A study of drug abuse treatment methodologies comparing Birmingham Alabama and Vancouver, Canada was released at PLoS One on July 24, 2010.
The Birmingham method focused on achieving abstinence and require persons who are homeless and have substance abuse problems to engage in intensive addiction treatment programs as a prerequisite to maintaining temporary housing.
"A meta-analysis of the four randomized controlled trials found that drug abstinence was higher in the abstinent contingent housing arm compared to the arm that offered only day treatment (58% vs. 26%) at six months. Interestingly, a small retrospective study that compared homeless patients receiving office-based buprenorphine treatment to housed patients found that the homeless patients had similar outcomes with respect to illicit drug use, treatment failure and use of addiction treatment despite having higher social instability, greater comorbidities, and more chronic drug use compared to the housed individuals in this study. Furthermore, 36% of the homeless group was housed at twelve months. The focus of addiction treatment is generally to reduce illicit drug use and improve social, vocational and interpersonal functioning, which would include attaining stable housing for homeless individuals."
Addiction treatment, including methadone maintenance therapy, addiction counseling and self-help groups are available through various community health centers, which also provide primary care health services throughout Vancouver and are covered by universal health care
"In total, 992 IDU participants eligible for this analysis. The median age of the cohort was 42.2 years (IQR: 35.947.1), just over one-third (N = 327) were female, 32.1% (N = 331) self-identified as of Aboriginal ancestry (i.e., First Nations, Inuit, or Métis), and 42.8% (N = 425) reported ever being diagnosed with a mental illness. The prevalence of the various mental health diagnoses was: depression (29.3%); anxiety disorder (12.2%); bipolar affective disorder (7.6%); post-traumatic stress disorder (6.1%); attention deficit disorder with or without hyperactivity (5.9%); and schizophrenia (3.0%). At baseline the proportion of the participants using drugs at least daily was substantial: crack cocaine (43.0%); injection cocaine (10.4%); and injection heroin (27.1%).
Of the 992 participants, 211 (21.3%) attained stable housing during the follow-up period for an incidence density of 9.7 (95% CI 8.411.0) per 100 person-years. At baseline, 380 (38.3%) were currently engaged in some form of addiction treatment at the baseline interview. During the follow-up period, there were 74 (7.5%) additional participants who reported addiction treatment exposure. Of the 992 participants, 811 (81.8%) reported that they had ever been homeless; 495 (50%) were homeless at baseline and of them 80 (26.4%) obtained stable housing during the follow up period. There were 497 participants who resided in SRO hotels at baseline: during the follow-up period, 366 (73.6%) remained in this form of housing and 131 (26.3%) attained stable housing in an apartment or house."
"In this prospective cohort study of injection drug users, current enrolment in addiction treatment was negatively associated with attaining stable housing, even after adjustment for potential confounders including relationship status, employment status and drug use. The negative association of addiction treatment prior to attaining stable housing is somewhat unexpected, but may reflect the inadequacy of appropriate treatment exposure to meaningfully impact long-term housing outcomes. These findings also suggest that accessing addiction treatment may be a marker of instability (i.e., periods of extreme vulnerability during which other basic necessities including food and shelter take precedence over obtaining stable housing). "
Neither method shows substantially positive results.
"A high proportion of our study participants who did not have prior addiction treatment exposure achieved stable housing over follow-up, suggesting that this group was more capable of accessing housing services that may have helped achieve this outcome and are quite separate from addiction treatment."
Addiction Treatment and Stable Housing among a Cohort of Injection Drug Users
Anita Palepu 1,2, Brandon D. L. Marshall 3,4, Calvin Lai 3, Evan Wood 3,5, Thomas Kerr 3,5
1 Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada
2 Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
3 British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
4 School of Population and Public Health, University of British Columbia, Vancouver, Canada
5 Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada
Citation: Palepu A, Marshall BDL, Lai C, Wood E, Kerr T (2010) Addiction Treatment and Stable Housing among a Cohort of Injection Drug Users. PLoS ONE 5(7): e11697. doi:10.1371/journal.pone.0011697
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