9 - The Association between Stable Housing and Service Retention among a Sample of Nevadans in Substance Use Disorder Services

Abstract Information:

Introduction: Substance use disorders (SUDs), such as opioid use disorder (OUD) and stimulant use disorder, remain prevalent across the United States. There are many evidence-based treatments available for those with SUDs; however, some vulnerable populations still fall through the cracks. One such population is people experiencing homelessness (PEH) and those without stable housing. Research has shown that PEH have less access to evidence-based OUD treatment, and not having stable housing can impair treatment outcomes for clients. The purpose of this study was to examine the association between stable housing and service retention in order to evaluate if SUD services in Nevada are adequately serving PEH.

Methods: Data were collected from September 2019 to January 2023 as part of the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) State Opioid Response (SOR) Grants, which provides funding for several SUD services in Nevada. The sample was restricted to clients with a history of SUD who completed a client outcome measures interview at both intake and a 6-month follow-up period (N=1105). These interviews included client information on demographic characteristics (i.e. gender, age, and race/ethnicity), stable housing status at the 6-month follow-up, and service retention at the 6-month follow-up. Multiple logistic regression was conducted to estimate the association between stable housing and service retention while controlling for demographic characteristics.

Results: 43.5% of clients interviewed (n=472) reported not having stable housing at the 6-month follow-up and 22.9% (n=253) reported not currently receiving services at the 6-month follow-up. The findings suggest those with stable housing had over two times higher odds of still receiving services at follow-up compared to those without stable housing (AOR: 2.17, 95% CI: 1.62-2.91).

Conclusion: This study shows a large percentage of those seeking SUD services in Nevada do not have stable housing. It also provides further evidence that clients without stable housing are not retaining and utilizing SUD services as long as their counterparts that do have stable housing. These findings support previous research suggesting that additional housing assistance programs (i.e. the Housing First model) could improve outcomes among the SUD population as a whole. They highlight a need for SUD services to adopt more supportive housing programs and to delegate additional funds from funding streams (i.e. SAMHSA’s SOR grants) to such programs.

Relevance Statement: Substance use continues to be a major public health concern in the United States. Substance use disorders (SUDs), such as opioid use disorder (OUD) and stimulant use disorder, increase risk of physical, behavioral, and psychosocial health conditions. Research has shown they are related to a variety of negative outcomes including: HIV, Hepatitis C, depression, unemployment, incarceration, and mortality (McLaughlin et al., 2021; Padwa et al., 2022). A common barrier to those seeking treatment for SUDs is homelessness and not having stable housing. People experiencing homelessness (PEH) have less access to evidence-based OUD treatment (McLaughlin et al., 2021) and clients without stable housing can have poorer treatment outcomes (Padwa et al., 2022). Funding towards additional supportive housing programs (i.e. the Housing First model) could be a solution for the population experiencing this barrier. Housing First is a model of supportive housing that prioritizes shelter and independent living for PEH before everything else. This model does not require prospective clients to meet traditional prerequisites, such as sobriety and enrollment in predetermined services. It is based on the principle that shelter is a fundamental human right (Kelleher et al., 2021). These types of supportive housing programs are associated with a greater likelihood of longer retention in SUD treatment and successful graduation (Mericle et al., 2022). Currently in Nevada, the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) State Opioid Response (SOR) grants only delegate housing assistance funds to three out of the twenty-one agencies funded. This helps explain why almost half of clients interviewed reported not having stable housing. This study demonstrates a potential gap in service provision and the need to expand housing assistance programs via funding streams like the SOR grants. It also provides further evidence that such programs can be beneficial for service retention and other positive outcomes. With the recent release of the SOR III grant, SAMHSA has allowed the ability to use additional funds for recovery support services, of which includes supportive housing. This presents Nevada, as well as other states that utilize SOR funds, the perfect opportunity to address this gap that affects a large portion of the population seeking help for SUDs.

References: Kelleher, K. J., Famelia, R., Yilmazer, T., Mallory, A., Ford, J., Chavez, L. J., & Slesnick, N. (2021). Prevention of opioid use disorder: The home (housing, opportunities, motivation and Engagement) feasibility study. Harm Reduction Journal, 18(1). https://doi.org/10.1186/s12954-021-00560-x McLaughlin, M. F., Li, R., Carrero, N. D., Bain, P. A., & Chatterjee, A. (2021). Opioid use disorder treatment for people experiencing homelessness: A scoping review. Drug and Alcohol Dependence, 224, 108717. https://doi.org/10.1016/j.drugalcdep.2021.108717 Mericle, A. A., Slaymaker, V., Gliske, K., Ngo, Q., & Subbaraman, M. S. (2022). The role of recovery housing during outpatient substance use treatment. Journal of Substance Abuse Treatment, 133, 108638. https://doi.org/10.1016/j.jsat.2021.108638 Padwa, H., Bass, B., & Urada, D. (2022). Homelessness and publicly funded substance use disorder treatment in California, 2016–2019: Analysis of treatment needs, level of care placement, and outcomes. Journal of Substance Abuse Treatment, 137, 108711. https://doi.org/10.1016/j.jsat.2021.108711