title: Predictors of contact with public service sectors among homeless adults with and without alcohol and other drug disorders.
abstract: OBJECTIVE
  Homeless persons with alcohol and other drug (AOD) disorders face multiple problems that go beyond their AOD use. As a consequence, they commonly access services in multiple sectors in addition to the AOD treatment system. This study examined the predictors of contact with agencies in the health, mental health, social welfare and criminal justice sectors by AOD status among a probability sample of homeless adults in Houston, Texas.
  
  
  METHODS
  Cross-sectional data were collected from a multistage random sample of 797 homeless adults (579 men), age 18 or older, who were living in shelters and on the streets of Houston in 1996. Structured face-to-face interviews provided screening diagnoses for AOD disorders, self-report data on AOD treatment use and candidate predictors of treatment use. Service use was tracked retrospectively through administrative data obtained from 10 federal, state, county and municipal agencies that provide finding for physical and mental health services and AOD treatment, as well as emergency income; we also tracked criminal justice contacts. Logistic regression analyses were stratified by AOD status.
  
  
  RESULTS
  Adjusting for eligibility factors, key aspects of need were significant predictors of any utilization among those without an AOD problem, but not for those with an AOD problem. For those with AOD disorders, contact with one sector was not predictive of contact with other sectors.
  
  
  CONCLUSIONS
  Our findings indicate that AOD disorders hinder utilization of public sector services by homeless persons. These disorders may be masking need or otherwise acting as a barrier to accessing treatment and support.
authors.affiliation: RAND, 1700 Main Street, P.O. Box 2138, Santa Monica, California 90407-2138, USA. chloe@rand.org
authors.forename: Chloe E
authors.initials: CE
authors.lastname: Bird
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Jinnett
authors.forename: M Audrey
authors.initials: MA
authors.lastname: Burnam
authors.forename: Paul
authors.initials: P
authors.lastname: Koegel
authors.forename: Greer
authors.initials: G
authors.lastname: Sullivan
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Wenzel
authors.forename: M Susan
authors.initials: MS
authors.lastname: Ridgely
authors.forename: Sally C
authors.initials: SC
authors.lastname: Morton
authors.forename: Angela
authors.initials: A
authors.lastname: Miu
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D005544:Forecasting; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017150:Public Sector / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy