Author

Objective

Participants

Methods

Conclusion

Appel et al. (2012)

This study was designed to test if Housing First would increase the rates of methadone compliance of
severely mentally ill homeless patients.

28 homeless participants
recruited to scattered-site
Housing First and a comparison group of 30 homeless participants who had entered into methadone maintenance therapy in New York City in 2006

Attendance at
methadone center
appointments were
analyzed at patient interviews in March of
2007 and June of 2008.

The Housing First arm of the study had more than double the retention rates in methadone programs compared to their homeless counterparts.

Collins et al. (2012)

This longitudinal study measured alcohol usage over two years among Congregate Housing First residents

95 ethnically diverse homeless individuals with known alcohol use disorders in Seattle, WA were selected to live in a Congregate Housing First building.

Participants were followed for 24 months with interviews at 3, 6, 9, 12, 18, and 24 months using questionnaires from the Alcohol Use Quantity Form, Addiction Severity Index (ASI), and the 15-item Short Inventory of Problems (SIP-2R).

The mean peak drinks per day of all participants decreased from 40 at baseline, to 26 after 24 months of intervention exposure. For every 3 months in Housing First, participants decreased daily alcohol use by 7%

Kirst et al. (2014)

This study used a randomized control design to examine if scattered-site Housing First could improve substance use outcomes among mentally ill homeless individuals, compared to treatment as usual.

575 individuals experiencing homelessness and mental illness, with or without a co-occurring substance use problem, in the parent Toronto At Home study

Substance use outcomes were compared between a Housing First intervention and treatment as usual group. 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).

Housing First can contribute to reductions in alcohol problems over time. However, the lack of effect of the intervention on illicit drug use suggests that homeless individuals with mental illness and drug problems may need additional support.

Rezansoff et al. (2016)

This study, nested in Somers et al. 2015, investigated whether Housing First in congregate and scattered-site configurations resulted in superior adherence to antipsychotic medication compared to treatment as usual.

165 adult participants met criteria for homelessness, schizophrenia, and initiation of antipsychotic pharmacotherapy prior to recruitment.                          Randomization arms were: congregate Housing First (CHF) with on-site supports (including physician and pharmacy services); scattered-site Housing First (SHF) with Assertive Community Treatment; or treatment as usual (TAU) consisting of existing services.

The mean Medication Possession Ratio was calculated for each study arm. An MPR of .80 was considered a treatment success. Participants were followed for an average of 2.6 years.

Compared to TAU, antipsychotic adherence was significantly higher in Scattered-site Housing First, at near therapeutic levels. However, Congregate Housing First clients had no statistically significant increase in medication adherence.

Padgett et al. (2010)

The purpose of this prospective cohort study was to measure the housing retention rates, substance use, and treatment utilization rates between clients in a Housing First program compared to those in a Treatment First program

27 clients in Housing First and 48 clients across three Treatment First programs in New York City. All participants had a dual diagnosis of mental illness and substance abuse disorder.

Participants were interviewed at baseline, 6 months, and 12 months using a psychosocial intake form, and Yes/No questions regarding substance use habits, and treatment utilization such as admission into a detox/rehab facility.

 HF had a much higher rate of housing stability after 12 months than Treatment First, and likely as a result of that residential stability, the participants in the Housing First arm had significantly less substance abuse. Treatment First’s coerced attendance in detox did not correlate to addiction recovery.

Parpouchi et al. (2018)

This study, nested within the Somers et al. 2015 study, investigated whether Housing First resulted in superior adherence to methadone compared to treatment as usual.

53 participants in Housing First and 44 in TAU, who had initiated methadone therapy during the parent study.

The mean Medication Possession Ratio was calculated for each study arm. Participants were followed for 24 months.

After 24 months, there was no statistically  significant difference in the MPR of methadone among Housing First versus TAU participants.

Somers et al (2015)

This landmark unblinded, 5-arm randomized controlled trial in Vancouver, Canada, compared daily substance use between homeless people assigned to HF or given treatment as usual.

297 homeless participants with mental illness labeled as “high needs” (HN) and 200 labeled as “moderate needs” (MN).

Daily substance use over 24 and 12 months was measured in each study arm using the Maudsley Addiction Profile. Also measured were demographics, homelessness history, psychiatric diagnoses, symptom severity, comorbid illnesses and duration of stable housing. Participants were followed for an average of 2.6 years.

Housing First did not reduce daily substance use compared with treatment as usual after 12 or 24 months.