U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, CT 06516, USA.
Psychiatr Serv. 2011 Feb;62(2):171-8. doi: 10.1176/ps.62.2.pss6202_0171.
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.
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.
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.
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.
最近的临床和政策趋势倾向于提供低需求住房（提供住房不依赖于酒精和毒品戒除），以帮助长期无家可归者。本研究比较了住房、临床和服务使用结果，比较了在住房入住时具有高水平物质使用的参与者和那些报告没有物质使用的参与者。
参与 11 个地点的慢性无家可归者合作倡议（N=756）的结果评估，他们在项目进入后 12 个月内获得住房，并在住房时和至少一次随访时接受评估（N=694，92%），根据进入支持性社区住房时的物质使用情况，分为高频物质使用者（>15 天使用酒精或>15 天使用大麻或过去 30 天内使用任何其他非法药物；N=120，16%）或戒断者（无使用日；N=290，38%）。一个报告使用 1 至 15 天的中间组（N=284，38%）被排除在分析之外。混合模型多变量回归调整了基线组差异的结果发现。
在 24 个月的随访期间，两组的住房天数都显著增加，没有显著差异。与戒断者相比，高频物质使用者在整个随访期间保持了更高但呈下降趋势的物质使用率。高频使用者的精神症状频率或严重程度继续高于戒断者。随着时间的推移，两组的总健康费用都有所下降。
基于低需求模式，成功地为活跃使用物质的使用者提供了住房。与戒断者相比，使用者在住房入住时保持了更高的物质使用率和更差的心理健康结果，但没有相对恶化。
