Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care
Aims Housing First (HF) is an established intervention for people experiencing homelessness and mental illness. We compared daily substance use (DSU) between HF and treatment as usual (TAU). Design Two concurrent randomized controlled trials with 24‐month follow‐up. Setting Market rental apartments...
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| Veröffentlicht in: | Addiction (Abingdon, England) England), 2015-10, Vol.110 (10), p.1605-1614 |
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| creator | Somers, Julian M. Moniruzzaman, Akm Palepu, Anita |
| description | Aims
Housing First (HF) is an established intervention for people experiencing homelessness and mental illness. We compared daily substance use (DSU) between HF and treatment as usual (TAU).
Design
Two concurrent randomized controlled trials with 24‐month follow‐up.
Setting
Market rental apartments with support provided by Assertive Community Treatment (ACT) or Intensive Case Management (ICM); a single building with on‐site supports (CONG); TAU in Vancouver, Canada.
Participants
Inclusion criteria were current homelessness and mental illness. Participants were assessed as having either ‘high needs’ (HN; n = 297) or ‘moderate needs’ (MN; n = 200). MN participants were randomized to ICM (n = 100) or MN‐TAU (n = 100). HN participants were randomized to ACT (n = 90), CONG (n = 107) or HN‐TAU (n = 100).
Interventions and comparators
All HF interventions included independent housing with support services, with an emphasis on promoting client choice and harm reduction in relation to substance use. TAU included existing services and support available to homeless adults with mental illness.
Measurements
DSU over 24 and 12 months was derived from the Maudsley Addiction Profile. Also measured were demographics, homelessness history, psychiatric diagnoses, symptom severity, comorbid illnesses and duration of stable housing.
Findings
Compared with HN‐TAU, neither CONG [adjusted odds (AOR) ratio = 0.73, 95% confidence interval (CI) = 0.39–1.37] nor ACT (AOR = 1.22, 95% CI = 0.61–2.45) differed on DSU at 24 months, and MN‐TAU did not differ from ICM (AOR = 0.78, 95% CI = 0.37–1.63). There were no differences at 12 months, when analyses were restricted to participants who indicated substance use at baseline, or when considering the duration of stable housing.
Conclusions
Housing First, an intervention to support recovery for homeless people who have co‐occurring mental illness and substance use disorders, did not reduce daily substance use compared with treatment as usual after 12 or 24 months. |
| doi_str_mv | 10.1111/add.13011 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_1721357984</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3800766561</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4601-a059764dc22e0a3b9efe8d6f99c8a35f3f35814c3733d5866a5fe65ce30802f73</originalsourceid><addsrcrecordid>eNqNks9u1DAQxi0EokvhwAsgS1y4pLXjP0m4Vbt0C1RFSCC4WV5n0nVx7GAnapfH4UlxdksPnLBljTXz-8a2_CH0kpITmsepbtsTygilj9CCMkkKwjl7jBakkaIoKSdH6FlKN4SQqm74U3RUSiJKKaoF-r3can8NCVuPW23dDqdpk0btDeApAdZ98Nd4gDA4wHA3QLTgjc25bejBQUo-L6x9i3vwo3bYOjen3uKSF1k8bnGYRpPhhLvgXLidxTELQm9_6dEGj8eAL8KU5sK5jWnEIebDp9zM6AjP0ZNOuwQv7uMx-nr-7svyorj8tH6_PLssDJeEFpqIppK8NWUJRLNNAx3UreyaxtSaiY51TNSUG1Yx1opaSi06kMIAIzUpu4odozeHvkMMPydIo-ptMuCc9pBvp2hVUiaqpub_gVIyc7zJ6Ot_0JswRZ8fsqcoz1Nm6tU9NW16aNUQba_jTv39qAycHoBb62D3UKdEzQ5Q2QFq7wB1tlrtN1lRHBQ2jXD3oNDxh5IVq4T6drVWH66-r8XnVa0-sj_ByLNj</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1710141416</pqid></control><display><type>article</type><title>Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Somers, Julian M. ; Moniruzzaman, Akm ; Palepu, Anita</creator><creatorcontrib>Somers, Julian M. ; Moniruzzaman, Akm ; Palepu, Anita</creatorcontrib><description>Aims
Housing First (HF) is an established intervention for people experiencing homelessness and mental illness. We compared daily substance use (DSU) between HF and treatment as usual (TAU).
Design
Two concurrent randomized controlled trials with 24‐month follow‐up.
Setting
Market rental apartments with support provided by Assertive Community Treatment (ACT) or Intensive Case Management (ICM); a single building with on‐site supports (CONG); TAU in Vancouver, Canada.
Participants
Inclusion criteria were current homelessness and mental illness. Participants were assessed as having either ‘high needs’ (HN; n = 297) or ‘moderate needs’ (MN; n = 200). MN participants were randomized to ICM (n = 100) or MN‐TAU (n = 100). HN participants were randomized to ACT (n = 90), CONG (n = 107) or HN‐TAU (n = 100).
Interventions and comparators
All HF interventions included independent housing with support services, with an emphasis on promoting client choice and harm reduction in relation to substance use. TAU included existing services and support available to homeless adults with mental illness.
Measurements
DSU over 24 and 12 months was derived from the Maudsley Addiction Profile. Also measured were demographics, homelessness history, psychiatric diagnoses, symptom severity, comorbid illnesses and duration of stable housing.
Findings
Compared with HN‐TAU, neither CONG [adjusted odds (AOR) ratio = 0.73, 95% confidence interval (CI) = 0.39–1.37] nor ACT (AOR = 1.22, 95% CI = 0.61–2.45) differed on DSU at 24 months, and MN‐TAU did not differ from ICM (AOR = 0.78, 95% CI = 0.37–1.63). There were no differences at 12 months, when analyses were restricted to participants who indicated substance use at baseline, or when considering the duration of stable housing.
Conclusions
Housing First, an intervention to support recovery for homeless people who have co‐occurring mental illness and substance use disorders, did not reduce daily substance use compared with treatment as usual after 12 or 24 months.</description><identifier>ISSN: 0965-2140</identifier><identifier>EISSN: 1360-0443</identifier><identifier>DOI: 10.1111/add.13011</identifier><identifier>PMID: 26052657</identifier><identifier>CODEN: ADICE5</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; British Columbia ; Canada ; Case Management ; Community care ; Community Mental Health Services ; Confidence intervals ; Drug use ; Experiment ; Female ; Homeless people ; Homeless Persons ; Homelessness ; Housing ; Housing First ; Humans ; Illnesses ; Male ; Mental disorders ; Mental Disorders - therapy ; Mental illness ; Middle Aged ; Odds Ratio ; Social theory ; Substance use ; Substance-Related Disorders - epidemiology</subject><ispartof>Addiction (Abingdon, England), 2015-10, Vol.110 (10), p.1605-1614</ispartof><rights>2015 Society for the Study of Addiction</rights><rights>2015 Society for the Study of Addiction.</rights><rights>Copyright © 2015 John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4601-a059764dc22e0a3b9efe8d6f99c8a35f3f35814c3733d5866a5fe65ce30802f73</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fadd.13011$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fadd.13011$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26052657$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Somers, Julian M.</creatorcontrib><creatorcontrib>Moniruzzaman, Akm</creatorcontrib><creatorcontrib>Palepu, Anita</creatorcontrib><title>Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care</title><title>Addiction (Abingdon, England)</title><addtitle>Addiction</addtitle><description>Aims
Housing First (HF) is an established intervention for people experiencing homelessness and mental illness. We compared daily substance use (DSU) between HF and treatment as usual (TAU).
Design
Two concurrent randomized controlled trials with 24‐month follow‐up.
Setting
Market rental apartments with support provided by Assertive Community Treatment (ACT) or Intensive Case Management (ICM); a single building with on‐site supports (CONG); TAU in Vancouver, Canada.
Participants
Inclusion criteria were current homelessness and mental illness. Participants were assessed as having either ‘high needs’ (HN; n = 297) or ‘moderate needs’ (MN; n = 200). MN participants were randomized to ICM (n = 100) or MN‐TAU (n = 100). HN participants were randomized to ACT (n = 90), CONG (n = 107) or HN‐TAU (n = 100).
Interventions and comparators
All HF interventions included independent housing with support services, with an emphasis on promoting client choice and harm reduction in relation to substance use. TAU included existing services and support available to homeless adults with mental illness.
Measurements
DSU over 24 and 12 months was derived from the Maudsley Addiction Profile. Also measured were demographics, homelessness history, psychiatric diagnoses, symptom severity, comorbid illnesses and duration of stable housing.
Findings
Compared with HN‐TAU, neither CONG [adjusted odds (AOR) ratio = 0.73, 95% confidence interval (CI) = 0.39–1.37] nor ACT (AOR = 1.22, 95% CI = 0.61–2.45) differed on DSU at 24 months, and MN‐TAU did not differ from ICM (AOR = 0.78, 95% CI = 0.37–1.63). There were no differences at 12 months, when analyses were restricted to participants who indicated substance use at baseline, or when considering the duration of stable housing.
Conclusions
Housing First, an intervention to support recovery for homeless people who have co‐occurring mental illness and substance use disorders, did not reduce daily substance use compared with treatment as usual after 12 or 24 months.</description><subject>Adult</subject><subject>British Columbia</subject><subject>Canada</subject><subject>Case Management</subject><subject>Community care</subject><subject>Community Mental Health Services</subject><subject>Confidence intervals</subject><subject>Drug use</subject><subject>Experiment</subject><subject>Female</subject><subject>Homeless people</subject><subject>Homeless Persons</subject><subject>Homelessness</subject><subject>Housing</subject><subject>Housing First</subject><subject>Humans</subject><subject>Illnesses</subject><subject>Male</subject><subject>Mental disorders</subject><subject>Mental Disorders - therapy</subject><subject>Mental illness</subject><subject>Middle Aged</subject><subject>Odds Ratio</subject><subject>Social theory</subject><subject>Substance use</subject><subject>Substance-Related Disorders - epidemiology</subject><issn>0965-2140</issn><issn>1360-0443</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNks9u1DAQxi0EokvhwAsgS1y4pLXjP0m4Vbt0C1RFSCC4WV5n0nVx7GAnapfH4UlxdksPnLBljTXz-8a2_CH0kpITmsepbtsTygilj9CCMkkKwjl7jBakkaIoKSdH6FlKN4SQqm74U3RUSiJKKaoF-r3can8NCVuPW23dDqdpk0btDeApAdZ98Nd4gDA4wHA3QLTgjc25bejBQUo-L6x9i3vwo3bYOjen3uKSF1k8bnGYRpPhhLvgXLidxTELQm9_6dEGj8eAL8KU5sK5jWnEIebDp9zM6AjP0ZNOuwQv7uMx-nr-7svyorj8tH6_PLssDJeEFpqIppK8NWUJRLNNAx3UreyaxtSaiY51TNSUG1Yx1opaSi06kMIAIzUpu4odozeHvkMMPydIo-ptMuCc9pBvp2hVUiaqpub_gVIyc7zJ6Ot_0JswRZ8fsqcoz1Nm6tU9NW16aNUQba_jTv39qAycHoBb62D3UKdEzQ5Q2QFq7wB1tlrtN1lRHBQ2jXD3oNDxh5IVq4T6drVWH66-r8XnVa0-sj_ByLNj</recordid><startdate>201510</startdate><enddate>201510</enddate><creator>Somers, Julian M.</creator><creator>Moniruzzaman, Akm</creator><creator>Palepu, Anita</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QG</scope><scope>7TK</scope><scope>8BJ</scope><scope>FQK</scope><scope>JBE</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201510</creationdate><title>Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care</title><author>Somers, Julian M. ; Moniruzzaman, Akm ; Palepu, Anita</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4601-a059764dc22e0a3b9efe8d6f99c8a35f3f35814c3733d5866a5fe65ce30802f73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>British Columbia</topic><topic>Canada</topic><topic>Case Management</topic><topic>Community care</topic><topic>Community Mental Health Services</topic><topic>Confidence intervals</topic><topic>Drug use</topic><topic>Experiment</topic><topic>Female</topic><topic>Homeless people</topic><topic>Homeless Persons</topic><topic>Homelessness</topic><topic>Housing</topic><topic>Housing First</topic><topic>Humans</topic><topic>Illnesses</topic><topic>Male</topic><topic>Mental disorders</topic><topic>Mental Disorders - therapy</topic><topic>Mental illness</topic><topic>Middle Aged</topic><topic>Odds Ratio</topic><topic>Social theory</topic><topic>Substance use</topic><topic>Substance-Related Disorders - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Somers, Julian M.</creatorcontrib><creatorcontrib>Moniruzzaman, Akm</creatorcontrib><creatorcontrib>Palepu, Anita</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Animal Behavior Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Addiction (Abingdon, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Somers, Julian M.</au><au>Moniruzzaman, Akm</au><au>Palepu, Anita</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care</atitle><jtitle>Addiction (Abingdon, England)</jtitle><addtitle>Addiction</addtitle><date>2015-10</date><risdate>2015</risdate><volume>110</volume><issue>10</issue><spage>1605</spage><epage>1614</epage><pages>1605-1614</pages><issn>0965-2140</issn><eissn>1360-0443</eissn><coden>ADICE5</coden><abstract>Aims
Housing First (HF) is an established intervention for people experiencing homelessness and mental illness. We compared daily substance use (DSU) between HF and treatment as usual (TAU).
Design
Two concurrent randomized controlled trials with 24‐month follow‐up.
Setting
Market rental apartments with support provided by Assertive Community Treatment (ACT) or Intensive Case Management (ICM); a single building with on‐site supports (CONG); TAU in Vancouver, Canada.
Participants
Inclusion criteria were current homelessness and mental illness. Participants were assessed as having either ‘high needs’ (HN; n = 297) or ‘moderate needs’ (MN; n = 200). MN participants were randomized to ICM (n = 100) or MN‐TAU (n = 100). HN participants were randomized to ACT (n = 90), CONG (n = 107) or HN‐TAU (n = 100).
Interventions and comparators
All HF interventions included independent housing with support services, with an emphasis on promoting client choice and harm reduction in relation to substance use. TAU included existing services and support available to homeless adults with mental illness.
Measurements
DSU over 24 and 12 months was derived from the Maudsley Addiction Profile. Also measured were demographics, homelessness history, psychiatric diagnoses, symptom severity, comorbid illnesses and duration of stable housing.
Findings
Compared with HN‐TAU, neither CONG [adjusted odds (AOR) ratio = 0.73, 95% confidence interval (CI) = 0.39–1.37] nor ACT (AOR = 1.22, 95% CI = 0.61–2.45) differed on DSU at 24 months, and MN‐TAU did not differ from ICM (AOR = 0.78, 95% CI = 0.37–1.63). There were no differences at 12 months, when analyses were restricted to participants who indicated substance use at baseline, or when considering the duration of stable housing.
Conclusions
Housing First, an intervention to support recovery for homeless people who have co‐occurring mental illness and substance use disorders, did not reduce daily substance use compared with treatment as usual after 12 or 24 months.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>26052657</pmid><doi>10.1111/add.13011</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0965-2140 |
| ispartof | Addiction (Abingdon, England), 2015-10, Vol.110 (10), p.1605-1614 |
| issn | 0965-2140 1360-0443 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult British Columbia Canada Case Management Community care Community Mental Health Services Confidence intervals Drug use Experiment Female Homeless people Homeless Persons Homelessness Housing Housing First Humans Illnesses Male Mental disorders Mental Disorders - therapy Mental illness Middle Aged Odds Ratio Social theory Substance use Substance-Related Disorders - epidemiology |
| title | Changes in daily substance use among people experiencing homelessness and mental illness: 24-month outcomes following randomization to Housing First or usual care |
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