title: Predictors of frequent withdrawal management unit use among chronically homeless, homeless, and housed men: a retrospective cohort study.
abstract: OBJECTIVE
  Reports suggest that repeat users of detoxification services are less likely to get rehabilitated. The goal of this study is to determine rates and predictors of detoxification unit visits among individuals who are chronically homeless with severe drinking problems compared to those who are housed and in the general homeless population.
  
  
  METHODS
  Visit records (n = 1027) from all inner city Toronto detoxification units (n = 5) by men (n = 169) over a 6 year period were analyzed and linked to structured interview data for three populations: chronically homeless individuals with severe drinking problems (CHDP, n = 50); members of the general homeless population (GH, n = 61); and low-income housed individuals (LIH, n = 58).
  
  
  RESULTS
  The CHDP group had 4.13 (3.86, 4.39) detoxification unit admissions per year, 18.1 (95% CI 12.5-23.7) and 33 (95% CI 21-46) times higher than the GH and LIH groups respectively. Admission rates were 43.8 % (95% CI 32.7-54.9%) higher in the winter than summer months for the CHDP group. The proportions of stays that involved police, leaving without discharge, and staying two days or less were 74%, 75%, and 89% among CHDP, GH, and LIH subjects.
  
  
  CONCLUSIONS
  Rather than being a resource for achieving abstinence, frequent short visits, treatment non-compliance, higher winter visit rates suggest that detoxification units are more likely used by individuals as shelter; high rates of admission related police involvement suggest that they continue to be used as an alternative to judicial intervention into public inebriation.
authors.affiliation: Department of Family and Community Medicine, Center for Research on Inner-City Health, Keenan Research Centre, St. Michael's Hospital, University of Toronto, Ontario, Canada. tomislav.svoboda@utoronto.ca
authors.forename: Tomislav
authors.initials: T
authors.lastname: Svoboda
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000534:rehabilitation / Q000628:therapy*; D015331:Cohort Studies; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006798:Housing; D006801:Humans; D007902:Length of Stay; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario; D011203:Poverty; D012189:Retrospective Studies; D012621:Seasons; D013375:Substance Withdrawal Syndrome / Q000628:therapy*