Risk Factors of Homelessness Following Substance Use Disorder Treatment

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Researchers analyzed data to determine housing outcomes for adults who were homeless at admission to substance use disorder treatment programs.

More than two-thirds of homeless adults treated in 2018 in federally funded substance use disorder treatment programs remained homeless after they left the program, according to new research from Psychiatric Services.

Researchers analyzed Substance Abuse and Mental Health Services Administration’s 2018 Treatment Episode Data Set: Discharges (TEDS-D) data (n=1,200,105 admissions), which involved 192,838 individuals who were “homeless” (no fixed address or residing in a shelter) at admission. At discharge, 132,561 individuals remained homeless, 31,366 were discharged to dependent housing, and 28,911 were discharged to independent housing.

In bivariate analysis, the researchers found that individuals aged at least 55 years and those without full-time employment were more likely to be homeless at discharge compared with younger adults and those employed full-time. Risk factors for remaining homeless included admission to substance detoxification facilities, compared with residential or ambulatory treatment; a stay less than 30 days in the treatment program; and admission related to opioid use (OR 0.62) compared with problematic alcohol use.

In multivariate logistic regression analysis, older adults and individuals without employment remained at higher risk of homelessness at discharge (OR 1.51, 1.63, respectively). Individuals in the Midwest region (1.98) and the West region (OR 4.90) were more likely to remain homeless compared with those in the Northeast.

Admission involving detoxification was linked with a higher risk of remaining homeless. Those who completed treatment successfully, rather than dropping out of the program or being transferred to another facility, were less likely to be homeless, particularly when they stayed at least 121 days (OR 0.08), compared with 1 to 30 days.

Gaining independent housing was most likely for married individuals, compared with never married or divorced, separated, or widowed, bivariate analyses showed.

Full-time employment and receipt of wages or salary were linked with higher likelihood of gaining independent housing, compared with no employment or receipt of retirement, pension, or disability income.

Midwest and South treatment program participation was linked with less likelihood of independent housing compared with West or Northeast program participation. Individuals who dropped out of treatment and obtained housing at discharge were more likely to gain independent housing compared with individuals who completed treatment, were transferred, or were incarcerated.

Compared with detoxification, the type of service setting at admission that was associated with the most success for obtaining independent housing at discharge was ambulatory, nonintensive treatment (OR 2.28). Individuals discharged from programs in the West (OR 1.53) were the most likely to obtain independent living.

Nonemployment and early termination of treatment due to incarceration or transfer were associated with lower odds. Individuals who stayed up to 30 days in treatment were more likely to obtain independent housing at discharge compared with individuals with longer stays.

Limitations of the study include limited data on services provided, local availability of low-income housing, lack of differentiation between single homeless adults and household heads of homeless families, and lack of data on level of disability.

The researchers said substance use disorder treatment program administrators should consider collaborating with existing housing programs or implementing integrated housing services.

Reference

Lo EA, Rhee TG, Rosenheck RA. Housing outcomes of adults who were homeless at admission to substance use disorder treatment programs nationwide. Psychiatric Services. Published online January 18, 2022. doi: 10.1176/appi.ps.202100430