title: Addiction treatment and stable housing among a cohort of injection drug users.
abstract: BACKGROUND
  Unstable housing and homelessness is prevalent among injection drug users (IDU). We sought to examine whether accessing addiction treatment was associated with attaining stable housing in a prospective cohort of IDU in Vancouver, Canada.
  
  
  METHODS
  We used data collected via the Vancouver Injection Drug User Study (VIDUS) between December 2005 and April 2010. Attaining stable housing was defined as two consecutive "stable housing" designations (i.e., living in an apartment or house) during the follow-up period. We assessed exposure to addiction treatment in the interview prior to the attainment of stable housing among participants who were homeless or living in single room occupancy (SRO) hotels at baseline. Bivariate and multivariate associations between the baseline and time-updated characteristics and attaining stable housing were examined using Cox proportional hazard regression models.
  
  
  RESULTS
  Of the 992 IDU eligible for this analysis, 495 (49.9%) reported being homeless, 497 (50.1%) resided in SRO hotels, and 380 (38.3%) were enrolled in addiction treatment at the baseline interview. Only 211 (21.3%) attained stable housing during the follow-up period and of this group, 69 (32.7%) had addiction treatment exposure prior to achieving stable housing. Addiction treatment was inversely associated with attaining stable housing in a multivariate model (adjusted hazard ratio [AHR]=0.71; 95% CI: 0.52-0.96). Being in a partnered relationship was positively associated with the primary outcome (AHR=1.39; 95% CI: 1.02-1.88). Receipt of income assistance (AHR=0.65; 95% CI: 0.44-0.96), daily crack use (AHR=0.69; 95% CI: 0.51-0.93) and daily heroin use (AHR=0.63; 95% CI: 0.43-0.92) were negatively associated with attaining stable housing.
  
  
  CONCLUSIONS
  Exposure to addiction treatment in our study was negatively associated with attaining stable housing and may have represented a marker of instability among this sample of IDU. Efforts to stably house this vulnerable group may be occurring in contexts outside of addiction treatment.
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, and Department of Medicine, University of British Columbia, Vancouver, Canada. anita@hivnet.ubc.ca
authors.forename: Anita
authors.initials: A
authors.lastname: Palepu
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
authors.forename: Calvin
authors.initials: C
authors.lastname: Lai
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000328:Adult; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D015819:Substance Abuse, Intravenous