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 post-detoxification

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

ResultsBaseline characteristic Total (n=416)

Age (SD) 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 27Continuously housed 33Housed to homeless 6Homeless 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