Abstract
The Housing First (HF) approach for homeless adults with serious mental illness has gained support as an alternative to the mainstream “Treatment First” (TF) approach. In this study, group differences were assessed using qualitative data from 27 HF and 48 TF clients. Dichotomous variables for substance use and substance abuse treatment utilization were created and examined using bivariate and logistic regression analyses. The HF group had significantly lower rates of substance use and substance abuse treatment utilization; they were also significantly less likely to leave their program. Housing First’s positive impact is contrasted with the difficulties Treatment First programs have in retaining clients and helping them avoid substance use and possible relapse.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Anthony, W. (1993). Recovery from mental illness: The guiding vision of the mental health system in the 1990s. Psychosocial Rehabilitation Journal, 16, 11.
Burt, M. R., Pearson, C. L., & Montgomery, A. E. (2005). Strategies for preventing homelessness. Washington, DC: U.S. Department of Housing and Urban Development.
Deegan, P. (1996). Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19(3), 57–68.
Dordick, G. A. (2002). Recovering from homelessness: Determining the ‘quality of sobriety’ in a transitional housing program. Qualitative Sociology, 25(1), 7–33.
Drake, R., McHugo, G., Xie, H., Fox, M., Packard, J., & Helmstetter, B. (2006). Ten-year recovery outcomes for clients with co-occurring schizophrenia and substance use disorders. Schizophrenia Bulletin, 32(3), 464–473.
Drake, R., Yovetich, N., Bebout, R., Harris, M., & McHugo, G. (1997). Integrated treatment for dually diagnosed adults. Journal of Nervous and Mental Disease, 185, 298–305.
Gladwell, M. (2006). Million dollar Murray: Why problems like homelessness may be easier to solve than manage. The New Yorker, February, 13, 96–107.
Greenwood, R., Shaefer-McDaniel, N., Winkle, G., & Tsemberis, S. (2005). Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. American Journal of Community Psychology, 36, 226–238.
Gulcur, L., Stefancic, A., Shinn, M., Tsemberis, S., & Fischer, S. (2003). Housing, hospitalization, and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and Housing First programmes. Journal of Community & Applied Social Psychology, 13, 171–186.
Locke, G., Khadduri, J., & O’Hara, A. (2007). Housing models. Paper presented at the National Symposium on Homelessness Research, Washington, DC.
Ma, G. X., & Shive, S. (2000). A comparative analysis of perceived risks and substance abuse among ethnic groups. Addictive Behaviors, 25(3), 361–371.
McHugo, G., Drake, R., Brunette, M., Xie, H., Essock, S., & Green, A. I. (2006). Enhancing validity in co-occurring disorders treatment research. Schizophrenia Bulletin, 32, 655–665.
Nelson, G., Sylvestre, J., Aubry, T., George, L., & Trainor, J. (2007). Housing choice and control, housing quality, and control over professional support as contributors to the subjective quality of life and community adaptation of people with severe mental illness. Administrative Policy in Mental Health & Mental Health Services Review, 34, 89–100.
Office of Applied Studies. (2004). Results from the 2003 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 04-3964, NSDUH Series H-25). Rockville, MD: Substance Abuse and Mental Health Services Administration.
Padgett, D. K. (2007). There’s no place like (a) home: Ontological security in the third decade of the homelessness crisis in the United States. Social Science and Medicine, 64, 1925–1936.
Padgett, D., Gulcur, L., & Tsemberis, S. (2006). Housing First services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice, 16, 74–83.
Padgett, D. K., Struening, E. L., & Andrews, H. (1990). Factors affecting the use of medical, mental health, alcohol, and drug treatment services by homeless adults. Medical Care, 28, 805–821.
SAMHSA. (2005). National Consensus statement on mental health recovery [Brochure].
Sandelowski, M. (2001). Real qualitative researchers do not count: The use of numbers in qualitative research. Research in Nursing and Health, 24, 230–240.
Shadish, W., Cook, T., & Campbell, D. (2002). Experimental and quasi-experimental designs for generalized causal inference. Boston: Houghton Mifflin.
Shinn, M., Baumohl, J., & Hopper, K. (2001). The prevention of homelessness revisited. Analyses of Social Issues and Public Policy, 1, 95–127.
Stake, R. E. (1995). The art of case study research. Thousand Oaks, CA: Sage.
Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94, 651–656.
Tsemberis, S., Moran, L., Shinn, M., Asmussen, S., & Shern, D. (2003). Consumer preference programs for people who are homeless and have psychiatric disabilities: A drop-in center and a supported housing program. American Journal of Community Psychology, 32, 305–317.
Acknowledgment
This project was supported by grant #R01-MH69865 from the National Institute of Mental Health.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Padgett, D.K., Stanhope, V., Henwood, B.F. et al. Substance Use Outcomes Among Homeless Clients with Serious Mental Illness: Comparing Housing First with Treatment First Programs. Community Ment Health J 47, 227–232 (2011). https://doi.org/10.1007/s10597-009-9283-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-009-9283-7