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Study Suggests Homelessness Affects Substance Use Treatment Outcomes and Costs among Veterans


Veterans composed approximately 15% of the sheltered homeless adult population in 2007. Moreover, despite efforts to address homelessness among Veterans, increasing numbers returning from service in Afghanistan and Iraq are becoming - or are at risk of becoming homeless. Individuals experiencing homelessness have higher rates of substance use, mental health, and physical health problems, but substance use may be the most significant factor causing homelessness. This secondary analysis evaluated homelessness among 622 Veterans who had entered VA outpatient substance use disorder treatment between 3/00 and 3/03, and also explored associations between housing status, treatment outcomes, and the use of VA services over one year. Investigators compared the continuously housed group to Veterans who had spent some or all of the study time homeless, using the Addiction Severity Index (ASI) Composite Scores as the primary outcome measure. ASI composite scores rate severity in seven areas impacted by substance use: medical, employment, alcohol, drugs, family/social, legal, and psychiatric.

Findings suggest that the problem of homelessness among Veterans with substance use disorders remains large, with 65% of 622 Veterans in this study spending at least one night homeless at some point during the study period. Veterans experiencing homelessness during the six months prior to treatment admission had more severe alcohol, medical, employment, legal and psychiatric problems than Veterans with housing. After controlling for baseline severity, final ASI drug and psychiatric scores were better among consistently housed Veterans compared to consistently homeless Veterans. However, abstinence rates did not differ between the homeless and housed groups, and about 65% of participants in each group remained engaged in treatment for 90 days. In addition, results showed that homeless Veterans used more services and had higher total costs than housed Veterans, e.g., homeless Veterans had more inpatient admissions and were more likely to use the emergency room. These differences indicate that stable housing may be associated with slightly more positive treatment outcomes and lower costs among Veterans in outpatient substance use treatment.

PubMed Logo Buchholz J, Malte C, Calsyn D, Baer J, Nichol P, Kivlahan D, Caldeiro R, and Saxon A. Associations between housing status and substance use disorder treatment and service use outcomes among Veterans. Psychiatric Services July 2010;61(7):698-706.

This study was partly funded by HSR&D (SUI 99-109). Dr. Kivlahan is part of VA/HSR&D's Substance Use Disorders Quality Enhancement Research Initiative (SUD-QUERI).

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.