Kirst Maritt, Zerger Suzanne, Misir Vachan, Hwang Stephen, Stergiopoulos Vicky
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.
Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond St., Toronto, ON, Canada M5B 1W8.
Drug Alcohol Depend. 2015 Jan 1;146:24-9. doi: 10.1016/j.drugalcdep.2014.10.019. Epub 2014 Oct 28.
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.
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).
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.
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.
Current controlled trials ISRCTN42520374.
有充分证据表明，“先住房后服务”干预措施对于改善患有精神疾病和成瘾问题的无家可归者的住房稳定性和生活质量是有效的。然而，关于“先住房后服务”在改善这一人群与物质使用相关结果方面的有效性的证据却非常少。本研究采用随机对照设计，以检验分散式“先住房后服务”对一个大型城市中心物质使用结果的影响。
在加拿大多伦多的“在家/在自己家”试验中，对575名有无家可归和精神疾病、有或无并发物质使用问题的个体样本，比较了“先住房后服务”干预组和常规治疗组的物质使用结果。使用广义线性模型来比较研究组在物质使用结果随时间（基线、6个月、12个月、18个月和24个月）的变化情况。
在24个月时，“先住房后服务”干预组的参与者在经历酒精问题的天数和在酒精上花费的金额方面的减少幅度明显大于常规治疗组的参与者。在24个月时，研究组在非法药物结果方面未发现差异。
这些发现表明，“先住房后服务”干预措施随着时间的推移可有助于减少酒精问题。然而，该干预措施对非法药物问题缺乏效果表明，有无家可归、精神疾病和药物问题的个体可能需要额外的支持来减少使用。
当前对照试验ISRCTN42520374。
