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Homelessness and Substance Use Disorders

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Clinical Management of the Homeless Patient

Abstract

Substance use disorders (SUDs) are more common among homeless persons, compared to those who are housed. There is bidirectional relationship between these disorders and homelessness, such that at times, SUD can lead to homelessness, and in other cases, homelessness can lead to SUD. In either case, homelessness is associated with more severe substance use, as well as significantly greater risk of multiple medical comorbidities, and poorer health outcomes, including suicide and other causes of mortality. This population can also present with concurrent serious mental illness, prominent trauma history, and/or PTSD. As a result, homeless persons with co-occurring SUD present significant challenges in clinical management. Initial efforts to work with this population will include community outreach and appropriate screening and assessment to identify these concerns early and offer services as soon as possible. Psychosocial interventions form the core of evidence-based treatments. Medications are available for some SUDs, but clinical management may require adaptations for use in homeless. Naloxone may be lifesaving for those with opioid use disorder. Acute hospitalization may be indicated for detoxification, and then intensive interventions, including residential programs, may be necessary post-discharge. The multi-pronged Chronic Care Model (CCM) has been successfully adapted to serving homeless persons with SUD, and can address such issues as stigma and chronicity, and offers an integrated care delivery system, to assure that comprehensive and wrap-around services are offered and made available to best serve this vulnerable population.

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References

  1. National Coalition for the Homeless. Substance abuse and homelessness. 2017. Available at www.natiohnalhomeless.org. Accessed 19 Nov 2019.

  2. Gillis L, Dickerson G, Hanson J. Recovery and homeless services: New directions for the field. Open Health Services Policy J. 2010;3:71–9.

    Article  Google Scholar 

  3. Spinelli MA, Ponath C, Tieu L, Hurstak EE, Guzman D, Kushel M. Factors associated with substance use in older homeless adults: Results from the HOPE HOME study. Subst Abus. 2017;38(1):88–94.

    Article  PubMed  Google Scholar 

  4. Fazel S, Khosla V, Doll H, Geddes J. The prevalence of mental disorders among the homeless in Western countries: Systematic review and meta-regression analysis. PLoS Med. 2008;5:e225.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Baggett TP, Rigotti NA. Cigarette smoking and advice to quit in a national sample of homeless adults. Am J Prev Med. 2010;39:164–72.

    Article  PubMed  Google Scholar 

  6. Hwang SW, Wilkins R, Tjepkema M, O’Campo PJ, Dunn JR. Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study. BMJ. 2009;339:b4036.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Substance Abuse and Mental Health Services Administration. Addressing viral hepatitis in people with substance use disorders. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2011. (Treatment Improvement Protocol (TIP) Series 53). HHS Publication No. (SMA) 11–4656.

    Google Scholar 

  8. Orwin RG, Scott CK, Arieira C. Transitions through homelessness and factors that predict them: Three-year treatment outcomes. J Subst Abuse Treat. 2005;28:S23–39.

    Article  PubMed  Google Scholar 

  9. North CS, Eyrich KM, Pollio DE, Foster DA, Cottler LB, Spitznagel EL. The Homeless Supplement to the Diagnostic Interview Schedule: Test–retest analyses. Int J Methods Psychiatr Res. 2004;13:184–91.

    Article  PubMed  Google Scholar 

  10. O’Toole TP, Conde-Martel A, Gibbon JL, Hanusa BH, Freyder PJ, Fine MJ. Substance-abusing urban homeless in the late 1990s: How do they differ from non-substance-abusing homeless persons? J Urban Health. 2004;81:606–17.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Buchholz JR, Malte CA, Calsyn DA, Baer JS, Nichol P, Kivlahan DR, et al. Associations of housing status with substance abuse treatment and service use outcomes among veterans. Psychiatr Serv. 2010;61:698–706.

    Article  PubMed  Google Scholar 

  12. Halpern SD, Mechem CC. Declining rate of substance abuse throughout the month. Am J Med. 2001;110(5):347–51.

    Article  CAS  PubMed  Google Scholar 

  13. Greenberg GA, Rosenheck RA. Jail Incarceration, Homelessness and mental Health: A National Study. Psychiatr Serv. 2008;59(2):170–7.

    Article  PubMed  Google Scholar 

  14. Homeless Hub. Substance use & addiction. 2019. Available at: www.homelesshub.ca/about-homelessness/topics/substance-use-addiction. Accessed 19 Nov 2019.

  15. O’Brien KK, Schuttke A, Alhakeem A, Donnelly-Swift E, Keogh C, O’Carroll A, et al. Health, perceived quality of life and health services use among homeless illicit drug users. Drug Alcohol Depend. 2015;154:139–45.

    Article  PubMed  Google Scholar 

  16. O’Connell JJ. Premature mortality in homeless populations: A review of the literature. National Healthcare for the Homeless Council: Nashville; 2005.

    Google Scholar 

  17. Seal KH, Kral AH, Gee L, Moore LD, Bluthenthal RN, Lorvick J, et al. Predictors and prevention of nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area, 1998–1999. Am J Public Health. 2001;91:1842–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Rosenheck R, Kasprow W, Frisman L, Liu-Mares W. Cost-effectiveness of supported housing for homeless persons with mental illness. Arch Gen Psychiatry. 2003;60:940–51.

    Article  PubMed  Google Scholar 

  19. Lee KH, Jun JS, Kim YJ, Roh S, Moon SS, Bukonda N, Hines L. Mental Health, Substance Abuse, and Suicide Among Homeless Adults. J Evid Inf Soc Work. 2017;14(4):229–42.

    Article  PubMed  Google Scholar 

  20. Bauer LK, Brody JK, León C, Health B, Baggett TP. Characteristics of Homeless Adults Who Died of Drug Overdose: A Retrospective Record Review HHS Public Access. J Heal Care Poor Underserved. 2016;27(2):846–59.

    Article  Google Scholar 

  21. Glasser I, Zywiak WH. Homelessness and substance misuse: a tale of two cities. Subst Use Misuse. 2003;38(3–6):551–76.

    Article  PubMed  Google Scholar 

  22. Johnson TP, Freels SA, Parsons JA, et al. Substance abuse and homelessness: Social selection or social adaptation? Addiction. 1997;92(4):437–45.

    Article  CAS  PubMed  Google Scholar 

  23. Didenko E, Pankratz N. Substance use: pathways to homelessness? or a way of adapting to street life? Substance use: pathways to homelessness? or a way of adapting to street life? | here to help. 2007. Available at http://www.heretohelp.bc.ca/visions/housing-and-homelessness-vol4/substance-usepathways-homelessness.) Accessed 29 Nov 2019.

  24. Fountain J, Howes S, Marsden J, et al. Drug and alcohol use and the link with homelessness: Results from a survey of homeless people in London. Addiction Res Theory. 2003;11(4):245–56.

    Article  Google Scholar 

  25. Eyrich-Garg KM, Cacciola JS, Carise D, Lynch KG, McLellan AT. Individual characteristics of the literally homeless, marginally housed, and impoverished in a US substance abuse treatment-seeking sample. Soc Psychiatry Psychiatr Epidemiol. 2008;43:831–42.

    Article  PubMed  Google Scholar 

  26. Center for Mental Health Services. Blueprint for change: Ending chronic homelessness for persons with serious mental illnesses and co-occurring substance use disorders. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2003. HHS Publication No. (SMA) 04-3870.

    Google Scholar 

  27. Ball SA, Cobb-Richardson P, Connolly AJ, Bujosa CT, O’Neall TW. Substance abuse and personality disorders in homeless drop-in center clients: Symptom severity and psychotherapy retention in a randomized clinical trial. Compr Psychiatry. 2005;46:371–9.

    Article  PubMed  Google Scholar 

  28. Wan JJ, Morabito DJ, Khaw L, Knudson MM, Dicker RA. Mental illness as an independent risk factor for unintentional injury and injury recidivism. J Trauma. 2006;61:1299–304.

    Article  PubMed  Google Scholar 

  29. Frencher SK Jr, Benedicto CM, Kendig TD, Herman D, Barlow B, Pressley JC. A comparative analysis of serious injury and illness among homeless and housed low income residents of New York City. J Trauma. 2010;69:S191–9.

    PubMed  Google Scholar 

  30. Tam TW, Zlotnick C, Robertson MJ. Longitudinal perspective: Adverse childhood events, substance use, and labor force participation among homeless adults. Am J Drug Alcohol Abuse. 2003;29:829–46.

    Article  PubMed  Google Scholar 

  31. Maniglio R. Severe mental illness and criminal victimization: A systematic review. Acta Psychiatr Scand. 2009;119:180–91.

    Article  CAS  PubMed  Google Scholar 

  32. Kulka RA. Considerations in estimating the prevalence of PTSD in Populations not typically covered in household surveys. National Academy of Sciences, Engineering and Medicine. 2016. Available at: https://sites.nationalacademies.org/cs/groups/dbassesite/documents/webpage/dbasse_173482.pdf. Accessed 28 Nov 2019.

  33. Whitbeck LB, Armenta BE, Gentzler KC. Homelessness‐related traumatic events and PTSD among women experiencing episodes of homelessness in three US cities. J Trauma Stress. 2015;28(4):355–60.

    Article  PubMed  Google Scholar 

  34. Tai B, Volkow ND. Treatment for substance use disorder: opportunities and challenges under the affordable care act. Soc Work Public Health. 2013;28(3–4):165–74.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Watkins KE, Ober AJ, Lamp K, Lind M, Setodji C, Osilla KC, et al. Collaborative care for opioid and alcohol use disorders in primary care: The SUMMIT Randomized Clinical Trial. JAMA Int Med. 2017;177(10):1480–8. https://doi.org/10.1001/jamainternmed.2017.3947.

    Article  Google Scholar 

  36. Dennis ML, Scott CK, Dennis M. Four-year outcomes from the Early Re-Intervention (ERI) experiment using Recovery Management Checkups (RMC). Drug Alcohol Depend. 2012;121(2):10–7.

    Article  PubMed  Google Scholar 

  37. O’Toole TP, Buckel L, Bourgault C, Blumen J, Redihan SG, Jiang L, et al. Applying the chronic care model to homeless veterans: effect of a population approach to primary care on utilization and clinical outcomes. Am J Public Health. 2010;100(12):2493–9.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Smelson DA, Kline A, Kuhn J, Rodrigues S, O’Connor K, Fisher W, et al. A Wraparound treatment engagement intervention for homeless veterans with co-occurring disorders. Psychol Serv. 2013;10(2):161–7.

    Article  PubMed  Google Scholar 

  39. Upshur C, Weinreb L, Bharel M, Reed G, Frisard C. A randomized control trial of a chronic care intervention for homeless women with alcohol use problems. J Subst Abuse Treat. 2015;51:19–29.

    Article  PubMed  Google Scholar 

  40. McClellan C, Lambdin BH, Ali MM, Mutter R, Davis CS, Wheeler E, et al. Opioid-overdose laws association with opioid use and overdose mortality. Addict Behav. 2018;86:90–5.

    Article  PubMed  Google Scholar 

  41. Blue Shield of California Foundation. Exploring low-income Californians’ needs and preferences for behavioral health care. 2015;(March). Available from: https://blueshieldcafoundation.org/sites/default/files/covers/Behavioral Health Langer Report_2015.pdf.

  42. Scott CK, Dennis ML, Laudet A, Funk RR, Simeone RS. Surviving drug addiction: the effect of treatment and abstinence on mortality. Am J Public Health. 2011;101:737–44.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Fisk D, Rakfeldt J, McCormack E. Assertive outreach: An effective strategy for engaging homeless persons with substance use disorders into treatment. Am J Drug Alcohol Abuse. 2006;32:479–86.

    Article  PubMed  Google Scholar 

  44. Gordon SJ, Grimmer K, Bradley A, Direen T, Baker N, Marin T, et al. Health assessments and screening tools for adults experiencing homelessness: a systematic review. BMC Public Health. 2019;19(1):994.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. McLellan AT, Luborsky L, O’Brien CP, Woody GE. An improved diagnostic instrument for substance abuse patients: The Addiction Severity Index. J Nerv Ment Dis. 1980;168:26–33.

    Article  CAS  Google Scholar 

  46. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.

    Google Scholar 

  47. Brain Injury Screening Questionnaire. (1998). New York: Research and Training Center on Community Integration, Mount Sinai School of Medicine.

    Google Scholar 

  48. Sullivan G, Dumenci L, Burnam A, Koegel P. Validation of the brief instrumental functioning scale in a homeless population. Psychiatr Serv. 2001;52(8):1097–9.

    Article  CAS  PubMed  Google Scholar 

  49. Cook PF, Farrell E, Perlman J. The CCH Consumer Outcome Scales: A Brief Instrument to Assess the Multiple Problems of Homelessness. J Nurs Meas. 2007;15(2):83–104.

    Article  PubMed  Google Scholar 

  50. Andrews FM, Crandall R. The validity of measures of self-reported well-being. Soc Indic Res. 1976;3(1):1–19.

    Article  Google Scholar 

  51. Craft-Rosenberg M, Powell SR, Culp K. Iowa Homeless Research Team. Health status and resources of rural homeless women and children. West J Nurs Res. 2000;22(8):863–78.

    Article  CAS  PubMed  Google Scholar 

  52. Baker GA, Jacoby A, Smith DF, Dewey ME, Chadwick DW. Development of a Novel Scale to Assess Life Fulfilment as Part of the Further Refinement of a Quality‐of‐Life Model for Epilepsy. Epilepsia. 1994;35(3):591–6.

    Article  CAS  PubMed  Google Scholar 

  53. Hunt SM. The Nottingham health profile: user’s manual. Measuring Health Status. 1986.

    Google Scholar 

  54. Ware JE Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.

    Article  PubMed  Google Scholar 

  55. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.

    Article  PubMed  Google Scholar 

  56. WHOQOL Group. Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Qual Life Res. 1993;2(2):153–9.

    Article  Google Scholar 

  57. Skevington SM, Lotfy M, O’Connell KA, WHOQOL Group. Qual Life Res. 2004;13(2):299–310.

    Article  CAS  PubMed  Google Scholar 

  58. O’Campo P, Kirst M, Schaefer-McDaniel N, Firestone M, Scott A, McShane K. Community-based services for homeless adults experiencing concurrent mental health and substance use disorders: A realist approach to synthesizing evidence. J Urban Health. 2009;86:965–89.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Center for Substance Abuse Treatment. Enhancing motivation for change in substance abuse treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration; 1999. (Treatment Improvement Protocol (TIP) Series 35). HHS Publication No. (SMA) 99-3354.

    Google Scholar 

  60. Fisk D, Sells D, Rowe M. Sober housing and motivational interviewing: The Treatment Access Project. J Prim Prev. 2007;28:281–93.

    Article  PubMed  Google Scholar 

  61. Bradford DW, Gaynes BN, Kim MM, Kaufman JS, Weinberger M. Can shelter-based interventions improve treatment engagement in homeless individuals with psychiatric and/or substance misuse disorders? A randomized controlled trial. Med Care. 2005;43:763–8.

    Article  PubMed  Google Scholar 

  62. Essock SM, Mueser KT, Drake RE, Covell NH, McHugo GJ, Frisman LK, et al. Comparison of ACT and standard case management for delivering integrated treatment for co-occurring disorders. Psychiatr Serv. 2006;57:185–96.

    Article  PubMed  Google Scholar 

  63. D’Amico EJ, Houck JM, Hunter SB, Miles JN, Osilla KC, Ewing BA. Group motivational interviewing for adolescents: Change talk and alcohol and marijuana outcomes. J Consult Clin Psychol. 2015;83(1):68–80.

    Article  PubMed  Google Scholar 

  64. Brown LD, Wituk S, Meissen G. Mental health self-help: Consumer and family initiatives. New York: Springer Science + Business Media; 2010. Consumer-run drop-in centers: Current State and Future Directions; pp. 155–167.

    Book  Google Scholar 

  65. Alcoholics Anonymous. The big book. Available at http://www.12steps.nz/12-step-programs/alcoholics-anonymous/the-big-book/#Low_Bottom_Alcoholic_Recovery_Stories. Accessed 2 Jan 2020.

  66. Rayburn R, Wright JD. Homeless men in alcoholics anonymous: barriers to achieving and maintaining sobriety. J Appl Soc Sci. 2009;3(1):55–70.

    Article  Google Scholar 

  67. Fellowship of Narcotics Anonymous. Narcotics Anonymous: 6th edition Basic Text. NA World Services Inc. 2008.

    Google Scholar 

  68. Booth BM, Sullivan G, Koegel P, Burnam A. Vulnerability factors for homelessness associated with substance dependence in a community sample of homeless adults. Am J Drug Alcohol Abuse. 2002;28(3):429–52.

    Article  PubMed  Google Scholar 

  69. Stark L. A century of alcohol and homelessness: Demographics and stereotypes. Alcohol Res Health. 1987;11(3):8.

    Google Scholar 

  70. Watson DP, Shuman V, Kowalsky J, et al. Housing First and harm reduction: a rapid review and document analysis of the US and Canadian open-access literature. Harm Reduct J. 2017;14:30.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Tsemberis S, Gulcur L, Nakae M. Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. Am J Public Health. 2004;94(4):651–6.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Tsai J, Rosenheck RA, Kasprow WJ, McGuire JF. Do faith-based residential care services affect the religious faith and clinical outcomes of homeless veterans? Comm MH J. 2012;48(6):682–91.

    Google Scholar 

  73. Center for Substance Abuse Treatment (US). Behavioral health services for people who are homeless. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013. (Treatment Improvement Protocol (TIP) Series, No. 55.) A Review of the Literature. Available from: https://www.ncbi.nlm.nih.gov/books/NBK138716. Accessed November 29, 2019.

    Google Scholar 

  74. Schumacher JE, Milby JB, Wallace D, Meehan DC, Kertesz S, Vuchinich R, et al. Meta-analysis of day treatment and contingency-management dismantling research: Birmingham Homeless Cocaine Studies (1990–2006). J Consult Clin Psychol. 2007;75:823–8.

    Article  PubMed  Google Scholar 

  75. Reback CJ, Peck JA, Dierst-Davies R, Nuno M, Kamien JB, Amass L. Contingency management among homeless, out-of-treatment men who have sex with men. J Subst Abuse Treat. 2010;39:255–63.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Morrison S. Self management support helping clients set goals to improve their health. National Health Care for the Homeless Council: Nashville; 2007.

    Google Scholar 

  77. Gilmer TP, Dolder CR, Lacro JP, Folsom DP, Lindamer L, Garcia P, et al. Adherence to treatment with antipsychotic medication and health care costs among Medicaid beneficiaries with schizophrenia. Am J Psychiatry. 2004;161:692–9.

    Article  PubMed  Google Scholar 

  78. Baggett TP, Hwang SW, O’Connell JJ, Porneala BC, Stringfellow EJ, Orav EJ, et al. Mortality among homeless adults in Boston: Shifts in causes of death over a 15-year period. JAMA Intern Med. 2013;173(3):189–95.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Strang J. Death matters: understanding heroin/opiate overdose risk and testing potential to prevent deaths. Addiction. 2015;110(Suppl 2):27–35.

    Article  PubMed  Google Scholar 

  80. FDA moves quickly to approve easy-to-use nasal spray to treat opioid overdose. 2015. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm473505.htm. Accessed 30 Nov 2019.

  81. Strang J, Manning V, Mayet S, Titherington E, Offor L, Semmler C, et al. Family carers and the prevention of heroin overdose deaths: unmet training need and overlooked intervention opportunity of resuscitation training and supply of naloxone. Drugs Educ Prev Policy. 2008;15(2):211–8.

    Article  Google Scholar 

  82. Davis C, Carr D. State legal innovations to encourage naloxone dispensing. J Am Pharm Assoc. 2017;57(Supplement):S180–4.

    Article  Google Scholar 

  83. Strang JMcDonald R, Campbell G, Degenhardt L, Nielsen S, Ritter A, Dale O. Take-home naloxone for the emergency interim management of opioid overdose: the public health application of an emergency medicine. Drugs. 2019;79(13):1395–418.

    Article  Google Scholar 

  84. Sohn M, Talbert JC, Huang Z, Lofwall MR, Freeman PR. Association of naloxone coprescription laws with naloxone prescription dispensing in the United States. JAMA Netw Open. 2019;21:2(6).

    Google Scholar 

  85. Pietrusza LM, Puskar KR, Ren D, Mitchell AM. Evaluation of an Opiate Overdose Educational Intervention and Naloxone Prescribing Program in Homeless Adults Who Use Opiates. J Addict Nurs. 2018;29(3):188–95.

    Article  PubMed  Google Scholar 

  86. Wallace B, Barber K. Pauly B (Bernie). Sheltering risks: Implementation of harm reduction in homeless shelters during an overdose emergency. Int J Drug Policy. 2018;53:83–9.

    Article  PubMed  Google Scholar 

  87. Alford DP, LaBelle CT, Richardson JM, O’Connell JJ, Hohl CA, Cheng DM, et al. Treating homeless opioid dependent patients with buprenorphine in an office-based setting. J Gen Intern Med. 2007;22:171–6.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Pasic J, Russo J, Roy-Byrne P. High utilizers of psychiatric emergency services. Psychiatr Serv. 2005;56:678–84.

    Article  PubMed  Google Scholar 

  89. Ng AT. Mobile crisis teams. In: Gillig PM, McQuistion HL, editors. Clinical guide to the treatment of the mentally ill homeless person. Arlington: American Psychiatric Publishing; 2006. p. 73–82.

    Google Scholar 

  90. Salit SA, Kuhn EM, Hartz AJ, Vu JM, Mosso AL. Hospitalization costs associated with homelessness in New York City. N Engl J Med. 1998;338:1734–40.

    Article  CAS  PubMed  Google Scholar 

  91. Hwang SW, Weaver J, Aubry T, Hoch JS. Hospital costs and length of stay among homeless patients admitted to medical, surgical, and psychiatric services. Med Care. 2011;49:350–4.

    Article  PubMed  Google Scholar 

  92. Irmiter C, McCarthy JF, Barry KL, Soliman S, Blow FC. Reinstitutionalization following psychiatric discharge among VA patients with serious mental illness: A national longitudinal study. Psychiatric Q. 2007;78:279–86.

    Article  Google Scholar 

  93. US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Treatment Episode Data Set—Admissions (TEDS-A), 2009. 2011. Inter-university Consortium for Political and Social Research (ICPSR).

    Google Scholar 

  94. Moos RH, Moos BS. Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction. 2006;101(2):212–22.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Paliwal P, Hyman SM, Sinha R. Craving predicts time to cocaine relapse: further validation of the Now and Brief versions of the cocaine craving questionnaire. Drug Alcohol Depend. 2008;93(3):252–9.

    Article  CAS  PubMed  Google Scholar 

  96. Chutuape MA, Jasinski DR, Fingerhood MI. Stitzer ML One-, three-, and six-month outcomes after brief inpatient opioid detoxification. Am J Drug Alcohol Abuse. 2001;27(1):19–44.

    Article  CAS  PubMed  Google Scholar 

  97. Kertesz SG, Horton NJ, Friedmann PD, Saitz R, Samet JH. Slowing the revolving door: Stabilization programs reduce homeless persons’ substance use after detoxification. J Subst Abuse Treat. 2003;24:197–207.

    Article  PubMed  Google Scholar 

  98. Moore JT, Skinner MA. Treatment mechanisms with homeless veterans. J Dual Diagn. 2017;13(4):291–7.

    Article  PubMed  Google Scholar 

  99. Tuten M, DeFulio A, Jones HE, Stitzer M. Abstinence-contingent recovery housing and reinforcement-based treatment following opioid detoxification. Addiction. 2012;107(5):973–82.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Roozen HG, Boulogne JJ, van Tulder MW, van den Brink W, De Jong CA, Kerkhof AJ. A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction. Drug Alcohol Depend. 2004;74(1):1–13.

    Article  PubMed  Google Scholar 

  101. Jason LA, Olson BD, Ferrari JR, Lo Sasso AT. Communal housing settings enhance substance abuse recovery. Am J Public Health. 2006;96(10):1727–9.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Tuten M, Shadur JM, Stitzer M, Jones HE. A comparison of Reinforcement Based Treatment (RBH) versus RBT plus Recovery Housing (RBTRH). J Subst Abuse Treat. 2017;72:48–55.

    Article  PubMed  Google Scholar 

  103. Watkins KE, Ober AJ, Lamp K, Lind M, Diamant A, Osilla KC, Heinzerling K, Hunter SB, Pincus HA. Implementing the chronic care model for opioid and alcohol use disorders in primary care. Prog Community Health Partnersh. 2017;11(4):399.

    Article  Google Scholar 

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Authors and Affiliations

  1. George Washington University Hospital, Department of Psychiatry, Washington, DC, USA

    Gary W. Stablein

  2. Georgetown University School of Medicine, Washington DC Veterans Affairs Medical Center, Department of Psychiatry, Washington, DC, USA

    Bruce S. Hill

  3. George Washington University, School of Medicine, Washington, DC, USA

    Samaneh Keshavarz

  4. Department of Veterans Affairs, Georgetown University School of Medicine, Department of Psychiatry, Washington, DC, USA

    Maria D. Llorente

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  1. Gary W. Stablein
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  2. Bruce S. Hill
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  3. Samaneh Keshavarz
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  4. Maria D. Llorente
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Correspondence to Maria D. Llorente .

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Editors and Affiliations

  1. Medstar Washington Hospital Center, Georgetown University School of Medicine, Department of Psychiatry, Washington, DC, USA

    Elspeth Cameron Ritchie

  2. Department of Veterans Affairs, Georgetown University School of Medicine, Department of Psychiatry, Washington, DC, USA

    Maria D. Llorente

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Stablein, G.W., Hill, B.S., Keshavarz, S., Llorente, M.D. (2021). Homelessness and Substance Use Disorders. In: Ritchie, E.C., Llorente, M.D. (eds) Clinical Management of the Homeless Patient. Springer, Cham. https://doi.org/10.1007/978-3-030-70135-2_12

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