Associations of housing stress with later substance use outcomes: A systematic review

Austin, Anna E.; Shiue, Kristin Y.; Naumann, Rebecca B.; Figgatt, Mary; Gest, Caitlin; Shanahan, Meghan

doi:10.1016/j.addbeh.2021.107076

Cited by 13 publications

(14 citation statements)

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“…Yet in contrast to social challenges, psychiatric comorbidities were not significantly related to housing at discharge. As both treatment discontinuation and unstable housing predict substance use ( 30 – 32 ), our studies indicate that psychiatric comorbidities and social challenges are differentially associated with important determinants of treatment success.…”

Section: Discussionmentioning

confidence: 85%

“…Patients could be engaged in outpatient psychiatric treatment over months, but more research is imperative to evaluate and optimize care strategies. Studying housing instability is insightful as it may not only be a consequence ( 28 , 29 ) but also a cause of substance use and even overdose death ( 30 , 31 ). Moreover, meeting the basic need for stable housing is essential for effective social and professional reintegration.…”

Section: Introductionmentioning

confidence: 99%

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Housing Correlates in Pregnant and Parenting Women Using Methamphetamine and Accessing Psychiatric Care

et al. 2022

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BackgroundIntegrated care is a promising model for pregnant and parenting women with problems related to methamphetamine use. Yet more research is imperative to guide services for this vulnerable population as methamphetamine use contributes to housing instability, which is associated with heavier use and overdose death.MethodThis prospective observational study analyzed how housing at discharge from psychiatric care was related to patient characteristics, program participation, and aftercare in 102 pregnant and/or parenting women.ResultsTwelve of 23 women who were unstably housed at admission (three of six homeless) achieved stable housing by discharge from integrated care. Women were more likely unstably housed at discharge when unstably housed at admission, single, living apart from at least one minor, or when the other parent had a substance use disorder (p < 0.05). Unstably housed women at discharge were also more likely to have used social and inpatient services, and to transition to inpatient rehabilitation (p < 0.05). Among baseline characteristics, logistic regression identified unstable housing at admission (OR = 6.07) and being single (OR = 4.01) as the strongest unique contributors to unstable housing at discharge (p < 0.05).ConclusionUnstably housed women and single women seem particularly at risk of remaining in precarious living conditions despite accessing integrated care for problems associated with methamphetamine use. Future work should investigate whether stronger partnerships with government and community agencies could be a way forward to help these women attain and maintain stable housing.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Housing Correlates in Pregnant and Parenting Women Using Methamphetamine and Accessing Psychiatric Care

et al. 2022

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“…Nevertheless, the associations were robust across numerous scenarios, including among studies with low risk of bias or that had adjusted for important confounders, supporting, at least in part, a causal relationship. 5 Causality is additionally supported by ample evidence illustrating the potential mechanisms through which risk could be elevated among people who inject drugs who are unstably housed 8 , 9 , 11 and an indication of a dose-response relationship between time unhoused and HCV risk 21 and of improved HIV treatment outcomes following housing assistance. 12 In projecting the tPAF, we modelled a complete reduction in the excess risk associated with unstable housing that will probably require a multi-factorial approach beyond simply providing housing.…”

Section: Discussionmentioning

confidence: 99%

“…We did sensitivity analyses to investigate how the global and national 10-year tPAF estimates for HIV and HCV would differ if: people who inject drugs mixed partially (25%) assortatively by housing status; all people who inject drugs started injecting as stably housed; the HIV or HCV epidemics were increasing or decreasing (modelled by increasing or decreasing the HIV or HCV transmission rates by 10% from 2020); unadjusted estimates were used for the relative increase in HIV transmission risk if people who inject drugs were unstably housed (RR 1·55; 85% CI 1·23–1·95; this was omitted for HCV because the unadjusted and adjusted estimates were similar 5 ); the high relative increase in HCV transmission risk was used for western and eastern European countries (RR 2·06; 95% CI 1·64–2·59; 5 the only region found to have a statistical difference in the RR for unstable housing 5 ); 10% of HCV infected people who inject drugs were treated per year with direct acting antivirals and reinfection occurs at the same rate as for primary infection; the rate of non-HIV mortality for unstably housed people who inject drugs was double that of people who inject drugs who are stably housed. 11 …”

Section: Methodsmentioning

confidence: 99%

“…Several studies have suggested that the chronic stress associated with meeting daily survival needs among people experiencing unstable housing can supersede efforts to reduce HCV and HIV risk. 8 , 9 Unstably housed people who inject drugs face multiple barriers to accessing medical and harm reduction services 10 and are more likely to engage in sex work and high-risk injecting behaviours than stably housed people who inject drugs, 11 , 12 possibly due to the absence of safe places to store sterile injecting equipment, competing priorities in addition to injecting safely, and a greater number of injecting partners. 8 , 9 Homelessness has also been linked to HIV outbreaks that occurred during 2011–16 among people who inject drugs in Europe, North America, and Israel.…”

Section: Introductionmentioning

confidence: 99%

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The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study

Stone

Artenie

Hickman

et al. 2022

The Lancet Public Health

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Background A considerable proportion of people who inject drugs are unstably housed. Although unstable housing is associated with HIV and HCV infection among people who inject drugs, its contribution to transmission is unknown. We estimated the global and national proportions of incident HIV and HCV infections among people who inject drugs attributed to housing instability from 2020 to 2029. MethodsIn this modelling study, we developed country-level models of unstable housing and HIV and HCV transmission among people who inject drugs in 58 countries globally, calibrated to country-specific data on the prevalences of HIV and HCV and unstable housing. Based on a recently published systematic review, unstably housed people who inject drugs were assumed to have a 39% (95% CI 6-84) increased risk of HIV transmission and a 64% (95% CI 43-89%) increased risk of HCV transmission. We used pooled country-level estimates from systematic reviews on HCV and HIV prevalence in people who inject drugs. Our models estimated the transmission population attributable fraction (tPAF) of unstable housing to HIV and HCV transmission among people who inject drugs, defined as the percentage of infections prevented from 2020 to 2029 if the additional risk due to unstable housing was removed. Findings Our models were produced for 58 countries with sufficient data (accounting for >66% of the global people who inject drugs population). Globally, we project unstable housing contributes 7•9% (95% credibility interval [CrI] 2•3-15•7) of new HIV infections and 11•2% (7•7-15•5) of new HCV infections among people who inject drugs from 2020 to 2029. Country-level tPAFs were strongly associated with the prevalence of unstable housing. tPAFs were greater in high-income countries (HIV 17•2% [95% CrI 5•1-30•0]; HCV 19•4% [95% CrI 13•8-26•0]) than in low-income or middle-income countries (HIV 6•6% [95% CrI 1•8-13•1]; HCV 8•3% [95% CrI 5•5-11•7]). tPAFs for HIV and HCV were highest in Afghanistan, Czech Republic, India, USA, England, and Wales where unstable housing contributed more than 20% of new HIV and HCV infections.Interpretation Unstable housing is an important modifiable risk factor for HIV and HCV transmission among people who inject drugs in many countries. The study emphasises the importance of implementing initiatives to mitigate these risks and reduce housing instability.

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Outpatient-Based Opioid Treatment Engagement and Attendance: A Prospective Cohort Study of Homeless-Experienced Adults

Fine,

Hart,

Critchley

et al. 2024

J GEN INTERN MED

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Associations of housing stress with later substance use outcomes: A systematic review

Cited by 13 publications

References 74 publications

Housing Correlates in Pregnant and Parenting Women Using Methamphetamine and Accessing Psychiatric Care

Housing Correlates in Pregnant and Parenting Women Using Methamphetamine and Accessing Psychiatric Care

The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study

Outpatient-Based Opioid Treatment Engagement and Attendance: A Prospective Cohort Study of Homeless-Experienced Adults

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