Study Shows No Significant Association between Public Support Income, VA Disability Compensation, and Money Spent on Alcohol and Drugs among Homeless Veterans

BACKGROUND:
In 1992, the U.S. Department of Housing and Urban Development (HUD) and VA collaboratively formed the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program. Substance abuse has been identified as one of the main risk factors for homelessness, and many homeless adults continue to purchase and use substances while homeless. There has long been concern that public support payments are used to support addictive behaviors. This study describes the amount of money homeless Veterans report spending on alcohol and drugs, and examines the association between public support dollars received – and VA disability compensation in particular – and dollars spent on alcohol and drugs. Investigators in this study identified 1,160 homeless Veterans from 19 sites upon entry into the HUD-VASH program (while they were still homeless) between 1992 and 2003. Based on interviews conducted by clinical staff in the HUD-VASH program, as well as a review of existing medical records, investigators also examined Veterans' income, service-connected disability, psychiatric and medical conditions, demographics, service era, and number of nights homeless in the past three months.

FINDINGS:

• About one-third of homeless Veterans reported spending money on alcohol and about one-fifth reported spending money on drugs in the past month. However, no positive association was found between public support income and money spent on alcohol or drugs, and there was no association found between VA disability compensation and substance use. This suggests that the amount of income homeless Veterans received from disability and other public support sources did not influence their amount of substance use.
• Employment income was positively associated with days of alcohol use and money spent on alcohol, as well as with money spent on drugs. Other sources of income (e.g., family and friends, panhandling) were also positively associated with alcohol use and money spent on alcohol along with drug use and money spent on drugs. In contrast, public support income was negatively associated with alcohol use and money spent on alcohol.
• Nearly half (49%) of the Veterans in this study sample had a drug abuse/dependency diagnosis and more than half (63%) had an alcohol abuse/dependency diagnosis.

LIMITATIONS:

• Only Veterans referred to the HUD-VASH program were examined, which may not be representative of all homeless Veterans.
• This study was limited to observational, cross-sectional data based on self-reported income and substance use by Veterans, thus causality of associations found cannot be inferred.
• Data are more than 10 years old, and may not account for trends in VA care since OEF/OIF, or the recent expansion in mental healthcare.

Tsai J and Rosenheck R. VA Disability Compensation and Money Spent on Substance Use Among Homeless Veterans: A Controversial Association. Psychiatric Services. March 1, 2015;e-pub ahead of print.