A review of housing-first strategies in reducing rates of substance use amongst people experiencing homelessness

Abstract

Substance use is a serious and prevalent health challenge among people who are homeless. The rate of alcohol use is 6 to 7 times more common in people experiencing homelessness than the general population, while approximately a quarter of all homeless individuals exhibit disordered use of one or more substances other than alcohol. Substance use is recognized as a significant risk factor for becoming homeless and is thought to complicate rehousing efforts and contribute to decreased adherence to rehabilitation programs that were and continue to be traditionally a requirement of rehousing. While studies have largely shown that housing-first strategies result in increased rates of retention in permanent housing compared to more established treatment-first strategies, it is less established whether housing-first strategies are equally successful among those homeless individuals with substance use challenges. In this review, we examine the available evidence on the efficacy of housing-first strategies in rehousing individuals with substance use challenges and in reducing the rates of substance use among people experiencing homelessness. We conclude that while housing-first strategies have not been shown to reduce rates of substance use compared to treatment-first strategies, both types of programs result in a comparable level of decrease in substance use rates despite treatment-first strategies mandating rehabilitation prior to rehousing. Finally, we provide a number of guidelines for an interdisciplinary approach to rehousing homeless individuals with substance use disorders through a housing-first strategy.