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Xu KY, Gold JA, Szlyk HS, Rolin SA, Shields MC. Mental Illness and Violence Among People Experiencing Homelessness: An Evidence-Based Review. MISSOURI MEDICINE 2024; 121:14-20. [PMID: 38404439 PMCID: PMC10887459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Kevin Y Xu
- Health and Behavior Research Center, Division of Addiction Science, Prevention, and Treatment, Washington University, and in the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Hannah S Szlyk
- Health and Behavior Research Center, Division of Addiction Science, Prevention, and Treatment, Washington University, and in the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Stephanie A Rolin
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Browne FA, Gichane MW, Shangase N, Ndirangu J, Bonner CP, Wechsberg WM. Social Determinants of Alcohol and Other Drug Misuse Among Women Living with HIV in Economically Underserved Communities in Cape Town, South Africa: A Cross-Sectional Study. AIDS Behav 2023; 27:1329-1338. [PMID: 36344731 PMCID: PMC9640812 DOI: 10.1007/s10461-022-03869-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to understand how social determinants-the economic and social factors that affect health and well-being-are associated with self-reported and biological alcohol and other drug misuse in South Africa among women living with HIV. Logistic regression analyses were performed using baseline data from an implementation science trial conducted from 2015 to 2018 with 480 Black and Coloured women who were living with HIV and reported recent alcohol or other drug misuse. Educational attainment, type of housing, access to running water, food insecurity, and housing instability were examined. Women with higher education had reduced odds of any drug misuse-both biological (aOR: 0.53; 95% CI: 0.33-0.84) and self-reported (aOR: 0.37; 95% CI: 0.22-0.64). Women living in formal housing had increased odds of a positive alcohol screening test (aOR: 1.92; 95% CI: 1.16-3.18) and women with housing instability had increased odds of self-reported alcohol misuse-daily (aOR: 1.99; 95% CI: 1.18-3.35) and weekly (aOR:1.91; 95% CI: 1.19-3.07). Food insecurity was associated with reduced odds of self-reported alcohol misuse (aOR: 0.40; 95% CI: 0.25-0.64) and increased odds of self-reported drug misuse (aOR: 2.05; 95% CI: 1.16-3.61). These findings indicate the complexity of the relationship between social determinants and alcohol and other drug misuse, and may have implications for addressing social and structural determinants as part of multilevel interventions focused on reducing alcohol and other drug misuse among key populations of women in South Africa.
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Affiliation(s)
- Felicia A Browne
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA.
- Health Behavior, University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
| | - Margaret W Gichane
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, Advancing New Standards in Reproductive Health, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA 94612, USA
| | - Nosipho Shangase
- Epidemiology, University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Jacqueline Ndirangu
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA
| | - Courtney Peasant Bonner
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA
- Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Wendee M Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA
- Maternal and Child Health, University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC 27599, USA
- Department of Psychology, North Carolina State University, 640 Poe Hall, Campus Box 7650, Raleigh, NC 27695, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710, USA
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Motta-Ochoa R, Incio-Serra N, Brulotte A, Flores-Aranda J. Motives for alcohol use, risky drinking patterns and harm reduction practices among people who experience homelessness and alcohol dependence in Montreal. Harm Reduct J 2023; 20:22. [PMID: 36829166 PMCID: PMC9955533 DOI: 10.1186/s12954-023-00757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 02/15/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND People experiencing homelessness are disproportionately affected by harms related to alcohol use. Indeed, their alcohol dependence is associated with numerous physical and mental health problems along with strikingly high rates of alcohol-related mortality. Recent research has extensively examined alcohol use patterns among people experiencing homelessness in an effort to develop interventions and treatments for this problem. However, only a few studies have incorporated the perspectives of the individuals under study about their drinking or examined the ways in which they manage the associated harms. To bridge this gap, we conducted a qualitative study exploring the relation between the drinking motives, risky drinking patterns and harm reduction practices of a group of people (n = 34) experiencing homelessness in Montreal, Canada. METHODS The qualitative methods we used consisted of semi-structured interviews (n = 12) and focus groups (n = 2, with a total of 22 participants). The content of the collected data was then analyzed. RESULTS Participants identified their various motives for alcohol use (coping with painful memories, dealing with harsh living conditions, socializing/seeking a sense of belonging, enjoying themselves/having fun); their risky drinking patterns (binge drinking, mixing alcohol with drugs, non-beverage alcohol drinking, failing to keep sufficient alcohol on hand to prevent acute withdrawal, drinking in public settings); their harm reduction practices (planning how much to drink, keeping a supply of alcohol to prevent acute withdrawal, hiding to drink, concealing alcohol, drinking alone, drinking/hanging out with others, drinking non-beverage alcohol, and taking benzodiazepines, cocaine or other stimulant drugs); and the rationales underpinning their alcohol use and harm reduction practices. CONCLUSION Associating the drinking motives of a group of study participants with their risky drinking patterns and harm reduction practices shed light on their rationales for alcohol use, yielding insights that could be used to better tailor policies and interventions to their needs.
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Affiliation(s)
- Rossio Motta-Ochoa
- grid.38678.320000 0001 2181 0211École de travail social, Université du Québec à Montréal, 455 René-Lévesque Blvd. Est Local W-4020, Montreal, QC H2L 4Y2 Canada ,grid.14848.310000 0001 2292 3357École de travail social, Université de Montréal, Pavillon Lionel-Groulx, 3150 Jean-Brillant Street (C-7075), Montreal, QC H3T 1J7 Canada ,Canada Research Chair in Sexually and Gender Diverse Individuals (SGD) and Their Psychoactive Substance Use Trajectories (TRADIS Chair), Montreal, Canada
| | - Natalia Incio-Serra
- grid.14709.3b0000 0004 1936 8649Faculty of Education, McGill University, 3700 McTavish Street, Montreal, QC H3A 1Y2 Canada
| | - Alexandre Brulotte
- grid.38678.320000 0001 2181 0211École de travail social, Université du Québec à Montréal, 455 René-Lévesque Blvd. Est Local W-4020, Montreal, QC H2L 4Y2 Canada ,Canada Research Chair in Sexually and Gender Diverse Individuals (SGD) and Their Psychoactive Substance Use Trajectories (TRADIS Chair), Montreal, Canada
| | - Jorge Flores-Aranda
- École de travail social, Université du Québec à Montréal, 455 René-Lévesque Blvd. Est Local W-4020, Montreal, QC, H2L 4Y2, Canada. .,Canada Research Chair in Sexually and Gender Diverse Individuals (SGD) and Their Psychoactive Substance Use Trajectories (TRADIS Chair), Montreal, Canada.
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Taylor KM, Mackelprang JL, Meyer D, Flatau P, Thielking M. Substance use and posttraumatic stress disorder: 12-month outcomes among adults experiencing chronic homelessness in Australia. Drug Alcohol Rev 2023; 42:439-449. [PMID: 36377202 PMCID: PMC10100311 DOI: 10.1111/dar.13565] [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] [Received: 12/04/2021] [Revised: 06/26/2022] [Accepted: 10/01/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Substance use disorder and posttraumatic stress disorder (PTSD) are highly prevalent among individuals who experience homelessness. However, evaluations of interventions that combine housing and mental health services have reported inconsistent mental health and substance use outcomes when compared to usual services. We investigated 12-month change in substance use severity and PTSD symptom severity among adults experiencing chronic homelessness and tested whether observed differences were associated with housing, support from mental health services or the Journey to Social Inclusion (J2SI) program. METHODS A randomised controlled trial compared the J2SI program with standard service provision (N = 135). Secondary analyses compared those who obtained housing or received mental health services with those who did not. Primary outcomes were alcohol and illicit substance use severity (alcohol, smoking and substance involvement screening test) and PTSD symptom severity (six-item PTSD checklist). RESULTS There was significant improvement at 12 months in alcohol use severity, illicit substance use severity and PTSD symptoms in the overall sample. Having seen a mental health professional in the previous 12 months was associated with a significant reduction in alcohol and illicit substance use severity but was not associated with changes in PTSD symptom severity. Being housed at 12 months was associated with significantly higher alcohol use severity. DISCUSSION AND CONCLUSIONS Findings highlight the importance of access to mental health care for people with a history of chronic homelessness. Research is needed to develop and test therapeutic and housing approaches to reduce PTSD symptom severity among people with experience of homelessness.
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Affiliation(s)
- Kathryn M. Taylor
- Department of Psychological Sciences, School of Health SciencesSwinburne University of TechnologyMelbourneAustralia
| | - Jessica L. Mackelprang
- Department of Psychological Sciences, School of Health SciencesSwinburne University of TechnologyMelbourneAustralia
| | - Denny Meyer
- Department of Health Sciences and Biostatistics, School of Health SciencesSwinburne University of TechnologyMelbourneAustralia
| | - Paul Flatau
- Centre for Social ImpactThe University of Western AustraliaPerthAustralia
| | - Monica Thielking
- Department of Psychological Sciences, School of Health SciencesSwinburne University of TechnologyMelbourneAustralia
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MacKinnon L, Kerman N, Socías ME, Brar R, Bardwell G. Primary care embedded within permanent supportive housing for people who use substances: A qualitative study examining healthcare access in Vancouver, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5062-e5073. [PMID: 35852403 PMCID: PMC9970158 DOI: 10.1111/hsc.13921] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/09/2022] [Accepted: 07/08/2022] [Indexed: 05/11/2023]
Abstract
Marginally housed people who use drugs and alcohol (PWUD/A) face barriers in accessing healthcare services, which may be improved by providing healthcare in housing settings. This case study examines the experiences of healthcare access amongst PWUD/A who live in a permanent supportive housing model in Vancouver, Canada. This model has an embedded multidisciplinary clinic providing in-reach services. Thirty participants were recruited via posters placed throughout the building and semi-structured qualitative interviews were conducted remotely. Interviews were conducted with participants who accessed onsite care regularly (n = 15) and those who do not (n = 15). Data were analysed to identify both a priori and emerging themes. Participants who accessed the onsite clinic reported benefiting from stigma-free care. Close proximity and convenience of drop-in appointments enabled participants to engage with healthcare services more consistently, though hours of operation and privacy concerns were barriers for others. Participants who did not use the onsite clinic highlighted the importance of continuity of care with their pre-existing primary care team, particularly if their clinic was in close geographic proximity. However, they also described utilising these services for urgent health needs or as an occasional alternative source of care. Shared perspectives across all participants emphasised the importance of low-barrier services, including medication delivery, convenience and positive therapeutic relationships. Our findings suggest that embedding access to primary care within supportive housing benefits PWUD/A who have previously encountered barriers to healthcare access. This model could be implemented to prevent utilisation of acute healthcare resources and improve health outcomes amongst PWUD/A.
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Affiliation(s)
- Laura MacKinnon
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - M. Eugenia Socías
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Rupinder Brar
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Fletcher OV, Chen JA, van Draanen J, Frost MC, Rubinsky AD, Blosnich JR, Williams EC. Prevalence of social and economic stressors among transgender veterans with alcohol and other drug use disorders. SSM Popul Health 2022; 19:101153. [PMID: 35813187 PMCID: PMC9260617 DOI: 10.1016/j.ssmph.2022.101153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/21/2022] Open
Abstract
Transgender persons have high rates of alcohol and other drug use disorders (AUD and DUD, respectively) and commonly experience social and economic stressors that may compound risk for adverse substance-related outcomes. National VA electronic health record data were extracted for all outpatients in each facility with documented alcohol screening 10/1/09-7/31/17. We describe the prevalence of eight individual-level social and economic stressors (barriers to accessing care, economic hardship, housing instability, homelessness, social and family problems, legal problems, military sexual trauma, and other victimization) among transgender patients with and without AUD and DUD (alone and in combination), overall and compared to cisgender patients in a national sample of VA outpatients. Among 8,872,793 patients, 8619 (0.1%) were transgender; the prevalence of AUD, DUD, and both was 8.6%, 7.2%, and 3.1% among transgender patients and 6.1%, 3.9%, and 1.7% among cisgender patients, respectively. Among all patients, prevalence of stressors was higher among those with AUD, DUD, or both, relative to those with neither. Within each of these groups, prevalence was 2-3 times higher among transgender compared to cisgender patients. For instance, prevalence of housing instability for transgender vs. cisgender patients with AUD, DUD, and both was: 40.8% vs 24.1%, 45.8% vs. 36.6%, and 57.4% vs. 47.0%, respectively. (all p-values <0.001). Social and economic stressors were prevalent among patients with AUD, DUD, or both, and the experience of these disorders and social and economic stressors was more common among transgender than cisgender patients in all groups. Further research regarding experiences of transgender persons and influences of stressors on risk of AUD and DUD, substance-related outcomes, and treatment uptake are needed. Routine screening for social and economic stressors among patients with substance use disorders (SUDs) could improve equitable substance-related care and outcomes. Treatment of SUDs among all persons should consider social and economic risk factors.
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Affiliation(s)
- Olivia V. Fletcher
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S Columbia Way, Seattle, WA, 98108, USA
| | - Jessica A. Chen
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S Columbia Way, Seattle, WA, 98108, USA
- Department of Psychiatry and Behavioral Science, University of Washington, 1959 NE Pacific St, Box 356560, Seattle, WA, 98195, USA
| | - Jenna van Draanen
- Department of Health Systems and Population Health, University of Washington School of Public Health, 3980 15th Ave NE, Box 351621, Seattle, WA, 98195, USA
- Department of Child, Family, and Population Health Nursing, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Madeline C. Frost
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S Columbia Way, Seattle, WA, 98108, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, 3980 15th Ave NE, Box 351621, Seattle, WA, 98195, USA
| | - Anna D. Rubinsky
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S Columbia Way, Seattle, WA, 98108, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, USA
| | - John R. Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34th St, Los Angeles, CA, 90089, USA
- Health Services Research & Development (HSR&D) Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA, 15240, USA
| | - Emily C. Williams
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S Columbia Way, Seattle, WA, 98108, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, 3980 15th Ave NE, Box 351621, Seattle, WA, 98195, USA
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Subedi K, Ghimire S. Comorbidity profiles of patients experiencing homelessness: A latent class analysis. PLoS One 2022; 17:e0268841. [PMID: 35609060 PMCID: PMC9128947 DOI: 10.1371/journal.pone.0268841] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 05/09/2022] [Indexed: 11/27/2022] Open
Abstract
Individuals experiencing homelessness are known to have increased rates of healthcare utilization when compared to the average patient population, often attributed to their complex health care needs and under or untreated comorbid conditions. With increasing focus on hospital readmissions among acute care settings, a better understanding of these comorbidity patterns and their impacts on acute care utilization could help improve quality of care. This study aims to identify distinct comorbidity profiles of homeless patients, and to explore the correlates of the identified comorbidity profiles and their impact on hospital readmission. This is a retrospective analysis using electronic health records (EHR) of patients experiencing homelessness encountered in the hospitals of ChristianaCare from 2015 to 2019 (N = 3445). Latent class analysis (LCA) was used to identify the comorbidity profiles of homeless patients. The mean age of the study population was 44-year, and the majority were male (63%). The most prevalent comorbid conditions were tobacco use (77%), followed by depression (58%), drug use disorder (56%), anxiety disorder (50%), hypertension (44%), and alcohol use disorder (43%). The LCA model identified 4 comorbidity classes-"relatively healthy" class with 31% of the patients, "medically-comorbid with SUD" class with 15% of the patients, "substance use disorder (SUD)" class with 39%, and "Medically comorbid" class with 15% of the patients. The Kaplan-Meir curves of probability of readmission against time from the index visits were significantly different for the four classes (p<0.001). The multivariable Cox proportional hazard model adjusted for age, sex, race, ethnicity, and insurance type showed that the hazard for readmission among patients in medically comorbid with SUD class is 3.16 (CI: 2.72, 3.67) times higher than the patients in the relatively healthy class.
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Affiliation(s)
- Keshab Subedi
- Institute for Research on Equity and Community Health, ChristianaCare Health Systems, Wilmington, Delaware, United States of America
| | - Shweta Ghimire
- Center for Bioinformatics and Computational Biology, University of Delaware, Newark, Delaware, United States of America
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Motta-Ochoa R, Incio-Serra N, Poliquin H, MacDonald SA, Huỳnh C, Côté PB, Fallu JS, Flores-Aranda J. "A place to be safe, feel at home and get better": including the experiential knowledge of potential users in the design of the first wet service in Montreal, Canada. Harm Reduct J 2022; 19:34. [PMID: 35382814 PMCID: PMC8985343 DOI: 10.1186/s12954-022-00616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background The harmful use of alcohol is one of the leading health risk factors for people’s health worldwide, but some populations, like people who experience homelessness, are more vulnerable to its detrimental effects. In the past decades, harm reduction interventions that target these complex issues has been developed. For example, wet services include a wide range of arrangements (wet shelters, drop-in centers, transitory housing, etc.) that allow indoor alcohol use and Managed Alcohol Programs provide regulated doses of alcohol in addition to accommodation and services. Although the positive impacts of these interventions have been reported, little is known about how to integrate the knowledge of people experiencing homelessness and alcohol dependence into the design of such programs. The aim of this study is to present the findings of such an attempt in a first wet service in Montreal, Canada.
Methods Community based participatory research approach and qualitative methods—including semi-structured interviews and focus groups—were used to collect the knowledge of potential users (n = 34) of the wet service. The data collected was thematically analyzed. Results Participants reported experiencing harsh living conditions, poverty, stigmatization and police harassment, which increased their alcohol use. The intersection between participants’ alcohol dependence and homelessness with the high barriers to access public services translated into their exclusion from several of such services. Participants envisioned Montreal’s wet service as a safe space to drink, a place that would provide multiple services, a home, and a site of recovery. Conclusions Integrating the knowledge of potential users into the design of harm reduction interventions is essential to develop better and more adapted services to meet complex needs. We propose that it could fosters users’ engagement and contribute to their sense of empower, which is crucial for a group that is typically discriminated against and suffers from marginalization.
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Affiliation(s)
- Rossio Motta-Ochoa
- École de travail social, Université du Québec à Montréal, 455, boul. René-Lévesque Est Local W-4020, Montreal, Québec, H2L 4Y2, Canada
| | - Natalia Incio-Serra
- Faculty of Education, McGill University, 3700 McTavish Street, Montreal, Québec, H3A 1Y2, Canada
| | - Hélène Poliquin
- National Collaborating Center for Healthy Public Policies at Institut national de santé publique du Québec, 190 Boul Crémazie E, Montreal, Québec, H2P 1E2, Canada
| | - Sue-Ann MacDonald
- École de travail social, Université de Montréal. Pavillon Lionel-Groulx, 3150, Jean-Brillant (C- 7069), Montreal, Québec, H3T 1J7, Canada
| | - Christophe Huỳnh
- École de psychoéducation, Université de Montréal. Pavillon Marie-Victorin, 90, av. Vincent- d'Indy, Montreal, Québec, H2V 2S9, Canada.,Département de psychiatrie et d'addictologie, Pavillon Roger-Gaudry, 2900, boul. Édouard- Montpetit, bureau S-750, Montreal, Québec, H3T 1J4, Canada.,Institut universitaire sur les dépendances, 950 rue de Louvain Est, Montreal, Québec, H2M 2E8, Canada
| | - Philippe-Benoit Côté
- Département de sexologie, Université du Québec à Montréal, 455, Boul. René-Lévesque Est, Montreal, Québec, H2L 4Y2, Canada
| | - Jean-Sébastien Fallu
- École de psychoéducation, Université de Montréal. Pavillon Marie-Victorin, 90, av. Vincent- d'Indy, Montreal, Québec, H2V 2S9, Canada.,Institut universitaire sur les dépendances, 950 rue de Louvain Est, Montreal, Québec, H2M 2E8, Canada
| | - Jorge Flores-Aranda
- École de travail social, Université du Québec à Montréal, 455, boul. René-Lévesque Est Local W-4020, Montreal, Québec, H2L 4Y2, Canada. .,Institut universitaire sur les dépendances, 950 rue de Louvain Est, Montreal, Québec, H2M 2E8, Canada.
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Housing First for homeless people with severe mental illness: extended 4-year follow-up and analysis of recovery and housing stability from the randomized Un Chez Soi d'Abord trial. Epidemiol Psychiatr Sci 2022; 31:e14. [PMID: 35125129 PMCID: PMC8851060 DOI: 10.1017/s2045796022000026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Housing First (HF), a recovery-oriented approach, was proven effective in stabilising housing situations of homeless individuals with severe mental disorders, yet had limited effectiveness on recovery outcomes on a short-term basis compared to standard treatment. The objective was to assess the effects of the HF model among homeless people with high support needs for mental and physical health services on recovery, housing stability, quality of life, health care use, mental symptoms and addiction issues on 4 years of data from the Un Chez Soi d'Abord trial. METHODS A multicentre randomised controlled trial was conducted from August 2011 to April 2018 with intent-to-treat analysis in four French cities: Lille, Marseille, Paris and Toulouse. Participants were homeless or precariously-housed patients with a DSM-IV-TR diagnosis of bipolar disorder or schizophrenia. Two groups were compared: the HF group (n = 353) had immediate access to independent housing and support from the assertive community treatment team; the Treatment-As-Usual (TAU) group (n = 350) had access to existing support and services. Main outcomes were personal recovery (Recovery Assessment Scale (RAS) scale), housing stability, quality of life (S-QoL), global physical and mental status (Medical Outcomes Study 36-item Short Form Health Survey (SF-36)), inpatient days, mental symptoms (Modified Colorado Symptom Index (MCSI)) and addictions (Mini International Neuropsychiatric Interview (MINI) and Alcohol Use Disorders Identification Test (AUDIT)). Mixed models using longitudinal and cluster designs were performed and adjusted to first age on the street, gender and mental disorder diagnosis. Models were tested for time × group and site × time interactions. RESULTS The 703 participants [123 (18%) female] had a mean age of 39 years (95% CI 38.0-39.5 years). Both groups improved RAS index from baseline to 48 months, with no statistically significant changes found between the HF and TAU groups over time. HF patients exhibited better autonomy (adjusted β = 2.6, 95% CI 1.2-4.1) and sentimental life (2.3, 95% CI 0.5-4.1), higher housing stability (28.6, 95% CI 25.1-32.1), lower inpatient days (-3.14, 95% CI -5.2 to -1.1) and improved SF-36 mental composite score (-0.8, 95% CI -1.6 to -0.1) over the 4-year follow-up. HF participants experienced higher alcohol consumption between baseline and 48 months. No significant differences were observed for self-reported mental symptoms or substance dependence. CONCLUSION Data at 4 years were consistent with 2-year follow-up data: similar improvement in personal recovery outcomes but higher housing stability, autonomy and lower use of hospital services in the HF group compared to the TAU group, with the exception of an ongoing alcohol issue. These sustained benefits support HF as a valuable intervention for the homeless patients with severe mental illness. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01570712.
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Austin AE, Shiue KY, Naumann RB, Figgatt MC, Gest C, Shanahan ME. Associations of housing stress with later substance use outcomes: A systematic review. Addict Behav 2021; 123:107076. [PMID: 34385075 DOI: 10.1016/j.addbeh.2021.107076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 12/20/2022]
Abstract
A synthesis of existing evidence regarding the association of housing stress with later substance use outcomes can help support and inform housing interventions as a potential strategy to address problematic substance use. We conducted a comprehensive search of PubMed, Web of Science, PsycInfo, CINAHL, Social Work Abstracts, and Sociological Abstracts and systematically screened for articles examining housing stress and later substance use outcomes among U.S. adults. Across 38 relevant articles published from 1991 to 2020, results demonstrated an association of homelessness with an increased likelihood of substance use, substance use disorders (SUD), and overdose death. Results regarding the association of homelessness with receipt and completion of SUD treatment were mixed, and one study indicated no association of homelessness with motivation to change substance use behaviors. Several studies did not find an association of unstable housing with substance use or receipt of SUD treatment, while others found an association of unstable housing with intensified SUD symptoms and a decreased likelihood of completing SUD treatment. Overall, while there is evidence of an association of homelessness with later substance use, SUD, and overdose death, results for other forms of housing stress and some substance use outcomes are less consistent. There are several methodological considerations specific to selected measures of housing stress and substance use, study populations, and analytic approaches that have implications for results and directions for future research. Despite these considerations, results collectively suggest that innovative interventions to address housing stress, namely homelessness, may help mitigate some substance use outcomes.
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Affiliation(s)
- Anna E Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States.
| | - Kristin Y Shiue
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Rebecca B Naumann
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Mary C Figgatt
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Caitlin Gest
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Meghan E Shanahan
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States
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Ayvaci ER, Pollio DE, Hong BA, North CS. Longitudinal Cost of Services in a Homeless Sample with Cocaine Use Disorder. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2019; 28:132-138. [PMID: 31844378 PMCID: PMC6914308 DOI: 10.1080/10530789.2019.1598618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/20/2019] [Accepted: 03/18/2019] [Indexed: 06/10/2023]
Abstract
Homeless people with cocaine use disorder have multiple comorbidities and costly service needs. This study examined service costs associated with cocaine use and substance service use in substance, psychiatric, and medical service sectors. 127 homeless participants with cocaine use disorder were interviewed annually. Self-report and agency-report service use and cost data were combined. Pairwise comparisons were made with cocaine abstinence and substance service use in relation to mean and yearly proportional service costs in 3 service sectors. Among substance service users, achievement of abstinence was not associated with decreased substance service costs. Cocaine abstinence was associated with proportional reduction of substance service costs over time. Substance service use was associated with proportional reduction of psychiatric service costs over time among the abstinent subgroup. Conversely, substance service use was associated with continuing higher medical service expenditures in the abstinent subgroup and higher psychiatric service expenditures in those not abstinent. Homeless individuals who achieved cocaine abstinence after using substance services had decreased substance service expenditures. Individuals with continued substance service use had greater medical and psychiatric service costs. Policy based on maximizing benefits while minimizing costs appears insufficiently complex to incorporate the multiple needs and associated with costs of treating homeless populations.
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Affiliation(s)
- Emine R. Ayvaci
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David E. Pollio
- Department of Social Work, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Barry A. Hong
- Department of Psychiatry, The Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carol S. North
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- The Altshuler Center for Education & Research, Metrocare Services, Dallas, Texas, USA
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12
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Anderson-Carpenter KD, Fletcher JB, Swendeman D, Reback CJ. Associations between sociodemographic characteristics and substance use disorder severity among methamphetamine-using men who have sex with men. Subst Use Misuse 2019; 54:1763-1773. [PMID: 31075997 PMCID: PMC6644069 DOI: 10.1080/10826084.2019.1610445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Men who have sex with men (MSM) have elevated rates of substance use disorders (SUDs) and differences across sociodemographic sub-groups of MSM are associated with a greater risk of deleterious outcomes. Although studies have shown that MSM report greater rates of polysubstance use relative to other adult populations, the associations between sociodemographic characteristics and both acute substance use and substance use severity among methamphetamine-using MSM are unknown. Objectives: The present study examines associations between sociodemographic characteristics and (a) recent substance use and (b) SUD severity. Method: From March 2014 to January 2016, 286 methamphetamine-using MSM were recruited to complete a baseline Audio Computer-Assisted Self-Interview (ACASI) assessment and the SCID MINI. Multivariable analyses employed generalized structural equation modeling given the non-continuous nature of the endogenous variables. Results: All measured sociodemographic characteristics except gay self-identification were significantly associated with recent substance use (all ps ≤ .05), and all characteristics except current homelessness were significantly associated with diagnostic SUD severity (all ps ≤ .05). However, nuanced risks were observed in participants' use of specific substances regarding recent substance use and substance use severity. Conclusion: These results suggest that multiple factors contribute to the risks of SUD severity among methamphetamine-using MSM. As such, these results are useful in the tailoring of clinical and psychosocial intervention strategies that serve this and other high-risk populations.
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Affiliation(s)
- Kaston D Anderson-Carpenter
- a David Geffen School of Medicine , Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles , CA , USA.,b Department of Psychology , Michigan State University , East Lansing , MI , USA
| | | | - Dallas Swendeman
- a David Geffen School of Medicine , Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles , CA , USA.,d Development Core, Center for HIV Identification, Prevention, and Treatment Services, University of California , Los Angeles , CA , USA
| | - Cathy J Reback
- a David Geffen School of Medicine , Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles , CA , USA.,c Friends Research Institute, Inc ., Los Angeles , CA , USA.,e Center for HIV Identification, Prevention and Treatment Services, University of California , Los Angeles , CA , USA
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