title: Slowing the revolving door: stabilization programs reduce homeless persons' substance use after detoxification.
abstract: This study examined whether homelessness predicted earlier resumption of substance use after detoxification, and sought evidence concerning the impact of post-detoxification stabilization programs among homeless and nonhomeless individuals. Kaplan-Meier plots and proportional hazards models were used to determine the association between homelessness, stabilization program use, and recurrent substance use in a prospective cohort of persons entering inpatient detoxification (n=470). Among 254 persons available at 6 months, 76% reported recurrent substance use. Homeless persons not using stabilization programs experienced the highest hazard of return to substance use after detoxification, Hazard Ratio (HR) 1.26, 95% CI (0.88, 1.80). Homeless persons using these programs had the lowest rate of return to substance use: HR 0.61, 95% CI (0.40, 0.94). A similar impact of stabilization programs was not seen among nonhomeless subjects. Post-detoxification stabilization programs were associated with improved outcomes for homeless addicted persons. This treatment modality may slow the "revolving door" phenomenon of relapse after detoxification among homeless persons.
authors.affiliation: Divisions of Preventive Medicine and General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, 1530 3rd Avenue South, MT608, Birmingham, AL 35294-4410, USA. skertesz@uab.edu
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Kertesz
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Horton
authors.forename: Peter D
authors.initials: PD
authors.lastname: Friedmann
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006208:Halfway Houses / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D016016:Proportional Hazards Models; D012008:Recurrence; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation* / Q000628:therapy*; D013997:Time Factors; D014505:Urban Population