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Kent H, Magner-Parsons B, Leckie G, Dulgar T, Lusiandari A, Hogarth L, Williams H, Kirby A. Profiles of vulnerability for suicide and self-harm in UK prisoners: Neurodisability, mood disturbance, substance use, and bullying. PLoS One 2024; 19:e0296078. [PMID: 38170719 PMCID: PMC10763929 DOI: 10.1371/journal.pone.0296078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Screening for vulnerability factors associated with historic suicidality and self-harm on entry to prison is critical to help prisons understand how to allocate extremely limited mental health resources. It has been established that having previous suicide attempts increases odds of future suicidality and self-harm in prison. We utilised administrative screening data from 665 adult male prisoners on entry to a category B prison in Wales, UK, collected using the Do-IT Profiler. This sample represents 16% of all prisoners who entered that prison during a 26-month period. 12% of prisoners reported a history of attempted suicide, 11% reported historic self-harm, and 8% reported a history of both. Historic traumatic brain injury and substance use problems were associated with a 3.3- and 1.9- times increased odds of a historic suicide attempt, respectively, but no significant increased risk of historic self-harm (95% CI: 1.51-6.60 and 1.02-3.50). However, those who were bullied at school had 2.7 times increased odds of reporting a history of self-harm (95% CI: 1.63-6.09). The most salient risk factors associated with both historic suicide and self-harm were higher levels of functional neurodisability (odds ratio 0.6 for a 1 standard deviation change in score, 95% CI: 0.35-0.75), and mood disturbance (odds ratio 2.1 for a 1 standard deviation change in score, 95% CI: 1.26-3.56). Therefore, it could be beneficial for prisons to screen for broader profiles of needs, to better understand how to provide appropriate services to prisoners vulnerable to suicide and self-harm. Multidisciplinary care pathways for prisoner mental health interventions are important, to account for complex multimorbidity. Adaptations may be needed for mental health interventions to be appropriate for, for example, a prisoner with a brain injury. Understanding this broad profile of vulnerability could also contribute to more compassionate responses to suicide and self-harm from prison staff.
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Affiliation(s)
- Hope Kent
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Devon, United Kingdom
| | - Bella Magner-Parsons
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Devon, United Kingdom
| | - George Leckie
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Tuna Dulgar
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Devon, United Kingdom
| | - Anggita Lusiandari
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Devon, United Kingdom
| | - Lee Hogarth
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Devon, United Kingdom
| | - Huw Williams
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Devon, United Kingdom
| | - Amanda Kirby
- Emeritus Professor, School of Education, University of South Wales, Wales, United Kingdom
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Roth SE, Jones KG, Vartanian KB. Assessing the impact of recovery housing on healthcare utilization in Portland, Oregon. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 9:100192. [PMID: 37822577 PMCID: PMC10563008 DOI: 10.1016/j.dadr.2023.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
Introduction Central City Concern (CCC) operates several recovery housing sites in the Portland, Oregon metropolitan region, including the Blackburn Center (Blackburn) and the Richard L. Harris Building (Harris). This retrospective, observational study was designed to assess recovery housing's impact on inpatient detoxification readmission rates and healthcare utilization patterns. Methods Our study population consisted of individuals discharged from CCC's Hooper Detox Stabilization Center from June 2019 to September 2020. A total of 75 clients housed at Blackburn, 63 clients housed at Harris, and 57 clients discharged as unhoused were included in the study sample. Using logistic regression for each of the two recovery housing groups relative to the unhoused group, we examined differences in readmissions to inpatient detoxification after their qualifying discharge. We then used Difference-In-Difference model to compare the per member per year (PMPY) use of different domains of health care before and after their qualifying discharge. Results Compared to clients discharged as unhoused, Blackburn and Harris residents had lower risk of readmissions to inpatient detoxification treatment at 90- and 180-days post-discharge. Additionally, while the mean number of PMPY emergency department visits increased for clients discharged as unhoused in the post period, the average number of emergency department visits decreased for clients who obtained recovery housing at Blackburn (DiD=-3.65 PMPY, p-value=0.02) and at Harris (DiD=-3.87 PMPY, p-value=0.01). Conclusion Findings highlight the impact and importance of recovery housing for individuals managing a substance use disorder and the value of healthcare system and public sector investment housing like Blackburn and Harris.
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Affiliation(s)
- Sarah E. Roth
- Center for Outcomes Research and Education (CORE), Providence Health and Services, 5251 NE Glisan St, Building A, Portland, OR 97213, United States
| | - Kyle G. Jones
- Center for Outcomes Research and Education (CORE), Providence Health and Services, 5251 NE Glisan St, Building A, Portland, OR 97213, United States
| | - Keri B. Vartanian
- Center for Outcomes Research and Education (CORE), Providence Health and Services, 5251 NE Glisan St, Building A, Portland, OR 97213, United States
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Kent H, Kirby A, Leckie G, Cornish R, Hogarth L, Williams WH. Looked after children in prison as adults: life adversity and neurodisability. Int J Prison Health 2023; 19:512-523. [PMID: 36689249 DOI: 10.1108/ijph-08-2022-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE Looked after children (LAC) are criminalised at five times the rate of children in the general population. Children in contact with both child welfare and child justice systems have higher rates of neurodisability and substance use problems, and LAC in general have high rates of school exclusion, homelessness and unemployment. This study aims to understand whether these factors persist in LAC who are in prison as adults. DESIGN/METHODOLOGY/APPROACH Administrative data collected by the Do-IT profiler screening tool in a prison in Wales, UK, were analysed to compare sentenced prisoners who were LAC (n = 631) to sentenced prisoners who were not LAC (n = 2,201). The sample comprised all prisoners who were screened on entry to prison in a two-year period. FINDINGS Prisoners who were LAC scored more poorly on a functional screener for neurodisability (effect size = 0.24), and on four self-report measures capturing traits of dyslexia (0.22), attention-deficit hyperactivity disorder (0.40), autism spectrum disorders (0.34) and developmental co-ordination disorder (0.33). Prisoners who were LAC were more likely to have been to a pupil referral unit (0.24), have substance use problems (0.16), be homeless or marginally housed (0.18) and be unemployed or unable to work due to disability (0.13). ORIGINALITY/VALUE This study uniquely contributes to our understanding of prisoners who were LAC as a target group for intervention and support with re-integration into the community upon release. LAC in prison as adults may require additional interventions to help with employment, housing and substance use. Education programmes in prison should screen for neurodisability, to develop strategies to support engagement.
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Affiliation(s)
- Hope Kent
- Department of Psychology, University of Exeter, Exeter, UK
| | - Amanda Kirby
- Dyscovery Centre, University of South Wales, Pontypridd, UK
| | - George Leckie
- School of Education, University of Bristol, Bristol, UK
| | - Rosie Cornish
- Bristol Medical School (PHS), University of Bristol, Bristol, UK
| | - Lee Hogarth
- Department of Psychology, University of Exeter, Exeter, UK
| | - W Huw Williams
- Department of Psychology, University of Exeter, Exeter, UK
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de la Fuente-Roldán IN, Corchado-Castillo AI, Dorado-Barbé A. Mental Health and Homelessness in the Community of Madrid (Spain): The Impact of Discrimination and Violence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2034. [PMID: 36767398 PMCID: PMC9915538 DOI: 10.3390/ijerph20032034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to analyze the impact of experiences of violence and discrimination on mental health among people in situations of homelessness (PSH). For this purpose, a quantitative, descriptive, and correlational investigation was conducted by conducting a survey with 603 PSH living in the Community of Madrid (Spain). The results show high levels of mental health impairment, as well as approximately half of the participants having experienced discrimination and violence in the course of their homelessness. Perceived experiences of discrimination are associated with higher levels of mental health impairment (OR = 0.458; p = < 0.001; 95% IC 0.31-0.68). This deterioration is also related to a negative self-assessment of the general state of health among participants (OR = 0.262; p = < 0.001; 95% IC 0.12-0.57). However, impaired mental health is not associated with experiences of violence. The findings also indicate that there are intersections in terms of being female, young, and foreign that result in greater psychological impairment and a higher risk of experiencing violence and discrimination. This study provides an insight into the PSH experiences in relation to mental health, violence, and discrimination and the need to implement actions aimed at improving their psychosocial wellbeing from the perspective of respect for citizens' rights.
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Affiliation(s)
- Iria Noa de la Fuente-Roldán
- Department of Social Work and Social Services (Faculty of Social Work), Complutense University of Madrid, 28223 Madrid, Spain
- Institute for Research in Development and Cooperation (IUDC-UCM), Complutense University of Madrid, 28015 Madrid, Spain
| | - Ana Isabel Corchado-Castillo
- Department of Social Work and Social Services (Faculty of Social Work), Complutense University of Madrid, 28223 Madrid, Spain
| | - Ana Dorado-Barbé
- Department of Social Work and Social Services (Faculty of Social Work), Complutense University of Madrid, 28223 Madrid, Spain
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Stone BM. A positive psychology framework for why people use substances: Implications for treatment. Front Psychol 2022; 13:1017186. [PMID: 36248491 PMCID: PMC9557359 DOI: 10.3389/fpsyg.2022.1017186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/13/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Bryant M. Stone
- Department of Psychological and Behavioral Sciences, Institute of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
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Yoo R, Krawczyk N, Johns E, McCormack RP, Rotrosen J, Mijanovich T, Gelberg L, Doran KM. Association of substance use characteristics and future homelessness among emergency department patients with drug use or unhealthy alcohol use: Results from a linked data longitudinal cohort analysis. Subst Abus 2022; 43:1100-1109. [DOI: 10.1080/08897077.2022.2060445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ruth Yoo
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Noa Krawczyk
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Eileen Johns
- NYC Center for Innovation through Data Intelligence, New York, NY, USA
| | - Ryan P. McCormack
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - John Rotrosen
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Tod Mijanovich
- Applied Statistics, Social Science, and Humanities, NYU Steinhardt School, New York, NY, USA
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA, The University of California, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Kelly M. Doran
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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A cohort study examining the relationship among housing status, patient characteristics, and retention among individuals enrolled in low-barrier-to-treatment-access methadone maintenance treatment. J Subst Abuse Treat 2022; 138:108753. [DOI: 10.1016/j.jsat.2022.108753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/24/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
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Affiliation(s)
- Kelly M Doran
- Department of Emergency Medicine, New York University (NYU) School of Medicine, New York
- Department of Population Health, NYU School of Medicine, New York
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Padwa H, Bass B, Urada D. Homelessness and publicly funded substance use disorder treatment in California, 2016-2019: Analysis of treatment needs, level of care placement, and outcomes. J Subst Abuse Treat 2021; 137:108711. [PMID: 35012791 DOI: 10.1016/j.jsat.2021.108711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/04/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Both homelessness and substance use have increased in recent years. People experiencing homelessness (PEH) are at increased risk for health problems and early mortality, both of which can be exacerbated by substance use disorders (SUD). Specialty SUD treatment is likely needed to address substance use among PEH, and more than 232,000 PEH received treatment from U.S. publicly funded SUD programs in 2015. The objective of this paper is to develop a better understanding of the SUD services that PEH receive in publicly funded treatment programs by (1) describing the characteristics and needs of the PEH population served in publicly funded SUD treatment programs, compared to non-PEH populations; (2) determining if differences exist in treatment placement (level of care) for PEH and non-PEH; and (3) gauging how successful programs are in treating PEH compared to non-PEH. METHODS Observational study using a two-way fixed effect model to determine associations among homelessness, retention, and outcomes among Medicaid beneficiaries receiving SUD treatment in California from 2016 to 2019 (n = 638,953). The study team used ordinary least squares (OLS) regression to measure the degree to which homelessness was associated with baseline characteristics, SUD services received, and treatment outcomes. RESULTS PEH were significantly more likely than non-PEH to be having methamphetamine or heroin as their primary substance. PEH had greater frequency of primary substance use prior to entering treatment, greater ER and hospital utilization, more criminal justice involvement, and greater prevalence of mental health diagnoses and unemployment. PEH were 9.82% more likely than non-PEH to receive residential treatment and 7.11% less likely than non-PEH to receive treatment intensive outpatient modalities. Homelessness was associated with an 11.90% decrease in retention, and a 19.40% decrease in successful discharge status. These trends were consistent across outpatient, intensive outpatient, and residential modalities. CONCLUSIONS Developing SUD treatment capacity and housing supports can improve treatment outcomes for PEH. Potential strategies to improve SUD services for PEH include providing more contingency management, opioid pharmacotherapies, programming designed to treat individuals with co-occurring mental health disorders, and resources for housing options that can support PEH in their recovery.
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Affiliation(s)
- Howard Padwa
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, United States of America.
| | - Brittany Bass
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, United States of America
| | - Darren Urada
- University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA 90025, United States of America
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Jurewicz A, Padgett DK, Ran Z, Castelblanco DG, McCormack RP, Gelberg L, Shelley D, Doran KM. Social relationships, homelessness, and substance use among emergency department patients. Subst Abus 2021; 43:573-580. [PMID: 34586981 DOI: 10.1080/08897077.2021.1975869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Emergency department (ED) patients commonly experience both substance use and homelessness, and social relationships impact each in varied ways not fully captured by existing quantitative research. This qualitative study examines how social relationships can precipitate or ameliorate homelessness and the connection (if any) between substance use and social relationships among ED patients experiencing homelessness. METHODS As part of a broader study to develop ED-based homelessness prevention interventions, we conducted in-depth interviews with 25 ED patients who used alcohol or drugs and had recently become homeless. We asked patients about the relationship between their substance use and homelessness. Interviews were recorded, transcribed, and coded line-by-line by investigators. Final codes formed the basis for thematic analysis through consensus discussions. RESULTS Social relationships emerged as focal points for understanding the four major themes related to the intersection of homelessness and substance use: (1) Substance use can create strain in relationships; (2) Help is there until it's not; (3) Social relationships can create challenges contributing to substance use; and (4) Reciprocal relationship of substance use and isolation. Sub-themes were also identified and described. CONCLUSIONS The association between substance use and homelessness is multifaceted and social relationships are a complex factor linking the two. Social relationships are often critical for homelessness prevention, but they are impacted by and reciprocally affect substance use. ED-based substance use interventions should consider the high prevalence of homelessness and the impact of social relationships on the interaction between homelessness and substance use.
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Affiliation(s)
| | | | - Ziwei Ran
- NYU Silver School of Social Work, New York, NY, USA
| | | | - Ryan P McCormack
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA
| | | | - Donna Shelley
- NYU College of Global Public Health, New York, NY, USA.,Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Kelly M Doran
- Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA.,Department of Population Health, NYU School of Medicine, New York, NY, USA
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11
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McLaughlin MF, Li R, Carrero ND, Bain PA, Chatterjee A. Opioid use disorder treatment for people experiencing homelessness: A scoping review. Drug Alcohol Depend 2021; 224:108717. [PMID: 33985863 PMCID: PMC9758007 DOI: 10.1016/j.drugalcdep.2021.108717] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND The opioid-related overdose epidemic remains a persistent public health problem in the United States and has been accelerated by the 2019 coronavirus disease pandemic. Existing, evidence-based treatment options for opioid use disorder (OUD) are broadly underutilized, particularly by people experiencing homelessness (PEH). PEH are also more likely to misuse and overdose on opioids. To better understand current gaps and disparities in OUD treatment experienced by PEH and efforts to address them, we synthesized the literature reporting on the intersection of housing status and OUD treatment. METHODS We conducted a scoping review of the literature from the electronic databases MEDLINE, Embase, PsycINFO, and Web of Science Core Collection. We included studies describing treatment-related outcomes specific to PEH and articles assessing OUD treatment interventions tailored to this population. Relevant findings were compiled via thematic analysis and narratively synthesized. RESULTS 60 articles met our inclusion criteria, including 43 descriptive and 17 intervention-focused studies. These studies demonstrated that PEH experience more barriers to OUD treatment than their housed counterparts and access inpatient and detoxification treatment more commonly than pharmacotherapy. However, the reviewed literature indicated that PEH have similar outcomes once engaged in pharmacotherapy. Efficacious interventions for PEH were low-barrier and targeted, with housing interventions also demonstrating benefit. CONCLUSIONS PEH have diminished access to evidence-based OUD treatment, particularly medications, and require targeted approaches to improve engagement and retention. To mitigate the disproportionate opioid-related morbidity and mortality PEH experience, innovative, flexible, and interdisciplinary OUD treatment models are necessary, with housing support playing an important role.
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Affiliation(s)
- Matthew F. McLaughlin
- Harvard College, Massachusetts Hall, Cambridge, MA, 02138, United States,Corresponding author. Present address at: San Francisco Department of Public Health, 25 Van Ness Ave. Suite 500, San Francisco, CA, 94102, United States
| | - Rick Li
- Harvard College, Massachusetts Hall, Cambridge, MA, 02138, United States
| | | | - Paul A. Bain
- Countway Library, Harvard Medical School, 10 Shattuck St., Boston, MA, 02115, United States
| | - Avik Chatterjee
- Boston Health Care for the Homeless Program, 780 Albany St., Boston, MA, 02118, United States,Boston University School of Medicine/Boston Medical Center, 72 E. Concord St., Boston, MA, 02118, United States
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12
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LeSaint KT, Snyder HR. Impact of Social Distancing on Individuals Who Use Drugs: Considerations for Emergency Department Providers. West J Emerg Med 2020; 21:1102-1104. [PMID: 32970561 PMCID: PMC7514381 DOI: 10.5811/westjem.2020.7.47896] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/15/2020] [Indexed: 11/27/2022] Open
Abstract
The isolation that comes from social distancing during the COVID-19 pandemic can be particularly detrimental to the United States’ population of people who use drugs. People with substance use disorders may be at risk for return to use, exacerbation of existing mental health disorders, and risky drug practices. In this commentary, we review the risk to people who use drugs and how emergency department providers can best support these individuals during the unprecedented time of social distancing.
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Affiliation(s)
- Kathy T LeSaint
- University of California San Francisco, Department of Emergency Medicine, San Francisco, California.,California Poison Control System, San Francisco, California
| | - Hannah R Snyder
- University of California San Francisco, Department of Family and Community Medicine, San Francisco, California
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Alunni-Menichini K, Bertrand K, Roy L, Brousselle A. Current emergency response in montreal: How does it fit in the services offered to homeless people who use substances? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 82:102758. [PMID: 32482488 DOI: 10.1016/j.drugpo.2020.102758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 11/19/2022]
Abstract
Background This paper presents an assessment of the current emergency response to homeless people who use substances in Montreal, a major North American city. This project addresses the rising concern about homelessness in high-income countries. Several studies have shown that homeless people frequently use emergency services (i.e., police, paramedical, and hospital), especially in the context of substance use. Yet, the key actors' perspectives are poorly documented. Method Our team conducted a needs analysis using a deliberative democratic evaluation. Data collection strategies included an intersectoral World Café (n = 34, including police, specialized professionals, community stakeholders, political representatives, researchers, and people who have been homeless) and individual interviews with health professionals (n = 5) and homeless people (n = 8). We performed a thematic content analysis based on a conceptual framework of access to health care and of collaboration. Findings This study provided key information on the role of emergency services and the needs of key actors, in terms of the dimensions of access to health care (approachability, acceptability, availability, and appropriateness) and continuity. Our main results show that, according to the participants, the emergency response is relevant when homeless people are a danger to themselves or to others, and during episodes of acute physical and psychological care. However, emergency service providers still stigmatize homelessness and substance use, which negatively affects intervention quality. Finally, our main results highlight the interdependence between the emergency services and health, social, and community services. Conclusion The emergency response is necessary and appropriate in some situations. It remains important to intervene upstream and to improve the attitudes and practices of emergency service providers. Finally, it is necessary to adapt services to the needs of homeless substance users and improve service continuity, for example, by adopting a population-based approach.
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Affiliation(s)
- Kristelle Alunni-Menichini
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Institut Universitaire en Dépendance, 150, place Charles-Le Moyne, bureau 200, Longueuil (QC), J4K 0A8, Canada; Institut universitaire sur les dépendances, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 rue de Louvain Est, Montréal (QC), H2M 2E8
| | - Karine Bertrand
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Institut Universitaire en Dépendance, 150, place Charles-Le Moyne, bureau 200, Longueuil (QC), J4K 0A8, Canada; Institut universitaire sur les dépendances, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 rue de Louvain Est, Montréal (QC), H2M 2E8
| | - Laurence Roy
- School of Physical & Occupational Therapy, McGill University, Davis House, 3654 Promenade Sir-William-Osler, Montreal (QC), H3G 1Y5, Canada; Douglas Mental Health University Institute, Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal, 6875 LaSalle Boulevard, Montreal (QC), H4H 1R3, Canada
| | - Astrid Brousselle
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Institut Universitaire en Dépendance, 150, place Charles-Le Moyne, bureau 200, Longueuil (QC), J4K 0A8, Canada; School of Public Administration, Faculty of Human and Social Development, University of Victoria, 3800 Finnerty Rd (Ring Rd), Human & Social Development Building, Room A302, Victoria (BC), V8P 5C2, Canada
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Lippert AM, Lee BA. Adult and Child Food Insecurity Among Homeless and Precariously-Housed Families at the Close of the Twentieth Century. POPULATION RESEARCH AND POLICY REVIEW 2020. [DOI: 10.1007/s11113-020-09577-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Daniulaityte R, Nahhas RW, Silverstein S, Martins S, Zaragoza A, Moeller A, Carlson RG. Patterns of non-prescribed buprenorphine and other opioid use among individuals with opioid use disorder: A latent class analysis. Drug Alcohol Depend 2019; 204:107574. [PMID: 31568934 PMCID: PMC6886684 DOI: 10.1016/j.drugalcdep.2019.107574] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 11/28/2022]
Abstract
AIM Non-prescribed buprenorphine (NPB) use increased in the US. This study aims to characterize heterogeneity in patterns of NPB and other opioid use among individuals with current opioid use disorder. METHODS The study recruited 356 participants in Dayton (Montgomery County), Ohio, area in 2017-2018 using targeted and Respondent Driven Sampling. Participants met the following criteria: 1) 18 years or older, 2) current moderate/severe opioid use disorder (DSM-5), 3) past 6-month NPB use. Latent class analysis (LCA) was conducted to identify subgroups based on past 6-month (days of NPB and heroin/fentanyl use; use of NPB to get high; use of non-prescribed and prescribed pharmaceutical opioids; participation in formal treatment) and lifetime (years since first NPB and other illicit opioid use) characteristics. Selected auxiliary variables were compared across classes using Asparouhov and Muthén's 3-step approach. RESULTS 49.7% were female, and 88.8% were non-Hispanic whites. 89% used NPB to self-treat withdrawal. LCA resulted in three classes: "Heavy Heroin/Fentanyl Use" (61%), "More Formal Treatment Use" (29%) and "Intense NPB Use" (10%). After adjusting for multiple testing, the following past 6-month variables differed significantly between classes: injection as a primary route of heroin/fentanyl administration (p < 0.001), cocaine use (p = 0.044), unintentional drug overdose (p = 0.023), and homelessness (p = 0.044), with the "Intense NPB Use" class having the lowest prevalences. CONCLUSION Predominance of self-treatment goals and the association between more intense NPB use and lower risks of adverse consequences suggest potential harm minimization benefits of NPB use. More research is needed to understand consequences of NPB use over time.
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Affiliation(s)
- Raminta Daniulaityte
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, United States.
| | - Ramzi W. Nahhas
- Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton,Department of Psychiatry, Boonshoft School of Medicine, Wright State University
| | - Sydney Silverstein
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University
| | - Silvia Martins
- Department of Epidemiology Columbia University Mailman School of Public Health
| | - Angela Zaragoza
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University
| | - Avery Moeller
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University
| | - Robert G. Carlson
- Center for Interventions, Treatment, and Addictions Research, Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University
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16
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Bedi G, Hao X, Van Dam NT, Cooper ZD, Rubin E, Vadhan NP, Marino L, Haney M. Social motivational processing and interpersonal function in aging cocaine smokers. Addict Biol 2019; 24:1044-1055. [PMID: 30328665 DOI: 10.1111/adb.12669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/09/2018] [Accepted: 07/18/2018] [Indexed: 01/19/2023]
Abstract
Illicit drug use among aging cohorts is increasing, yet little is known about functional impairments in older drug users. Given the importance of social integration for aging and documented social decrements in cocaine users, we examined social function and its neurocognitive substrates in aging cocaine users relative to carefully matched non-cocaine users. Regular (≥twice/week), long-term (≥15 years) cocaine smokers 50-60 years old (COCs; n = 22; four women) and controls (CTRLs; n = 19; four women) underwent standardized probes of social reward and threat processing during functional magnetic resonance imaging and a behavioral facial affect recognition task. Self-report and peer-report of daily interpersonal function were also collected. COCs, and CTRLs reporting current marijuana or alcohol use, were tested after four drug-free inpatient days. COCs had pronounced problems in daily social function relative to CTRLs indicated by both their own and their peers' reports. Compared with CTRLs, COCs had stronger amygdala responses to social threat versus control stimuli, with no other differences in social processing or cognition. Aging cocaine users appear to have marked, generalized difficulties in 'real-world' interpersonal function but largely intact social processing on laboratory-based measures when compared with appropriately matched controls and tested under well-controlled conditions. Daily social difficulties may be related to transient factors such as acute/residual drug effects or cocaine-related changes in health behaviors (e.g. disrupted sleep and poor diet). These data suggest that interpersonal function may be a valid intervention target for aging cocaine users and warrants further study in older drug users.
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Affiliation(s)
- Gillinder Bedi
- Department of Psychiatry; Columbia University Medical Center and New York State Psychiatric Institute; New York NY USA
- Centre for Youth Mental Health; University of Melbourne; Australia
- Orygen, National Centre of Excellence in Youth Mental Health; Australia
| | - Xuejun Hao
- Department of Psychiatry; Columbia University Medical Center and New York State Psychiatric Institute; New York NY USA
| | | | - Ziva D. Cooper
- Department of Psychiatry; Columbia University Medical Center and New York State Psychiatric Institute; New York NY USA
| | - Eric Rubin
- Department of Psychiatry; Columbia University Medical Center and New York State Psychiatric Institute; New York NY USA
| | - Nehal P. Vadhan
- Hofstra-Northwell School of Medicine and Feinstein Institute for Medical Research; Great Neck NY USA
| | - Leslie Marino
- Department of Psychiatry; Columbia University Medical Center and New York State Psychiatric Institute; New York NY USA
| | - Margaret Haney
- Department of Psychiatry; Columbia University Medical Center and New York State Psychiatric Institute; New York NY USA
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17
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Gerber E, Gelberg L, Rotrosen J, Castelblanco D, Mijanovich T, Doran KM. Health-related material needs and substance use among emergency department patients. Subst Abus 2019; 41:196-202. [PMID: 31368863 DOI: 10.1080/08897077.2019.1635960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Emergency department (ED) visits related to substance use are common. ED patients also have high levels of health-related material needs (HRMNs), such as homelessness and food insecurity. However, little research has examined the intersection between ED patient HRMNs and substance use. Methods: We surveyed a random sample of public hospital ED patients. Surveys included validated single-item screeners for unhealthy alcohol and any drug use and questions on self-reported past-year material needs. We compared individual HRMNs and cumulative number of HRMNs by substance use screening status using bivariate and multivariable analyses. Results: A total of 2312 surveys were completed. Nearly one third of patients (32.3%, n = 747) screened positive for unhealthy alcohol use, and 21.8% (n = 503) screened positive for drug use. Prevalence of HRMNs for all patients-including food insecurity (50.8%), inability to meet essential expenses (40.8%), cost barriers to medical care (24.6%), employment issues (23.8%), and homelessness (21.4%)-was high and was significantly higher for patients with unhealthy alcohol use or drug use. In multivariable analyses, homelessness was independently associated with unhealthy alcohol use (adjusted odds ratio [aOR]: 1.61, 95% confidence interval [CI]: 1.24-2.09) and drug use (aOR: 2.30, 95% CI: 1.74-3.05). There was a significant stepwise increase in the odds of patient unhealthy alcohol or drug use as number of HRMNs increased. Conclusions: ED patients with unhealthy alcohol or drug use have higher prevalence of HRMNs than those without. Our findings suggest that HRMNs may act additively and that homelessness is particularly salient. Patients' comorbid HRMNs may affect the success of ED-based substance use interventions.
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Affiliation(s)
- Evan Gerber
- NYU School of Medicine, New York, New York, USA
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.,Office of Healthcare Transformation and Innovation, VA Greater Los Angeles, Healthcare System, Los Angeles, California, USA
| | - John Rotrosen
- Department of Psychiatry, NYU School of Medicine, New York, New York, USA
| | - Donna Castelblanco
- Department of Emergency Medicine, NYU School of Medicine, New York, New York, USA
| | - Tod Mijanovich
- Department of Applied Statistics, Social Science, and Humanities, NYU Steinhardt School of Culture, Education and Human Development, New York, New York, USA
| | - Kelly M Doran
- Department of Emergency Medicine, NYU School of Medicine, New York, New York, USA.,Department of Population Health, NYU School of Medicine, New York, New York, USA
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18
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Mericle AA, Mahoney E, Korcha R, Delucchi K, Polcin DL. Sober living house characteristics: A multilevel analyses of factors associated with improved outcomes. J Subst Abuse Treat 2019; 98:28-38. [PMID: 30665601 PMCID: PMC6605057 DOI: 10.1016/j.jsat.2018.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/06/2018] [Accepted: 12/13/2018] [Indexed: 12/14/2022]
Abstract
Safe and stable housing is integral to addiction recovery. Across numerous studies, recovery housing has been found to be associated with improvements in a variety of domains. Although procedures for operating some types of recovery housing have been manualized and national standards established, there are few empirical findings identifying which recovery residence characteristics may lead to improved outcomes. Using data from 330 newly admitted residents recruited from 49 sober living houses in California and re-contacted for 6- and 12-month follow-up interviews, this study examines the effects of organizational, operational, and programming characteristics on substance use, criminal justice, and employment outcomes. Results from multilevel analyses adjusting for resident demographics and length of stay indicate that organizational characteristics were associated with outcomes. Residents recruited from houses that were part of a larger organization or group of houses had increased odds of total abstinence (aOR = 3.98, p < 0.001) and drug abstinence (aOR = 3.19, p < 0.001). Residents recruited from houses that were affiliated with a treatment program had increased odds of employment (aOR = 2.92, p = 0.003). Operational characteristics such as where the house was located and whether the house required incoming residents to be sober for at least 30 days prior to entry were also related to improved outcomes, but additional work is needed to develop tools to assess and measure recovery housing characteristics and to better understand how these factors contribute to improved outcomes.
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Affiliation(s)
- Amy A Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA.
| | - Elizabeth Mahoney
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
| | - Rachael Korcha
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
| | - Kevin Delucchi
- University of California San Francisco, San Francisco, CA 94143, USA
| | - Douglas L Polcin
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
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19
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Substance use and homelessness among emergency department patients. Drug Alcohol Depend 2018; 188:328-333. [PMID: 29852450 PMCID: PMC6478031 DOI: 10.1016/j.drugalcdep.2018.04.021] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Homelessness and substance use often coexist, resulting in high morbidity. Emergency department (ED) patients have disproportionate rates of both homelessness and substance use, yet little research has examined the overlap of these issues in the ED setting. We aimed to characterize alcohol and drug use in a sample of homeless vs. non-homeless ED patients. METHODS A random sample of urban hospital ED patients were invited to complete an interview regarding housing, substance use, and other health and social factors. We compared substance use characteristics among patients who did vs. did not report current literal (streets/shelter) homelessness. Additional analyses were performed using a broader definition of homelessness in the past 12-months. RESULTS Patients who were currently homeless (n = 316, 13.7%) versus non-homeless (n = 1,993, 86.3%) had higher rates of past year unhealthy alcohol use (44.4% vs. 30.5%, p < .0001), any drug use (40.8% vs. 18.8%, p < .0001), heroin use (16.7% vs. 3.8%, p < .0001), prescription opioid use (12.5% vs. 4.4%, p < .0001), and lifetime opioid overdose (15.8% vs. 3.7%, p < .0001). In multivariable analyses, current homelessness remained significantly associated with unhealthy alcohol use, AUDIT scores among unhealthy alcohol users, any drug use, heroin use, and opioid overdose; past 12-month homelessness was additionally associated with DAST-10 scores among drug users and prescription opioid use. CONCLUSIONS Patients experiencing homelessness have higher rates and greater severity of alcohol and drug use than other ED patients across a range of measures. These findings have implications for planning services for patients with concurrent substance use and housing problems.
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20
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Reingle Gonzalez JM, Businelle MS, Kendzor D, Staton M, North CS, Swartz M. Using mHealth to Increase Treatment Utilization Among Recently Incarcerated Homeless Adults (Link2Care): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e151. [PMID: 29871852 PMCID: PMC6008513 DOI: 10.2196/resprot.9868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/23/2018] [Accepted: 04/10/2018] [Indexed: 11/13/2022] Open
Abstract
Background There is a significant revolving door of incarceration among homeless adults. Homeless adults who receive professional coordination of individualized care (ie, case management) during the period following their release from jail experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be reincarcerated. This is because case managers work to meet the various needs of their clients by helping them to overcome barriers to needed services (eg, food, clothing, housing, job training, substance abuse and mental health treatment, medical care, medication, social support, proof of identification, and legal aid). Many barriers (eg, limited transportation, inability to schedule appointments, and limited knowledge of available services) prevent homeless adults who were recently released from incarceration from obtaining available case management, crisis management, substance abuse, and mental health services. Objective The aim of the Link2Care study is to assess the effectiveness of a smartphone app for increasing case management and treatment service utilization, and in turn reduce homelessness and rearrest. The goals of this research are to (1) assess the impact of an innovative smartphone app that will prompt and directly link recently incarcerated homeless adults to community-based case management services and resources and (2) utilize in-person and smartphone-based assessments to identify key variables (eg, alcohol or drug use, social support, psychological distress, and quality of life) that predict continued homelessness and rearrest. Methods Homeless adults (N=432) who enroll in a shelter-based Homeless Recovery Program after release from the Dallas County Jail will be randomly assigned to one of the three treatment groups: (1) usual case management, (2) usual case management plus smartphone, and (3) usual case management with a study-provided smartphone that is preloaded with an innovative case management app (smartphone-based case management). Those assigned to smartphone-based case management will receive smartphones that prompt (twice weekly) connections to shelter-based case managers. The app will also offer direct links to case managers (available during normal business hours) and crisis interventionists (available 24 hours a day, 7 days a week) with the touch of a button. Results Recruitment began in the spring of 2018, and data collection will conclude in 2021. Conclusions This research represents an important step toward integrated service connection and health care service provision for one of the most underserved, high need, and understudied populations in the United States. Trial Registration ClinicalTrials.gov NCT03399500; https://clinicaltrials.gov/ct2/show/NCT03399500 (Archived by WebCite at http://www.webcitation.org/6zSJwdgUS) Registered Report Identifier RR1-10.2196/9868
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Affiliation(s)
- Jennifer M Reingle Gonzalez
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX, United States
| | - Michael S Businelle
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center and Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Darla Kendzor
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center and Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Michele Staton
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Carol S North
- Metrocare Services and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michael Swartz
- Department of Biostatistics, School of Public Health, University of Texas, Houston, TX, United States
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22
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Benjaminsen L, Birkelund JF. Explaining excess morbidity amongst homeless shelter users: A multivariate analysis for the Danish adult population. Scand J Public Health 2018. [PMID: 29528774 DOI: 10.1177/1403494818759839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims: This article analyses excess morbidity amongst homeless shelter users compared to the general Danish population. The study provides an extensive control for confounding and investigates to what extent excess morbidity is explained by homelessness or other risk factors. Methods: Data set includes administrative micro-data for 4,068,926 Danes who were 23 years or older on 1 January 2007. Nationwide data on shelter use identified 14,730 individuals as shelter users from 2002 to 2006. Somatic diseases were measured from 2007 to 2011 through diagnosis data from hospital discharges. The risk of somatic diseases amongst shelter users was analysed through a multivariate model that decomposed the total effect into a direct effect and indirect effects mediated by other risk factors. Results: The excess morbidity associated with shelter use is substantially lower than in studies that did not include an extensive control. Approximately 80% of excess morbidity amongst shelter users is attributed to other risk factors. A large part of the excess morbidity is explained by substance abuse problems and lack of employment, whilst mental illness, low income, low education, civil status and ethnic minority background explain only a limited part. However, when conducting an extensive control for confounding, a significantly higher morbidity was identified amongst shelter users for infectious diseases, lung, skin, blood and digestive diseases, injuries, and poisoning. Conclusions: Ill health amongst homeless shelter users is widely explained by substance abuse problems and other risk factors. Nonetheless, for many diseases homelessness poses an additional risk to the health.
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Affiliation(s)
- Lars Benjaminsen
- The Danish Center for Social Science Research, Copenhagen, Denmark
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23
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Smith-Bernardin S, Carrico A, Max W, Chapman S. Utilization of a Sobering Center for Acute Alcohol Intoxication. Acad Emerg Med 2017; 24:1060-1071. [PMID: 28493551 DOI: 10.1111/acem.13219] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective was to describe the population utilizing a sobering center for public alcohol intoxication and compare between single-visit users, repeat users, and high users. METHODS We conducted a secondary analysis of 1,271 adults cared for in a sobering center from July 2014 to June 2015. We divided the population into three groups-single use (one visit), repeat users (two to five visits), and high (six or more) users-and evaluated demographics, lifetime health diagnoses utilizing the Elixhauser Comorbidity Index, rates of public service utilization including ambulance and emergency department, and related costs. RESULTS The population was primarily male, middle-aged, and ethnically diverse. Compared to single-visit users (n = 869), repeat (n = 287) and high users (n = 115) were older, were more likely to be currently homeless, and had spent more time homeless. Repeat and high users had significantly higher rates of hypertension, liver disease, diabetes, depression, psychoses, and drug abuse diagnoses compared to single-visit users. In addition to sobering visits, utilization of ambulance and ED and related costs were significantly greater for the high users compared to repeat and single-visit users. CONCLUSIONS From an overall heterogeneous population, more frequent utilizers of the sobering center, both high and repeat users compared to low users, had significantly greater prevalence of chronic disorders, service utilization, and homelessness. Findings indicate that a sobering center can have a prominent role in the care for those with acute alcohol intoxication, particularly those individuals with chronic public intoxication who are likewise homeless. Further longitudinal research could offer important insights as to the population served over time, investigating changes in utilization and efforts toward health and housing stabilization.
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Affiliation(s)
- Shannon Smith-Bernardin
- School of Nursing; Department of Social & Behavioral Sciences; University of California at San Francisco; San Francisco CA
- The Alcohol Research Group; Emeryville CA
| | - Adam Carrico
- Department of Public Health Sciences; Division of Prevention Science & Community Health; University of Miami Health System; Miami FL
| | - Wendy Max
- The Institute for Health & Aging; University of California at San Francisco; San Francisco CA
| | - Susan Chapman
- School of Nursing; Department of Social & Behavioral Sciences; University of California at San Francisco; San Francisco CA
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Mericle AA, Polcin DL, Hemberg J, Miles J. Recovery Housing: Evolving Models to Address Resident Needs. J Psychoactive Drugs 2017; 49:352-361. [PMID: 28657823 DOI: 10.1080/02791072.2017.1342154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Recovery housing is a service delivery modality that simultaneously addresses the social support and housing needs of those in recovery from substance use disorders. This article describes a group of recovery homes in Texas (N = 10) representing a lesser-studied type of recovery housing, one which explicitly bridges treatment and peer support by providing a variety of recovery support services. All residents meet with a recovery coach, undergo regular drug screening, and have access to intensive outpatient treatment-a program that was developed specifically to support the needs of residents in the homes. Unlike the Oxford HouseTM model and California sober living houses, which are primarily financed through resident fees, these homes are supported through a mix of resident fees as well as private and public insurance. While adhering to some aspects of the social model of recovery, none of these homes would meet criteria to be considered a true social model program, largely because residents have a limited role in the governance of the homes. Residences like the ones in this study are not well-represented in the literature and more research is needed.
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Affiliation(s)
- Amy A Mericle
- a Research Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Douglas L Polcin
- b Senior Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Jordana Hemberg
- c Research Associate , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Jennifer Miles
- d Doctoral Candidate , The Heller School for Social Policy and Management, Brandeis University , Waltham , MA , USA
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Substance Abuse Treatment Patients in Housing Programs Respond to Contingency Management Interventions. J Subst Abuse Treat 2016; 72:97-102. [PMID: 27492676 DOI: 10.1016/j.jsat.2016.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/21/2016] [Accepted: 07/11/2016] [Indexed: 11/20/2022]
Abstract
Use of homeless and transitional housing (e.g., recovery homes) programs can be associated with success in substance abuse treatment, perhaps because many of these programs encourage or mandate sobriety. In this study, we examined whether contingency management (CM) protocols that use tangible incentives for submission of drug-free specimens or other specific behaviors are effective for treatment-seeking substance abusers whose behavior may also be shaped by housing programs. Of 355 participants in randomized trials of CM, 56 (16%) reported using transitional housing during the 12-week treatment period. Main and interaction effects of housing status and treatment condition were evaluated for the primary substance abuse treatment outcomes: a) longest duration of abstinence from alcohol, cocaine, and opioids, b) percentage of samples submitted that were negative for these substances, and c) treatment retention. After controlling for demographic and clinical characteristics, those who accessed housing programs submitted a higher percentage of negative samples (75%) compared to those who did not access housing programs (67%). Housing status groups did not differ in terms of longest duration of abstinence (accessed housing: M=3.1 weeks, SE=0.6; did not access housing: M=3.9 weeks, SE=0.3) or retention in substance abuse treatment (accessed housing: M=6.4 weeks, SE=0.6; did not access housing: M=6.6 weeks, SE=0.3). Regardless of housing status, CM was associated with longer durations of abstinence and treatment retention. No interactive effects of housing and treatment condition were observed (p>.05). Results suggest that those who accessed housing programs during substance abuse treatment benefit from CM to a comparable degree as their peers who did not use such programs. These effects suggest that CM remains appropriate for those accessing housing in community-based programs.
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Bedi G, Shiffrin L, Vadhan NP, Nunes EV, Foltin RW, Bisaga A. Effects of levodopa-carbidopa-entacapone and smoked cocaine on facial affect recognition in cocaine smokers. J Psychopharmacol 2016; 30:370-7. [PMID: 26921145 PMCID: PMC4794345 DOI: 10.1177/0269881115626308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In addition to difficulties in daily social functioning, regular cocaine users have decrements in social processing (the cognitive and affective processes underlying social behavior) relative to non-users. Little is known, however, about the effects of clinically-relevant pharmacological agents, such as cocaine and potential treatment medications, on social processing in cocaine users. Such drug effects could potentially alleviate or compound baseline social processing decrements in cocaine abusers. Here, we assessed the individual and combined effects of smoked cocaine and a potential treatment medication, levodopa-carbidopa-entacapone (LCE), on facial emotion recognition in cocaine smokers. Healthy non-treatment-seeking cocaine smokers (N = 14; two female) completed this 11-day inpatient within-subjects study. Participants received LCE (titrated to 400mg/100mg/200mg b.i.d.) for five days with the remaining time on placebo. The order of medication administration was counterbalanced. Facial emotion recognition was measured twice during target LCE dosing and twice on placebo: once without cocaine and once after repeated cocaine doses. LCE increased the response threshold for identification of facial fear, biasing responses away from fear identification. Cocaine had no effect on facial emotion recognition. Results highlight the possibility for candidate pharmacotherapies to have unintended impacts on social processing in cocaine users, potentially exacerbating already existing difficulties in this population.
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Affiliation(s)
- Gillinder Bedi
- Division on Substance Abuse, New York State Psychiatric Institute, and Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Laura Shiffrin
- Division on Substance Abuse, New York State Psychiatric Institute, and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Nehal P. Vadhan
- Department of Psychiatry, Stony Brook University School of Medicine
| | - Edward V. Nunes
- Division on Substance Abuse, New York State Psychiatric Institute, and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Richard W. Foltin
- Division on Substance Abuse, New York State Psychiatric Institute, and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
| | - Adam Bisaga
- Division on Substance Abuse, New York State Psychiatric Institute, and Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY
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Abstract
Housing options for people exiting homelessness and seeking recovery from substance use disorders are limited. Policies tend to favor low-demand models such as housing first and permanent supportive housing that do not require abstinence, but offer immediate housing placement based on consumer choice and separate housing from clinical services. While these models have proven effective in promoting housing retention, especially among individuals with a primary diagnosis of mental illness, evidence to support positive outcomes related to people with a primary or co-occurring substance use disorder are mixed. Recovery housing models provide abstinence-focused environments and integrated peer support embedded within a recovery framework. Various models exist along a continuum from fully peer-run to clinically staffed residences. However, this continuum is typically separate from the homeless services system, and many barriers to integration persist. Recent national dialogues have begun to explore opportunities to integrate housing and substance use recovery approaches to meet the needs of people who need both types of support. This perspective paper argues that recovery housing is essential for supporting some homeless individuals and families. Within a comprehensive continuum based on choice, both recovery housing and low-demand models can support housing retention, reduce homelessness, promote recovery, and foster self-determination.
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28
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Mericle AA, Grella CE. Integrating Housing and Recovery Support Services: Introduction to the Special Section. J Dual Diagn 2016; 12:150-2. [PMID: 27070498 PMCID: PMC5001463 DOI: 10.1080/15504263.2016.1176408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Amy A Mericle
- a Alcohol Research Group at the Public Health Institute , Emeryville , California , USA
| | - Christine E Grella
- b Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at the University of California , Los Angeles , California , USA
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Mericle AA, Miles J, Way F. Recovery Residences and Providing Safe and Supportive Housing for Individuals Overcoming Addiction. JOURNAL OF DRUG ISSUES 2015. [DOI: 10.1177/0022042615602924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recovery residences provide safe and supportive housing to help individuals initiate and sustain recovery from substance abuse. They are a potentially important yet understudied component of the substance abuse continuum of care. Unlike other substance abuse treatment and service delivery options, recovery residences are largely privately owned and funded by the residents themselves, and we know little about how these residences open and the factors that influence their ability to stay open. Using qualitative data from interviews with recovery home operators ( N = 21) in Philadelphia, this article explores what recovery home operators want to accomplish with their homes, how they try to do this, the obstacles they encounter in trying to run their homes, and why they keep at it. Themes highlight the potential of recovery residences as well as the challenges faced by those who operate them.
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Affiliation(s)
- Amy A. Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, CA, USA
| | | | - Fred Way
- Pennsylvania Association of Recovery Residences, Philadelphia, PA, USA
- National Alliance for Recovery Residences, St. Paul, MN, USA
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Krupski A, Graves MC, Bumgardner K, Roy-Byrne P. Comparison of Homeless and Non-Homeless Problem Drug Users Recruited from Primary Care Safety-Net Clinics. J Subst Abuse Treat 2015; 58:84-9. [PMID: 26153073 DOI: 10.1016/j.jsat.2015.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/01/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The present study of homeless non-treatment-seeking problem drug users was designed to complement and extend previous studies which focused exclusively on treatment-seeking homeless problem drug users. METHOD Data were available for 866 primary care patients with drug problems, 30% homeless and 70% housed. RESULTS In the 2 years prior to baseline, homeless participants had less chronic medical co-morbidity than problem drug users who were housed yet were significantly more likely to have used emergency department services, to have used them more frequently, and at higher cost. Compared to their housed counterparts, homeless participants were also more likely to have been admitted to specialized chemical dependency treatment and/or detoxification services, to have been arrested for a felony or gross misdemeanor, and to report having psychiatric problems in the prior 30 days. CONCLUSIONS Additional support may be necessary for homeless patients presenting in primary care to benefit from substance abuse treatment given their more severe drug use problems coupled with their co-morbid health, psychiatric, and psychosocial problems.
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Affiliation(s)
- Antoinette Krupski
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA.
| | - Meredith C Graves
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA; Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Kristin Bumgardner
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA
| | - Peter Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA
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Tsai J, Rosenheck RA. VA Disability Compensation and Money Spent on Substance Use Among Homeless Veterans: A Controversial Association. Psychiatr Serv 2015; 66:641-4. [PMID: 25726979 PMCID: PMC4518553 DOI: 10.1176/appi.ps.201400245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There has long been concern that public support payments are used to support addictive behaviors. This study examined the amount of money homeless veterans spend on alcohol and drugs and the association between public support income, including VA disability compensation, and expenditures on alcohol and drugs. METHODS Data were from 1,160 veterans from 19 sites on entry into the Housing and Urban Development-Veterans Affairs Supportive Housing program. Descriptive statistics and nonparametric analyses were conducted. RESULTS About 33% of veterans reported spending money on alcohol and 22% reported spending money on drugs in the past month. No significant association was found between public support income, VA disability compensation, and money spent on alcohol and drugs. CONCLUSIONS A substantial proportion of homeless veterans spend some income on alcohol and drugs, but disability income, including VA compensation, does not seem to be related to substance use or money spent on addictive substances.
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Affiliation(s)
- Jack Tsai
- The authors are with the Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, and with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: )
| | - Robert A Rosenheck
- The authors are with the Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven, and with the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (e-mail: )
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Collins SE, Duncan MH, Smart BF, Saxon AJ, Malone DK, Jackson TR, Ries RK. Extended-Release Naltrexone and Harm Reduction Counseling for Chronically Homeless People With Alcohol Dependence. Subst Abus 2015; 36:21-33. [DOI: 10.1080/08897077.2014.904838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gicas KM, Vila-Rodriguez F, Paquet K, Barr AM, Procyshyn RM, Lang DJ, Smith GN, Baitz HA, Giesbrecht CJ, Montaner JS, Krajden M, Krausz M, MacEwan GW, Panenka WJ, Honer WG, Thornton AE. Neurocognitive profiles of marginally housed persons with comorbid substance dependence, viral infection, and psychiatric illness. J Clin Exp Neuropsychol 2014; 36:1009-22. [DOI: 10.1080/13803395.2014.963519] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mackelprang JL, Collins SE, Clifasefi SL. Housing First is associated with reduced use of emergency medical services. PREHOSP EMERG CARE 2014; 18:476-82. [PMID: 24878364 PMCID: PMC5102506 DOI: 10.3109/10903127.2014.916020] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Chronically homeless adults with severe alcohol problems are disproportionately burdened with health-care problems and are high utilizers of emergency medical services (EMS). Single-site Housing First (HF), which provides immediate, permanent, low-barrier, nonabstinence-based, supportive housing, has been associated with reduced publicly funded service utilization. The aims of the current study were to determine whether time spent in single-site HF predicted decreases in EMS contacts 2 years subsequent to single-site HF move-in, and to describe medical conditions and injuries associated with EMS contacts in a sample of chronically homeless individuals with severe alcohol problems. METHODS Participants were 91 chronically homeless adults with severe alcohol problems who were enrolled in a single-site HF program between December 2005 and March 2007 in Seattle, Washington. We obtained administrative data on exposure to HF and EMS utilization for the 2 years prior to and the 2 years subsequent to participants' move-in date. EMS utilization variables included patient type (i.e., primary presenting problem), trauma/injury mechanism (i.e., EMS classification of the cause of the trauma or injury), level of care (i.e., basic life support, advanced life support), and transport destination. RESULTS After controlling for baseline EMS contacts, participants evinced 3% fewer EMS contacts for each additional month of single-site HF exposure. From the baseline to follow-up period, the mean number of EMS contacts declined from 15.85 (SD = 22.96) to 9.54 (SD = 15.08), representing a 54% reduction in the number of EMS contacts. Most calls were responded to by EMTs providing basic life support, and the majority resulted in transport to a local level I trauma center. The most common presenting difficulties were medical illness and trauma. Substance use and psychiatric difficulties were infrequently documented as the primary problem. CONCLUSIONS Our findings support recent assertions that housing is health care and indicate that the amount of time spent in single-site HF is associated with significant reductions in EMS utilization for at least 2 years subsequent to move-in. These findings also underscore the high levels of medical illness and trauma exposure among chronically homeless adults with severe alcohol problems.
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Thompson RG, Wall MM, Greenstein E, Grant BF, Hasin DS. Substance-use disorders and poverty as prospective predictors of first-time homelessness in the United States. Am J Public Health 2013; 103 Suppl 2:S282-8. [PMID: 24148043 DOI: 10.2105/ajph.2013.301302] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether substance-use disorders and poverty predicted first-time homelessness over 3 years. METHODS We analyzed longitudinal data from waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions to determine the main and interactive effects of wave 1 substance use disorders and poverty on first-time homelessness by wave 2, among those who were never homeless at wave 1 (n = 30,558). First-time homelessness was defined as having no regular place to live or having to live with others for 1 month or more as a result of having no place of one's own since wave 1. RESULTS Alcohol-use disorders (adjusted odds ratio [AOR] = 1.34), drug-use disorders (AOR = 2.51), and poverty (AOR = 1.34) independently increased prospective risk for first-time homelessness, after adjustment for ecological variables. Substance-use disorders and poverty interacted to differentially influence risk for first-time homelessness (P < .05), before, but not after, adjustment for controls. CONCLUSIONS This study reinforces the importance of both substance-use disorders and poverty in the risk for first-time homelessness, and can serve as a benchmark for future studies. Substance abuse treatment should address financial status and risk of future homelessness.
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Affiliation(s)
- Ronald G Thompson
- Ronald G. Thompson Jr, Melanie M. Wall, and Deborah S. Hasin are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY. Melanie M. Wall, Eliana Greenstein, and Deborah S. Hasin are with the New York State Psychiatric Institute, New York. Bridget F. Grant is with the Laboratory of Epidemiology and Biometry, Division of Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
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Ibabe I, Stein JA, Nyamathi A, Bentler PM. Predictors of substance abuse treatment participation among homeless adults. J Subst Abuse Treat 2013; 46:374-81. [PMID: 24238716 DOI: 10.1016/j.jsat.2013.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 09/11/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
The current study focuses on the relationships among a trauma history, a substance use history, chronic homelessness, and the mediating role of recent emotional distress in predicting drug treatment participation among adult homeless people. We explored the predictors of participation in substance abuse treatment because enrolling and retaining clients in substance abuse treatment programs is always a challenge particularly among homeless people. Participants were 853 homeless adults from Los Angeles, California. Using structural equation models, findings indicated that trauma history, substance use history and chronicity of homelessness were associated, and were significant predictors of greater recent emotional distress. The most notable result was that recent emotional distress predicted less participation in current substance abuse treatment (both formal and self-help) whereas a substance use history alone predicted significantly more participation in treatment. Implications concerning treatment engagement and difficulties in obtaining appropriate dual-diagnosis services for homeless mentally distressed individuals are discussed.
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Affiliation(s)
- Izaskun Ibabe
- Department of Social Psychology and Behavior Sciences Methodology, University College of Psychology, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Avda. Tolosa 70, 20018 Donostia-San Sebastián, Spain.
| | - Judith A Stein
- Department of Psychology, 3566 Franz Hall, University of California, Los Angeles, CA 90095-1563, USA.
| | - Adeline Nyamathi
- School of Nursing, Room 2-250, Factor Building, University of California, Los Angeles, CA 90095-1702, USA.
| | - Peter M Bentler
- Department of Psychology, Franz Hall, Box 951563, University of California, Los Angeles, CA 90095-1563, USA.
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Levola J, Kaskela T, Holopainen A, Sabariego C, Tourunen J, Cieza A, Pitkänen T. Psychosocial difficulties in alcohol dependence: a systematic review of activity limitations and participation restrictions. Disabil Rehabil 2013; 36:1227-39. [DOI: 10.3109/09638288.2013.837104] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lo CC, Cheng TC. American Youths' Access to Substance Abuse Treatment: Does Type of Treatment Facility Matter? JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2013. [DOI: 10.1080/1067828x.2012.733582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Celia C. Lo
- a University of Alabama , Tuscaloosa , AL , USA
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Collins SE, Malone DK, Larimer ME. Motivation to change and treatment attendance as predictors of alcohol-use outcomes among project-based Housing First residents. Addict Behav 2012; 37:931-9. [PMID: 22513197 PMCID: PMC3358454 DOI: 10.1016/j.addbeh.2012.03.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 03/13/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
Collins et al. (2012) indicated that time spent in a project-based Housing First (HF) intervention was associated with improved two-year alcohol-use trajectories among chronically homeless individuals with alcohol problems. To explore potential correlates of these findings, we tested the relative prediction of alcohol-use outcomes by motivation to change (MTC) and substance abuse treatment attendance. Participants (N=95) were chronically homeless individuals with alcohol problems receiving a project-based HF intervention in the context of a larger nonrandomized controlled trial (Larimer et al., 2009). Participants were interviewed regularly over the two-year follow-up. Treatment attendance and MTC were measured using items from the Addiction Severity Index and the SOCRATES, respectively. Alcohol-use outcomes included alcohol quantity, problems and dependence. Generalized estimating equation modeling indicated that MTC variables and not treatment attendance consistently predicted alcohol-use outcomes over the two-year follow-up. Findings suggest that the importance of motivation to change may outweigh treatment attendance in supporting alcohol behavior change in this population.
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Affiliation(s)
- Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, 325 9th Ave., Seattle, WA 98104, USA.
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Maguire M, Sheahan TM, White WL. Innovations in Recovery Management for People Experiencing Prolonged Homelessness in the City of Philadelphia: “I wanted a new beginning”. ALCOHOLISM TREATMENT QUARTERLY 2012. [DOI: 10.1080/07347324.2012.635548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Psychosocial and behavioral correlates of anxiety symptoms in a sample of HIV-positive, methamphetamine-using men who have sex with men. AIDS Care 2011; 23:628-37. [PMID: 21293993 DOI: 10.1080/09540121.2010.525608] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Studies show high rates of psychiatric symptoms among methamphetamine users; however, little information exists regarding methamphetamine use and anxiety. This study investigated psychosocial and behavioral correlates of anxiety symptoms in a sample of 245 HIV-positive men having sex with men (MSM) who were enrolled in a sexual risk-reduction intervention. In a multiple regression analysis, anxiety symptoms were associated with homelessness, recent experience of HIV symptoms, injection drug use, lifetime sexual abuse, engaging in risky sexual behaviors, and seeking out partners at risky sexual venues when "high" on methamphetamine. These findings can be used to inform and refine sexual risk-reduction interventions and substance-use treatment programs for HIV-positive methamphetamine-using MSM.
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Abstract
Unstable housing is related to a range of health problems including substance abuse, poor mental health, and HIV. Little is known about how sexual partners' attributes influence access to resources such as housing. The purpose of the present study was to examine the relationship between sexual network characteristics and improvements in housing situation among a sample of drug users using a longitudinal design. Size of one's sex network was not associated with housing change. However, having a main partner and having a sex partner who lent money was associated with moving from a homeless state at baseline to being housed at follow-up. Also, having a sex partner who was a drug user was associated with decrease in the odds of improving one's housing situation.
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Affiliation(s)
- Melissa A Davey-Rothwell
- Department of Health, Behavior and Society, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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North CS, Eyrich-Garg KM, Pollio DE, Thirthalli J. A prospective study of substance use and housing stability in a homeless population. Soc Psychiatry Psychiatr Epidemiol 2010; 45:1055-62. [PMID: 19816646 DOI: 10.1007/s00127-009-0144-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 09/22/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study examined self-report and urine test data about homeless substance use over time, prospectively comparing substance use with attainment of stable housing. METHODS 400 homeless people systematically sampled from shelters and streets in St. Louis, Missouri were assessed with structured diagnostic interviews and urine substance testing annually over 2 years. Nearly two-thirds (n = 255) completed all three assessments, constituting the sample for this prospective study. RESULTS More than half (55%) of this homeless sample had detectable cocaine use during the study. Most cocaine users continued using during the next 2 years and failed to achieve and maintain stable housing. Cocaine use in the first follow-up year predicted housing patterns over the next 2 years, independent of lifetime diagnosis of cocaine use disorder. Alcohol abuse/dependence in the 2-year follow-up period did not predict housing outcomes. CONCLUSIONS The course of cocaine use and abuse/dependence, but not continuing alcohol addiction, was associated with subsequent attainment of stable housing, especially cocaine use in the first prospective year. Replication of these findings in other locations to determine generalizability may have implications for designing housing service models.
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Affiliation(s)
- Carol S North
- VA North Texas Health Care System, 4500 S. Lancaster Rd., Dallas, TX 75216, USA.
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Keaney F, Gossop M, Dimech A, Guerrini I, Butterworth M, Al-Hassani H, Morinan A. Physical health problems among patients seeking treatment for substance use disorders: A comparison of drug dependent and alcohol dependent patients. JOURNAL OF SUBSTANCE USE 2010. [DOI: 10.3109/14659890903580474] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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