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Obtaining housing associated with
achieving abstinence after
detoxification in adults with addiction
Tae Woo Park, Christine Maynié-François, Richard Saitz
Boston University Schools of Medicine and Public Health
and Boston Medical Center
Background
• Addiction is common in homeless persons
• Approximately half of homeless adults have substance
use disorders
• Homelessness associated with poor prognosis
• Increased morbidity
• Increased mortality
• High health service use
Background
• Detoxification often point of entry to addiction
treatment for homeless substance users
• Impact of housing on achieving abstinence
after detoxification is unclear
Objective
• To study the prospective association between
housing and later abstinence in a cohort of
adults with substance dependence postdetoxification
Hypothesis
• Obtaining housing is associated with a greater
probability of later abstinence in homeless adults
with substance dependence compared to
continuous homelessness
Data source
• Secondary analysis of randomized clinical trial
that compared integrated addiction, medical
and mental health care with usual separate
care
• No effect of integrated care on abstinence at 12
months (primary outcome)
Study design
• Cohort study
• Data collected prospectively
• Analyses and hypothesis completed after
data collected
• Study period: 12 months
Study population
• Adults with alcohol and/or drug dependence
(CIDI-SF) and recent heavy alcohol or drug
use
• Screened at inpatient detoxification unit (74%
of the whole RCT population, N = 416)
• Exclusion criteria: pregnancy, cognitive
impairment, lack of English or Spanish fluency
Main independent variable
• Housing status (at baseline and 6 months)
• Continuously homeless
• Homelessness defined as any night on the street or in a
shelter in the past 3 months
• Continuously housed
• Homeless to housed
• Housed to homeless
Outcomes
• 30-day abstinence from heavy drinking,
stimulants and opioids at 12 months assessed
by the Addiction Severity Index
Analysis
• Logistic regression model
• Adjusted for:
◦ Socio-demographics
◦ Age, sex, race
◦ Physical and mental health measures
◦ SF-12 PCS, PHQ-9
◦ Addiction characteristics
◦ Both alcohol and drug dependence, ASI drug and
alcohol composite scores, past addiction treatment
Results
Baseline characteristic
Age (SD)
Total (n=416)
36 (10)
Male gender (%)
74
White race (%)
56
Both alcohol and drug dependence (%)
61
Addiction Severity Index – alcohol (SD)
0.45 (0.35)
Addiction Severity Index – drug (SD)
0.32 (0.14)
PHQ-9 ≥ 10
89
Any addiction treatment past 3 months (%)
62
SF-12 Physical Component Summary (%)
42 (8)
Results
Housing status (n=350)
%
Continuously homeless
27
Continuously housed
33
Housed to homeless
6
Homeless to housed
33
Association between housing status
and abstinence
Housing status (n=338)
Odds ratio*
95% CI
P-value
Continuously homeless (ref)
1.00
N/A
N/A
Continuously housed
1.26
0.70-2.26
0.44
Housed to homeless
1.41
0.51-3.88
0.51
Homeless to housed
1.85
1.04-3.30
.04
*Adjusted for socio-demographics, physical and mental health measures, and addiction
characteristics
Conclusion
• Among adults with substance dependence
undergoing detoxification, those who
transitioned from homelessness to being
housed were more likely to achieve abstinence
12 months later compared to those
continuously homeless
Limitations
• Examined housing status at only 2 time points
• Results may be confounded by unmeasured
differences between those who gained housing
and those that did not
Implications
• Provision of housing might improve addiction
outcomes in patients with substance
dependence leaving detox
Acknowledgments
NIH/NIAAA R01 AA010870 and NIH/NIDA R01
DA010019, Addiction Health Evaluation And Disease
Management (AHEAD) Study, PI Saitz