Substance use outcomes among homeless clients with serious mental illness: comparing Housing First with treatment first programs
Open accessAbstract
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.
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In homeless adults with serious mental illness, all HF participants who used substances kept their housing.
“all HF participants who used substances kept their housing”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Padgett et al. (2011)
The Results (page not provided) say that all eight Housing First participants who reported substance use stayed enrolled in the program, including two who relapsed. The Discussion says substance use did not disqualify Housing First clients from retaining housing, but the reported outcome for those eight is program enrollment, not an explicit measure of whether each kept their housing. (LLM, conf=0.82)
Experimental — accuracy not yet measuredStudies comparing Housing First with Treatment First or TAU reported mixed results on clients' alcohol and illegal substance use.
“Studies comparing Housing First with Treatment First programs7,26 or TAU15,22,24,28 reported mixed results on clients’ alcohol and illegal substance use”
In homeless adults with serious mental illness, more participants in the TF group used detoxification or rehabilitative services during the study period than the HF group.
“More participants in the TF group used detoxification or rehabilitative services during the study period than the HF group”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Padgett et al. (2011)
In homeless adults with serious mental illness, 26 of the 31 TF participants who used substances prematurely left the TF program.
“26 of the 31 TF participants who used substances prematurely left the TF program”
From Harm reduction outcomes and practices in Housing First: A mixed-methods systematic review (2021) · cites this paper as Padgett et al. (2011)
Abstinence-based housing is not necessarily more effective than Housing First approaches.
“Recent studies have shown that abstinence-based housing is not necessarily more effective than Housing First approaches26,27”
From Project-Based Housing First for Chronically Homeless Individuals With Alcohol Problems: Within-Subjects Analyses of 2-Year Alcohol Trajectories (2012) · cites this paper as [26]
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References 22 · Cited by 335
Research works printed but not linked: 1
- Locke G Khadduri J O’Hara A 2007 Housing models Paper presented at the National Symposium on Homelessness Research Washington, DC
- Authors
- Padgett, D. K., Stanhope, V., Henwood, B. F., & Stefancic, A.
- Affiliations
- New York University (US)
- Corresponding author
- Padgett, Deborah K.
- Venue
- Community Mental Health Journal
- Published
- 2010-01-09
- Volume
- 47
- Issue
- 2
- Pages
- 227-232
- ISSN
- 0010-3853 (ISSN-L)
- 1573-2789
- PMC
- PMC2916946
- OpenAlex
- W2100421191
- Cited by
- 335
- References
- 22
- Citations by year
- 2026: 13 · 2025: 8 · 2024: 12 · 2023: 11 · 2022: 23 · 2021: 25 · 2020: 19 · 2019: 17 · 2018: 15 · 2017: 63 · 2016: 27 · 2015: 25 · 2014: 17 · 2013: 26 · 2012: 18
- FWCI
- 27.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Community Mental Health Journal (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01 MH69865, R01MH069865)
- Topics
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- Housing First, homelessness, severe mental illness, substance use, customer retention, program dropout, relapse prevention
- MeSH terms
- Adult, Mental Disorders, Female, Ill-Housed Persons, Humans, Male, Mental Health Services, Middle Aged, New York, Public Housing, Severity of Illness Index, Outcome Assessment, Health Care, Diagnosis, Dual (Psychiatry), Case Management, Substance-Related Disorders, Qualitative Research, Young Adult
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