title: Need and non-need factors associated with addiction treatment utilization in a cohort of homeless and housed urban poor.
abstract: BACKGROUND
  Research on addiction treatment utilization in indigent samples mainly has been retrospective, without measures of addictive consequences, social network influences, and motivation. Prospective assessment of factors influencing utilization could inform policy and clinical care.
  
  
  OBJECTIVE
  We sought to identify factors associated with utilization of addiction treatment and mutual help groups among substance-dependent persons with high rates of homelessness.
  
  
  METHODS
  This was a prospective cohort of patients detoxified from alcohol or drugs at baseline who were followed for 2 years in a randomized clinical trial of linkage to primary care (n = 274). Outcomes included utilization of Inpatient/Residential, Outpatient, Any Treatment, and Mutual Help Groups. Predictor variables in longitudinal regression analyses came from the literature and clinical experience, organized according to theoretical categories of Need, and non-Need (eg, Predisposing and Enabling).
  
  
  RESULTS
  Many subjects used Inpatient/Residential (72%), Outpatient (62%), Any Treatment (88%) or Mutual Help Groups (93%) at least once. In multivariable analyses, addictive consequences (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.12-1.71), motivation (OR 1.32, 95% CI 1.09-1.60), and female gender (OR 1.80, 95% CI 1.13-2.86) were associated with most treatment types (ORs are for Any Treatment). Homelessness was associated with Residential/Inpatient (for Chronically Homeless vs. Housed, OR 1.75, 95% CI 1.04-2.94). Living with one's children (OR 0.51, 95% CI 0.31-0.84) and substance-abusing social environment (OR 0.65, 95% CI 0.43-0.98) were negatively associated with Any Treatment.
  
  
  CONCLUSIONS
  In this cohort of substance-dependent persons, addictive consequences, social network variables, and motivation were associated with treatment utilization. Non-need factors, including living with one's children and gender, also were significant.
authors.affiliation: Divisions of Preventive and General Internal Medicine, University of Alabama at Birmingham School of Medicine, AL 35294-4410, USA. skertesz@uab.edu
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Kertesz
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Larson
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: Jalie A
authors.initials: JA
authors.lastname: Tucker
authors.forename: Michael
authors.initials: M
authors.lastname: Winter
authors.forename: Ashley
authors.initials: A
authors.lastname: Mullins
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D001900:Boston; D015331:Cohort Studies; D005260:Female; D006301:Health Services Needs and Demand; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D009042:Motivation; D011203:Poverty; D011446:Prospective Studies; D012650:Self Disclosure; D012944:Social Support; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000628:therapy*; D014505:Urban Population