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A naturalistic longitudinal study of the order of service provision with respect to cocaine use and outcomes in an urban homeless sample

Published online by Cambridge University Press:  02 May 2017

E. R. Ayvaci Open the ORCID record for E. R. Ayvaci [Opens in a new window] ,
O. Obiri ,
D. Pollio  and
C. S. North
E. R. Ayvaci*
Affiliation:
Psychiatry Department, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
O. Obiri
Affiliation:
Psychiatry Department, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
D. Pollio
Affiliation:
Department of Social Work, University of Alabama at Birmingham, Birmingham, Alabama, USA
C. S. North
Affiliation:
Psychiatry Department, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA Altshuler Center for Education and Research, Metrocare Services, Dallas, Texas, USA
*
*Address for correspondence: Dr E. R. Ayvaci, Psychiatry Department, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA. (Email: emine.ayvaci@phhs.org)
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Abstract

Aims.

Little is known about outcomes of drug abuse related to attainment of stable housing. This study examined outcomes of cocaine use and service provision in an urban homeless sample.

Methods.

Two-year longitudinal study of systematically selected homeless individuals (N = 255) in St. Louis, Missouri from 1999 to 2001. The sample was interviewed three times annually using a structured diagnostic interview. Urine drug testing was conducted at every interview, and service utilisation data were obtained from the structured interviews and the agency-provided service use data.

Results.

Cocaine use disorder and cocaine use proved to be distinct concepts because they predicted different outcomes across time. Cocaine use predicted subsequent poor housing outcomes, but stable housing had no apparent effect on subsequent use of cocaine. Service use predicted neither subsequent reduced cocaine use nor attainment of stable housing. Services used were appropriate to type of mental health need, but cocaine use may have reduced successful utilisation of appropriate psychiatric services.

Conclusion.

These findings reinforce the concept that homelessness represents a complex phenomenon and consequently, service systems need to address multiple problems. Service approaches are needed that simultaneously address the complex needs of homeless individuals.

Keywords

Cocaine usehomelessnessHousing Firstpsychiatric disordersservice utilisationsubstance use disorder
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 6 , December 2018 , pp. 611 - 618
Copyright
Copyright © Cambridge University Press 2017 

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References

Appel, PW, Hoffman, JH, Blane, HT, Frank, B, Oldak, R, Burke, M (2001). Comparison of self-report and hair analysis in detecting cocaine use in a homeless/transient sample. Journal of Psychoactive Drugs 33, 47–55.Google Scholar
Carrà, G, Crocamo, C, Borrelli, P, Tabacchi, T, Bartoli, F, Popa, I, Montomoli, C, Clerici, M (2016). Area-level deprivation and adverse consequences in people with substance use disorders: findings from the Psychiatric and Addictive Dual Disorder in Italy (PADDI) Study. Substance Use & Misuse 52, 1–8.Google Scholar
Cottler, LB, Compton, WM (1993). Advantages of the CIDI family of instruments in epidemiological research of substance use disorders. International Journal of Methods in Psychiatric Research 3, 109–119.Google Scholar
Drake, RE, Mueser, KT, Brunette, MF (2007). Management of persons with co-occurring severe mental illness and substance use disorder: program implications. World Psychiatry 6, 131–136.Google Scholar
Fuehrlein, BS, Cowell, AJ, Pollio, DE, Cupps, LY, Balfour, ME, North, CS (2014). Deriving costs of service use among an urban homeless population. Journal of Substance Abuse Treatment 46, 491–497.Google Scholar
Jencks, C (1994). The Homeless. Harvard University Press: Cambridge, Massachusetts.Google Scholar
Kertesz, SG, Crouch, K, Milby, JB, Cusimano, RE, Schumacher, JE (2009). Housing first for homeless persons with active addiction: are we overreaching? Milbank Q 87, 495–534.Google Scholar
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, H-U, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.Google Scholar
Koegel, P, Burnam, MA, Farr, RK (1988). The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. Archives of General Psychiatry 45, 1085–1092.Google Scholar
Lambert, EY, Caces, MF (1995). Correlates of drug abuse among homeless and transient people in the Washington, DC, metropolitan area in 1991. Public Health Reports 110, 455–461.Google Scholar
McVicar, D, Moschion, J, van Ours, JC (2015). From substance use to homelessness or vice versa? Social Science & Medicine 136, 89–98.Google Scholar
North, CS, Eyrich, KM, Pollio, DE, Foster, DA, Cottler, LB, Spitznagel, EL (2004 a). The homeless supplement to the diagnostic interview schedule: test-retest analyses. International Journal of Methods in Psychiatric Research 13, 184–191.Google Scholar
North, CS, Eyrich, KM, Pollio, DE, Spitznagel, EL (2004 b). Are rates of psychiatric disorders in the homeless population changing? American Journal of Public Health 94, 103–108.Google Scholar
North, CS, Eyrich-Garg, KM, Pollio, DE, Thirthalli, J (2010). A prospective study of substance use and housing stability in a homeless population. Social Psychiatry and Psychiatric Epidemiology 45, 1055–1062.Google Scholar
North, CS, Black, M, Pollio, DE (2012). Predictors of successful tracking over time in a homeless population. Social Work Research 36, 153–159.Google Scholar
O'Toole, TP, Conde-Martel, A, Gibbon, JL, Hanusa, BH, Freyder, PJ, Fine, MJ (2004). Substance-abusing urban homeless in the late 1990s: how do they differ from non-substance-abusing homeless persons? Journal of Urban Health 81, 606–617.Google Scholar
Robins, L, Cottler, L, Bucholz, K, Compton, W (1995). Diagnostic Interview Schedule for the DSM-IV (DIS-IV). Washington University: St Louis, MO.Google Scholar
Smith, EM, North, CS, Spitznagel, EL (1992). A systematic study of mental illness, substance abuse, and treatment in 600 homeless men. Annals of Clinical Psychiatry 4, 111–120.Google Scholar
Smith, EM, North, CS, Spitznagel, EL (1993). Alcohol, drugs, and psychiatric comorbidity among homeless women: an epidemiologic study. Journal of Clinical Psychiatry 54, 82–87.Google Scholar
Stahler, GJ, Shipley, TE Jr.,, Kirby, KC, Godboldte, C, Kerwin, ME, Shandler, I, Simons, L (2005). Development and initial demonstration of a community-based intervention for homeless, cocaine-using, African-American Women. Journal of Substance Abuse Treatment 28, 171–179.Google Scholar
Stringfellow, EJ, Kim, TW, Gordon, AJ, Pollio, DE, Grucza, RA, Austin, EL, Johnson, NK, Kertesz, SG (2016). Substance use among persons with homeless experience in primary care. Substance Abuse 37, 1–8.Google Scholar
Tsai, J, Kasprow, WJ, Rosenheck, RA (2014). Alcohol and drug use disorders among homeless veterans: prevalence and association with supported housing outcomes. Addictive Behaviors 39, 455–460.Google Scholar
Tsemberis, S, Gulcur, L, Nakae, M (2004). Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health 94, 651–656.Google Scholar