Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis.
OBJECTIVE
We examined the longitudinal effects of a Housing First program for homeless, mentally ill individuals' on those individuals' consumer choice, housing stability, substance use, treatment utilization, and psychiatric symptoms.


METHODS
Two hundred twenty-five participants were randomly assigned to receive housing contingent on treatment and sobriety (control) or to receive immediate housing without treatment prerequisites (experimental). Interviews were conducted every 6 months for 24 months.


RESULTS
The experimental group obtained housing earlier, remained stably housed, and reported higher perceived choice. Utilization of substance abuse treatment was significantly higher for the control group, but no differences were found in substance use or psychiatric symptoms.


CONCLUSIONS
Participants in the Housing First program were able to obtain and maintain independent housing without compromising psychiatric or substance abuse symptoms.
Tsemberis
Sam
S
Pathways to Housing, Inc, New York, NY 10027, USA. tsemberis@pathwaystohousing.org
Gulcur
Leyla
L
Nakae
Maria
M
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002755:Choice Behavior; D003266:Continuity of Patient Care / Q000458:organization & administration; D017831:Diagnosis, Dual (Psychiatry) / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D040261:Harm Reduction; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D010358:Patient Participation; D019989:Persons with Intellectual Disabilities / Q000523:psychology* / Q000534:rehabilitation / Q000706:statistics & numerical data; D015397:Program Evaluation; D011638:Public Housing / Q000592:standards*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors