Study Shows Strong Association between Substance Abuse and Homelessness among Veterans

BACKGROUND:
One of the major identified risk factors for homelessness is substance abuse, and one of the main programs funded to help homeless Veterans find housing is the Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program. This program provides subsidized housing with case management services, but formal substance abuse treatment is not provided as a core part of the program, although some HUD-VASH teams have substance abuse specialists. This study examined the prevalence of alcohol and drug use disorders among homeless Veterans entering the HUD-VASH program, and its association with both housing and clinical outcomes. Using administrative data from 1/08 to 4/11, investigators identified 29,143 homeless Veterans who were categorized as having: no substance use disorder (n=11,753), alcohol use disorder only (n=4,848), drug use disorder only (n=3,193), or both alcohol and drug use disorders (n=9,349). Veterans were compared on housing and clinical status prior to admission to HUD-VASH, and a sub-group of 14,086 HUD-VASH clients were compared regarding outcomes six months after entering the program. In addition to assessing mental health diagnoses and clinical status (e.g., functional status, substance use), investigators examined demographics, war era, combat exposure, and episodes of homelessness.

FINDINGS:

• There was a strong association between substance abuse and homelessness, particularly in Veterans with comorbid alcohol and drug use disorders. The majority (60%) of homeless Veterans admitted to the HUD-VASH program had a substance use disorder (SUD), and the majority (54%) of those had both an alcohol and drug use disorder.
• In the first 6 months after entering the HUD-VASH program, significant improvements were observed in both housing and clinical outcomes, with no significant differences between Veterans with and without substance use disorders on housing outcomes. However, Veterans with any substance use disorder showed improvement at a slower rate than those with no SUD.
• These findings suggest that despite strong associations between SUD and homelessness, the HUD-VASH program is able to successfully house homeless Veterans with SUD, although additional services may be needed to address their substance abuse after they become housed.
• Before entering supported housing, homeless Veterans with comborbid alcohol and drug use disorders had more extensive histories of being homeless than Veterans with only alcohol or only drug use disorders, while those with no SUD had the least extensive homeless histories.
• Compared to other homeless Veterans, those with both alcohol and drug use disorders were most likely to have comorbid psychotic or mood disorders. Homeless Veterans with both alcohol and drug use disorders or only a drug use disorder were more likely to also have PTSD.

LIMITATIONS:

• This study relied on administrative data, which is not always reliable.
• Psychiatric diagnoses were made by referring clinicians instead of structured diagnostic interviews.

AUTHOR/FUNDING INFORMATION:
Dr. Tsai is supported by an HSR&D Career Development Award, and he is part of HSR&D's Pain Research, Informatics, Multi-Morbidities, and Education Center, and the VA New England Mental Illness Research, Education, and Clinical Center (MIRECC), located in West Haven, CT.

Tsai J, Kasprow W, and Rosenheck R. Alcohol and Drug Use among Homeless Veterans: Prevalence and Association with Supported Housing Outcomes. Addictive Behaviors February 2014;39(2):455-60.