Need and Non-Need Factors Associated with Addiction Treatment Utilization in a Cohort of Homeless and Housed Urban Poor

BACKGROUND: Research on addiction treatment utilization in indigent samples mainly has been retrospective, without measures of addictive consequences, social network influences, and motivation. Prospective assessment of factors influencing utilization could inform policy and clinical care. OBJECTIVE: We sought to identify factors associated with utilization of addiction treatment and mutual help groups among substance-dependent persons with high rates of homelessness. RESEARCH AND METHODS: This was a prospective cohort of patients detoxified from alcohol or drugs at baseline who were followed for 2 years in a randomized clinical trial of linkage to primary care (n = 274). Outcomes included utilization of Inpatient/Residential, Outpatient, Any Treatment, and Mutual Help Groups. Predictor variables in longitudinal regression analyses came from the literature and clinical experience, organized according to theoretical categories of Need, and non-Need (eg, Predisposing and Enabling). RESULTS: Many subjects used Inpatient/Residential (72%), Outpatient (62%), Any Treatment (88%) or Mutual Help Groups (93%) at least once. In multivariable analyses, addictive consequences (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.12-1.71), motivation (OR 1.32, 95% CI 1.09-1.60), and female gender (OR 1.80, 95% CI 1.13-2.86) were associated with most treatment types (ORs are for Any Treatment). Homelessness was associated with Residential/Inpatient (for Chronically Homeless vs. Housed, OR 1.75, 95% CI 1.04-2.94). Living with one's children (OR 0.51, 95% CI 0.31-0.84) and substance-abusing social environment (OR 0.65, 95% CI 0.43-0.98) were negatively associated with Any Treatment. CONCLUSIONS: In this cohort of substance-dependent persons, addictive consequences, social network variables, and motivation were associated with treatment utilization. Non-need factors, including living with one's children and gender, also were significant

Addiction · Cohort study · Confidence interval · Logistic regression · Odds · Odds ratio · Prospective cohort study · Psychiatry · Retrospective cohort study · Demography · HIV, Drug Use, Sexual Risk · Homelessness and Social Issues · Internal Medicine · Medicine · Substance Abuse Treatment and Outcomes

• Interest in online supports and brief self-help interventions among cannabis using Canadian university students

  Alexandra Loverock, Igor Yakovenko et al.•Drugs Education Prevention and…•2021

  Incluir item

• Comparing Homeless Persons’ Care Experiences in Tailored Versus Nontailored Primary Care Programs

  Stefan G Kertesz, Cheryl L Holt et al.•American Journal of Public Health•2013

  Incluir item

• Longitudinal Data Analysis for Discrete and Continuous Outcomes

  Scott L Zeger, Kung-Yee Liang et al.•Biometrics•1986

  Incluir item

• The fifth edition of the addiction severity index

  Open Access•A Thomas McLellan, Harvey W Kushner et al.•Journal of Substance Abuse…•1992

  Incluir item

• Drug Dependence, a Chronic Medical Illness

  A Thomas McLellan, David C Lewis et al.•JAMA•2000

  Incluir item

• “Mini-mental state”

  Open Access•Marshal F Folstein, Susan E Folstein et al.•Journal of Psychiatric Research•1975

  Incluir item

• The Measurement of Observer Agreement for Categorical Data

  J R Landis, Gary G Koch•Biometrics•1977

  Incluir item

• The CES-D Scale

  Open Access•Lenore Sawyer Radloff•Applied Psychological Measurement•1977

  Incluir item

• The MOS 36-ltem Short-Form Health Survey (SF-36)

  John E Ware, Cathy Donald Sherbourne•Medical Care•1992

  Incluir item

• Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization

  Open Access•R Kuhn, Dennis P Culhane•American Journal of Community…•1998

  Incluir item

• An expensive policy

  Sylvestre Clancier, H Amaro•American Journal of Public Health•1999

  Incluir item

• To House or Not to House

  Jesse B Milby, Joseph E Schumacher et al.•American Journal of Public Health•2005

  Incluir item

• Access to Inpatient or Residential Substance Abuse Treatment Among Homeless Adults With Alcohol or Other Drug Use Disorders

  Suzanne L Wenzel, M Audrey Burnam et al.•Medical Care•2001

  Incluir item

• Homeless Chronicity and Health-Related Quality of Life Trajectories Among Adults With Addictions

  Stefan G Kertesz, Juan Bautista Varela de Vega et al.•Medical Care•2005

  Incluir item

• Utilization of Mental Health and Substance Abuse Services Among Homeless Adults in Los Angeles

  Paul Koegel, Greer Sullivan et al.•Medical Care•1999

  Incluir item

• Revisiting the Behavioral Model and Access to Medical Care

  Ronald Andersen, Ronald M Andersen•Journal of Health and Social…•1995

  Incluir item