatment and are they are even more of an issue for the treatment of homeless individuals. Similarly, the level of comorbidities in homelessness seems to be higher than in the general population increasing the need for an interdisciplinary approach. Research focused on this marginalized and stigmatized population, while still limited, has produced a number of findings which are helpful to developed more efficient interventions.
Trends in Substance Use Treatment Admissions among the Homeless in the United States: 2005-2015
Journal of Public Health Issues and Practices
Substance abuse is a significant public health problem among the homeless population in the United States. In this study, we sought to investigate the recent patterns of substance abuse among homeless people in the United States and estimate the prevalence of co-occurring mental illness in this population, using the substance use treatment episode data set for admissions (TEDS-A) during 2005 through 2015. Males and non-Hispanic Black Americans constituted a disproportionately high percentage of the admissions. Five substance groups accounted for 98.1% of primary substances reported between 2005 and 2015: alcohol (46%), opiates (24.6%), cocaine/crack (13%), methamphetamine (MA) (8.5%) and marijuana/hashish (6%). Though there was a decline in the proportion of admissions that reported alcohol abuse, alcohol was the most frequently reported substance of abuse at admission, while opioids (heroin and non-heroin opiates) were the most common illicit drug reported. Admissions due to opioid...
The American Journal of Drug and Alcohol Abuse, 2007
Homeless shelters provide a unique opportunity to intervene with occupants who have substance abuse problems, as not addressing these issues may lead to continuation of problems playing a contributing role in homelessness. Attempts to implement Contingency Management (CM) with this population have often been complex, costly, and not straightforward to replicate in community settings. We conducted a randomized trial evaluating a simple, low-cost 4-week CM program for 30 individuals seeking shelter in a community-based homeless shelter who had both current substance and psychiatric disorders. Behavioral assessments were performed at baseline, weekly, and termination of the study. Overall retention in the trial was high; participants assigned to CM reduced their cocaine and alcohol use more than those in assessment-only. This pilot trial suggests that application of low-cost CM procedures is feasible within this novel setting and may decrease substance use.