Special Considerations for Substance Abuse Issues in Shared Housing

Connection, support, sobriety, employment, and quality of life are all essential outcomes for people in recovery from substance abuse issues when considering shared housing options such as Housing First or recovery housing.

Special Considerations for Substance Abuse Issues in Shared Housing

Connection, support, sobriety, employment, and quality of life are all essential outcomes for people in recovery. Recovery is a unique journey for each individual, so there are a variety of housing options available to them, whether they are transitioning from homelessness, a treatment center, or even their own home. Continuity of affordable housing models, from Housing First to recovery housing, are invaluable to people in recovery from all walks of life. A recent study conducted by Dr.

Tsai and colleagues on alcohol and drug use disorders among homeless veterans analyzed the housing outcomes of some 30,000 veterans who entered the HUD-VASH program supported by the Department of Housing and Urban Development and Veterans Affairs. More than half of the participants had substance use disorders. The results showed that there was no difference in housing outcomes between participants with or without substance use disorders after six months in the program. This finding coincides with other studies that demonstrate that Housing First is an effective way to get people with substance use disorders into housing.

Once housed, people who entered the HUD-VASH program with a history of substance use disorders continued to report problems related to substance use. Dr. Tsai and colleagues conducted another study which compared users with people who did not use them and found that residents who used substances continued to use substances and had worse mental health than those who participated in Housing First programs. However, their substance use conditions did not worsen.

This raises questions about when and how to incorporate treatment into these programs. Tsai noted that some doctors report the need for interventions to reduce social isolation or help people reintegrate into their communities. Having a case manager who works with participants is a fundamental component of Housing First programs. Different approaches to case management exist, but many programs involve case managers who manage residents' rent payments which can drive housing success.

Some doctors are concerned about the lack of treatment requirements in the programs and whether participants are learning what they need to become independent. The best ways to impart those necessary skills are not yet clear. The VA is considering adapting case management to the needs of its program residents according to Dr. Tsai.

One way to help participants in Housing First programs may be to supplement individual case management with group case management. Tsai and her colleagues are testing such a model at the VA where groups work together on issues such as obtaining housing vouchers, staying sober, and other measures for reintegration. The program has helped combat social isolation among participants according to Dr. The Housing First model may not be a one-size-fits-all solution for all types of substance use.

Two studies have shown that people who use cocaine do not do as well in housing as those who drink excessive amounts of alcohol and many end up being left homeless. To make Housing First programs as effective as possible, Dr. Tsai recommends that service providers include services designed to keep participants housed and help them reintegrate successfully. Health services researchers note that collaboration is not a dichotomous variable; it is simply present or absent in varying degrees (Schmitt, 200).

A growing number of people in each of these categories are also receiving treatment in the public outpatient system (or equivalent based on a community mental health clinic). Likewise, Housing First helps individuals and families maintain permanent housing quickly regardless of prior participation in services while states continue to rebalance their Medicaid long-term care programs moving away from institutional care in favor of community integration for older people and people with disabilities. These levels range from peer-managed facilities such as Oxford Housing (level I) to supervised sober living homes (level II), supervised housing (level III), and residential treatment housing (level IV). Affordable housing models include permanent supportive housing (PSH), Housing First, and recovery housing.

A longitudinal study of patients in mental health and drug treatment settings revealed that mental illnesses were as prevalent and serious among people treated in substance use treatment centers as among patients in mental health treatment centers. By implementing evidence-based practices, early intervention, and an emphasis on long-term recovery, DBHIDS has been able to achieve Medicaid savings and reinvest them in system improvements including an initiative to house homeless people as described below: Federal low-income housing tax credits (LIHTC) and disaster recovery funds under the Community Development Block Grant (CDBG) were used to finance housing. As comprehensive delivery models that seek to unite physical and behavioral health care, intensive and long-term care, institutional and community services, and social supports gain more ground in Medicaid, interest in coordinated efforts grows.

Gracie Oesterling
Gracie Oesterling

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