title: Does active substance use at housing entry impair outcomes in supported housing for chronically homeless persons?
abstract: OBJECTIVE
  Recent clinical and policy trends have favored low-demand housing (provision of housing not contingent on alcohol and drug abstinence) in assisting chronically homeless people. This study compared housing, clinical, and service use outcomes of participants with high levels of substance use at time of housing entry and those who reported no substance use.
  
  
  METHODS
  Participants in the outcome evaluation of the 11-site Collaborative Initiative on Chronic Homelessness (N=756), who were housed within 12 months of program entry and received an assessment at time of housing and at least one follow-up (N=694, 92%), were classified as either high-frequency substance users (>15 days of using alcohol or >15 days of using marijuana or any other illicit drugs in the past 30 days; N=120, 16%) or abstainers (no days of use; N=290, 38%) on entry into supported community housing. An intermediate group reporting from one to 15 days of use (N=284, 38%) was excluded from the analysis. Mixed-model multivariate regression adjusted outcome findings for baseline group differences.
  
  
  RESULTS
  During a 24-month follow-up, the number of days housed increased dramatically for both groups, with no significant differences. High-frequency substance users maintained higher, though declining, rates of substance use throughout follow-up compared with abstainers. High-frequency users continued to have more frequent or more severe psychiatric symptoms than the abstainers. Total health costs declined for both groups over time.
  
  
  CONCLUSIONS
  Active-use substance users were successfully housed on the basis of a low-demand model. Compared with abstainers, users maintained the higher rates of substance use and poorer mental health outcomes that were observed at housing entry but without relative worsening.
authors.affiliation: U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, CT 06516, USA. ellen.edens@va.gov
authors.forename: Ellen Lockard
authors.initials: EL
authors.lastname: Edens
authors.forename: Alvin S
authors.initials: AS
authors.lastname: Mares
authors.forename: Jack
authors.initials: J
authors.lastname: Tsai
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
mesh_terms: D005260:Female; D006297:Health Services Accessibility; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D016018:Least-Squares Analysis; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011638:Public Housing; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000523:psychology* / Q000628:therapy; D013997:Time Factors; D014481:United States