A new study has found that alcohol problems can be effectively reduced in homeless people with mental illness when they are given a place to live with no preconditions, such as sobriety or seeing a psychiatrist.
The approach, known as ‘Housing First,’ focuses on moving homeless people into independent and permanent housing as quickly as possible and then providing additional supports and services as needed. The underlying principle is that people are better able to move forward with their lives if they are first housed.
These interventions improve housing stability and community functioning for this population, said lead author Dr. Vicky Stergiopoulos, psychiatrist-in-chief at St. Michael’s Hospital and a scientist in its Centre for Research on Inner City Health.
For the study, the researchers tracked 378 homeless people with mental illness in Toronto, Canada’s largest and most diverse urban center, for 24 months. Half were randomized into a Housing First program with intensive case management while the other half received treatment as usual.
The study participants were primarily men in their 40s. The most common mental health diagnoses were substance dependence or abuse (46 percent), major depression (45 percent), alcohol dependence or abuse (40 percent), post-traumatic stress disorder (29 percent) and psychotic disorder (26 percent).
Among those in the Housing First group, there was a significant 53 percent drop in the number of days spent experiencing alcohol-related problems, compared to the treatment-as-usual group. At the beginning of the study, those in the Housing First group on average experienced alcohol problems on 4.3 out of 30 days. By the end of the study, this number decreased to 1.7 days.
In comparison, the treatment-as-usual group experienced alcohol problems on 3.4 out of 30 days at the start of the study start, which decreased to 2.9 days by the end.
Furthermore, the amount of money they spent on alcohol in the previous 30 days dropped significantly. At the start of the study, Housing First participants spent an average of $62 on alcohol in the past 30 days, which dropped to $53 by the end of the study. However, treatment-as-usual participants increased spending from $70 to $114.
After 12 months, the severity of substance use fell by 28 percent for Housing First compared to treatment-as-usual participants, but wasn’t statistically significant at 24 months.
Although the number of hospital emergency department visits and days did not differ significantly between the two groups, fewer Housing First participants reported one or more hospitalizations during the 24 month time period (70 percent vs. 81 percent).
The findings are published in the online journal PLOS ONE.
Source: St. Michael’s Hospital