ONCERNS ABOUT HIGH PUBLIC system costs incurred by chronically homeless individuals have inspired nationwide efforts to eliminate chronic homelessness. 1,2 Homeless people have high barriers to health care access generally but use acute care services at high rates. [3][4][5] Mortality rates among homeless adults are 3 or more times that of the general population. 6,7 Chronically homeless people with severe alcohol problems, sometimes referred to as chronic public inebriates, are highly visible on the streets and are costly to the public through high use of publicly funded health and criminal justice systems resources. [8][9][10][11][12] Typical interventions such as shelters, abstinence-based housing, and treatment programs fail to reverse these patterns for this population. 10,13 Health conditions and mortality rates within this population are similar to those found in developing countries. 14,15 Average age at death is estimated to be 42 to 52 years, with 30% to 70% of deaths related to alcohol. 7,16,17 The provision of housing reduces hospital visits, admissions, and duration of hospital stays among homeless individuals, 5,18,19 and overall public system spending is reduced by nearly as much as is spent on housing. 19 One type

Homeless youths who identify themselves as members of sexual minority groups are at increased risk for negative outcomes. Recommendations for treatment programs and implications for public health are discussed.

The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or 1 of 2 control groups. The 1-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at 1 and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at 1-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group.

A large and heterogeneous sample of 364 homeless adolescents was interviewed about residential and family histories, as well as about their experiences while homeless.They were also administered a diagnostic interview and various self-report measures of emotional and behavioral functioning. Analyses were conducted to provide a better description of these youth, with a special focus on gender and age heterogeneity. Results of analyses suggested that homeless youth came from generally troubled backgrounds and had elevated rates of psychiatric disorders. For boys, their histories typically included physical abuse during childhood, physical assault on the street, and elevated rates of externalizing disorders. For girls, histories were more often marked by sexual abuse during childhood, sexual victimization on the streets, and elevated rates of internalizing disorders. Implications of these results for service delivery are discussed.

Findings did not support the enabling hypothesis. Although the project-based Housing First program did not require abstinence or treatment attendance, participants decreased their alcohol use and alcohol-related problems as a function of time and intervention exposure.

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