title: Self-reported changes in drug and alcohol use after becoming homeless.
abstract: OBJECTIVE
  We identified substance use patterns and factors associated with increased substance use after users become homeless.
  
  
  METHODS
  We carried out a 2-city, community-based survey that used population-proportionate sampling of 91 sites with random selection at each site.
  
  
  RESULTS
  Five hundred thirty-one adults were interviewed; 78.3% of them met Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for substance abuse or dependence. Most of those who met the criteria reported using drugs and alcohol less since they became homeless, commonly because they were in recovery. Factors independently associated with increased use were no health insurance (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.02, 2.58), alcohol abuse or dependence (OR = 3.5; 95% CI = 1.85, 6.78), and selling plasma (OR = 2.6; 95% CI = 1.32, 5.14) or panhandling (OR = 3.0; 95% CI = 1.65, 5.55) to acquire drugs.
  
  
  CONCLUSIONS
  Becoming homeless plays a role in self-reported substance use. Multiservice treatment programs and tailored interventions for homeless persons are needed.
authors.affiliation: Welch Center, Room 2-513, Johns Hopkins University School of Medicine, 2024 E. Monument Street, Baltimore, MD 21205, USA. totoole@jhmi.edu
authors.forename: Thomas P
authors.initials: TP
authors.lastname: O'Toole
authors.forename: Jeanette L
authors.initials: JL
authors.lastname: Gibbon
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Hanusa
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Freyder
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Conde
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006703:Ill-Housed Persons; D006801:Humans; D016015:Logistic Models; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires