Housing versus treatment first for supportive housing participants with substance use disorders: A comparison of housing and public service use outcomes.

Background: Homeless persons with substance use disorders (SUD) have high disease risk, poor access to health care, and are frequent users of Medicaid and other social services. Low-demand supportive housing with no prerequisites for treatment or sobriety has been shown to improve housing stability and decrease public service use for chronically homeless persons with serious mental illness (SMI) and chronic medical conditions. The impact of low-demand housing on individuals with SUD but without co-occurring SMI has been little studied. This evaluation compares housing retention and use of crisis public services (jail, emergency department visits, hospitalization, and substance detoxification) between individuals treated and untreated for SUD before move-in to a low-demand supportive housing program in New York City.
Methods: The authors used matched administrative records for individuals with SUD but no SMI placed in supportive housing during 2007-2012. Participants received SUD treatment (n = 1425; treated participants) or were not treated (n = 512; active users) at housing application. Propensity score-weighted regression analyses were used to best estimate the effect of SUD treatment on incarceration, public service utilization, and housing retention.
Results: Persons not treated for SUD had a significantly longer tenure in supportive housing than treated participants. However, not treated tenants were more likely to be incarcerated. Opioid agonist therapy and older age decreased the risk of housing discharge, whereas detoxification and inpatient SUD treatment increased the risk of discharge. Conclusions: Persons with SUD can achieve residential stability in supportive housing that does not require SUD treatment before admission.