title: The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness.
abstract: BACKGROUND
  There is strong evidence that Housing First interventions are effective in improving housing stability and quality of life among homeless people with mental illness and addictions. However, there is very little evidence on the effectiveness of Housing First in improving substance use-related outcomes in this population. This study uses a randomized control design to examine the effects of scatter-site Housing First on substance use outcomes in a large urban centre.
  
  
  METHODS
  Substance use outcomes were compared between a Housing First intervention and treatment as usual group in a sample of 575 individuals experiencing homelessness and mental illness, with or without a co-occurring substance use problem, in the At Home/Chez Soi trial in Toronto, Canada. Generalized linear models were used to compare study arms with respect to change in substance use outcomes over time (baseline, 6, 12, 18 and 24 month).
  
  
  RESULTS
  At 24 months, participants in the Housing First intervention had significantly greater reductions in number of days experiencing alcohol problems and amount of money spent on alcohol than participants in the Treatment as Usual group. No differences between the study arms in illicit drug outcomes were found at 24 months.
  
  
  CONCLUSIONS
  These findings show that a Housing First intervention can contribute to reductions in alcohol problems over time. However, the lack of effect of the intervention on illicit drug problems suggests that individuals experiencing homelessness, mental illness and drug problems may need additional supports to reduce use.
  
  
  BACKGROUND
  Current controlled trials ISRCTN42520374.
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond St., Toronto, ON, Canada M5B 1W8; Toronto Central Community Care Access Centre, 250 Dundas St. W., Toronto, ON, Canada M5T 2Z5. Electronic address: maritt.kirst@utoronto.ca.
authors.forename: Maritt
authors.initials: M
authors.lastname: Kirst
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond St., Toronto, ON, Canada M5B 1W8.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Zerger
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond St., Toronto, ON, Canada M5B 1W8.
authors.forename: Vachan
authors.initials: V
authors.lastname: Misir
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond St., Toronto, ON, Canada M5B 1W8; Department of Medicine, University of Toronto, 200 Elizabeth St., Toronto, ON, Canada M5G 2C4.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond St., Toronto, ON, Canada M5B 1W8; Department of Psychiatry, University of Toronto, 250 College St., 8th floor, Toronto, ON, Canada M5T 1R8.
authors.forename: Vicky
authors.initials: V
authors.lastname: Stergiopoulos
mesh_terms: D000328:Adult; D002170:Canada; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006798:Housing; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology*; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D012940:Social Problems; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology*
keywords: Homelessness; Housing First; Mental illness; Substance use