Substance Abuse Continued Use of Research Continued

Substance Abuse

Continued use of research

Continued use of research in professional life:

Stable housing for substance abusers

Substance abuse is strongly correlated with a wide array of risky behaviors, including a failure to live in some form of stable housing, as well as high-risk sexual behaviors. This is significant, because stable housing situations in the form of rehabilitation centers or 'halfway' homes are often used as bases of treatment for addicts. However, a review of the existing literature indicates that simply providing housing for addicts should not be regarded as a panacea or as an automatic form of treatment for addiction. In fact, the results are mixed regarding a correlation between substance abuse and the ability to obtain stable housing. For the purposes of this review, a definition of 'stable housing' will be defined as "not having lived on the street" versus "living in a shelter or single room occupancy hotel (SRO)" at any time in the past 6 months (Des Jarlais 2007).

Literature review

According to Palepu (et al. 2010), "unstable housing and homelessness is prevalent among injection drug users (IDU)" and finding a stable housing situation is often a critical component of drug treatment for substance abusers. However, in a study of 992 intravenous drug uses, "exposure to addiction treatment" and "the attainment of stable housing among participants who were homeless or living in single room occupancy (SRO) hotels…was negatively associated with attaining stable housing and may have represented a marker of instability among this sample of IDU [intravenous drug users]" (Palepu 2010). This caused the authors of the study to surmise that the most effective housing placement was actually occurring outside of addiction treatment.

Thus, surprisingly, addiction treatment was associated with persons less likely to have found stable housing, despite the clear intent of most treatment programs to introduce a more stable life situation for participants. Drawing upon these findings, it seems probable that addicts only seek treatment after addiction has had an extremely negative impact upon their life situation, and has made them less likely to be employable and able to fit into society. Even after addiction treatment, these 'hardened' addicts still struggled with finding housing, more so than addicts with 'less' treatment. This clearly reflects the tendency towards recidivism within most substance abuse programs. The results point to a larger goal for addiction treatment as a whole: rather than simply focusing upon attempting to find stable housing for hardened addicts, also focusing upon treating addicts before their situation has had a negative impact upon their housing situation and their ability to hold a job is the wider policy is wise.

The suggestion that addiction treatment is negatively associated with the ability to find stable housing does not mean that improving addicts' housing situation is still not a laudable goal, though. According to Des Jarlais (2007) in a study of substance abusers in 15 syringe exchange programs who engaged in injection risk behavior, there was consistently "more frequent injection risk behavior among unstably housed exchange participants" (Des Jarlais 2007). A lack of appropriate social controls, as imposed by a lack of a stable housing situation, can have an extremely negative effect upon substance abusers. The need to find stable housing not only normalizes the addict's life and hopefully increases exposure to treatment but can also protect the addict against the risks associated with dangerous needle use, such as Hepatitis C and AIDS. From a public health perspective, stable housing can thus perform an important function for society as well as heal the individual addict.

In the study, Des Jarlais (2007) also noted that of participants in substance abuse programs, there was a "lack of significant variation in the odds ratios for increased injection risk" suggesting that "none of the programs were 'better' or 'worse' at reducing injection risk behavior among unstably housed participants" (De Jarlais 2007). Once again, there was an extremely high rate of recidivism for programs for addicts and a notable lack of efficacy, suggesting a need for "dramatically new interventions to reduce injecting risk behavior" given the failure of current programs to result in permanent life changes (Des Jarlais 2007). However, another, smaller study 336 adult women supported the usefulness of providing stable housing for female drug users identified at high risk for engaging in HIV risk behaviors: stable housing was associated with lower-risk behavior, regardless of the specific program in which the women were enrolled (Elifson 2007).