The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness
The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness
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DOI：
10.1016/j.drugalcdep.2014.10.019
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发表时间：
2015-01-01
影响因子：
4.2
通讯作者：
Stergiopoulos, Vicky
中科院分区：
文献类型：
--
作者：
Kirst, Maritt;Zerger, Suzanne;Stergiopoulos, Vicky
背景：有强有力的证据表明，住房优先干预在改善患有精神疾病和成瘾的无家可归者的住房稳定性和生活质量方面是有效的。然而，几乎没有证据表明住房优先在改善这一人群中与物质使用相关的结果方面的有效性。本研究采用随机对照设计，在加拿大多伦多的At Home/Chez Soi试验中，比较了住房优先干预和照常治疗组中575名无家可归者和精神疾病患者的物质使用结果。使用广义线性模型来比较研究臂随时间(基线、6、12、18和24个月)的物质使用结果的变化。结果：在24个月时，住房优先干预组的参与者经历酒精问题的天数和酒精花费的金额比通常治疗组的参与者显著减少。在24个月后，研究人员在非法药物结果方面没有发现差异。结论：这些发现表明，住房优先干预可以帮助减少超时饮酒问题。然而，对非法药物问题的干预缺乏效果表明，经历无家可归、精神疾病和毒品问题的个人可能需要额外的支持来减少使用。试验登记：当前对照试验ISRCTN42520374。(C)2014爱思唯尔爱尔兰有限公司。保留所有权利。
Background: There is strong evidence that Housing First interventions are effective in improving housing stability and quality of life among homeless people with mental illness and addictions. However, there is very little evidence on the effectiveness of Housing First in improving substance use-related outcomes in this population. This study uses a randomized control design to examine the effects of scatter-site Housing First on substance use outcomes in a large urban centre.Methods: Substance use outcomes were compared between a Housing First intervention and treatment as usual group in a sample of 575 individuals experiencing homelessness and mental illness, with or without a co-occurring substance use problem, in the At Home/Chez Soi trial in Toronto, Canada. Generalized linear models were used to compare study arms with respect to change in substance use outcomes over time (baseline, 6, 12, 18 and 24 month).Results: At 24 months, participants in the Housing First intervention had significantly greater reductions in number of days experiencing alcohol problems and amount of money spent on alcohol than participants in the Treatment as Usual group. No differences between the study arms in illicit drug outcomes were found at 24 months.Conclusions: These findings show that a Housing First intervention can contribute to reductions in alcohol problems overtime. However, the lack of effect of the intervention on illicit drug problems suggests that individuals experiencing homelessness, mental illness and drug problems may need additional supports to reduce use. Trial Registration: Current controlled trials ISRCTN42520374. (C) 2014 Elsevier Ireland Ltd. All rights reserved.