Substance Use Outcomes Among Homeless Clients with Serious Mental Illness: A Comparative Study of Housing with Treatment Programs

Substance Use Outcomes Among Homeless Clients with Serious Mental Illness: A Comparative Study of Housing with Treatment Programs

                                                             Dyane Montoya

Grand Canyon University: NRS-433V

July 3, 2015

Problem Statement

        This qualitative research study analyzes the clinical problem of substance abuse and mental illness among the homeless, and how housing can affect outcomes for this population (dual diagnosis, mental health, homelessness). Group settings were researched assessing the difference of 27 representatives, Housing First (HF), & 48 representatives, Treatment First (TF). Split variables were researched for substance abuse use & substance abuse treatment by incorporating data for two variables, “two types related data & regression analyses, identifies this research in abstract,” (Gladwell, 2006; Nelson et al. 2007; Padgett 2007; Padgett et al. 2006).

 The research provides information on the positive outcomes of the HF group which displayed lower ratios in the use of substance abuse and treatment. This group also displayed positive outcomes in utilizing the treatment program that was given. In comparison the representatives from TF had difficulties in treatment and setback in substance abuse.

Purpose and Research Questions

        The homeless are the most challenging population to assist and educate positive health outcomes. This population suffers from not just one mental health diagnosis but several, from substance abuse to PTSD. This study reflects the theoretical framework to unveil the differences between representatives receiving treatment first (TF), reflecting the services available throughout the U.S. over the past 30 years. How does this population gain positive outcomes through receiving treatment and housing? Which should be first treatment then housing, or housing then treatment? What criteria is used to assess whether this population is ready for the steps of withdrawal symptoms to occur? The theoretical framework used to assess these types of questions was; the TF program allowed the representatives to be provided temporary housing with the status or requirement of detoxification from the drugs and alcohol used. In order for the representatives to receive housing they had to complete the first step of detox. This may impact the group because it is not a free will choice to detoxify, but a must in order to benefit fir shelter, this type of qualitative research reflects phenomenological and grounded theory, philosophy and group, social interaction, personal experiences (Grove, S. 2011). Both consist of analytical approaches.

Literature Review

        The authors do site qualitative study criteria by describing the sample size which is smaller the TF group 48, and the HF group 27, description of contrast and comparison of the two groups and the quality of the study in which the groups benefitted more from treatment first, then housing or housing first then treatment. Housing first is related to the subjective data that was provided by the nurses or case managers in the assessments of the group, identifying whether the representatives were able to live in housing without any type of observation. An organization named Pathways to housing abides by this first philosophy. The philosophy is allowing housing without a criteria of detox. Other measures incorporated are safe environment to self and others while under the influence and allowing the representative to make their own free will choices, stability, & lower residential costs (decrease in substance use not specified). There has been proof through this type of intervention has had positive outcomes with the homeless population which has been recognized as a “long-term homelessness,” (Gladwell, 2006; Nelson et al. 2007; Padgett 2007; Padgett et al. 2006). The TF group did utilize the treatment program given, because this was part of the criteria or requirement in order to be provided housing. It is pointed out by the author (s) that despite the two treatment programs there was no variable in substance use between the two groups. Substance abuse is a barrier to receiving positive behavioral health outcomes, which places greater risk for secondary physical morbidities as well as physical abuse, and incarceration. The study points the validity of the study, there were difficulties in accurately assessing the substance use more than likely by the subjective data and considering dual diagnosis. Other information provided in race/ethnic differences in the use of substances, African Americans use crack cocaine and heroin than non-African Americans, White population have increased overall life rates and use and abuse drugs, for instance; powder cocaine, alcohol, hallucinogens, & inhalants. The reference retrieved in 2000, Ma and Shive. The author (s) point out that the clinical problem is substance abuse in the population, and states statistically women abuse substances less than men, (Office of Applied Studies 2004). References used by author (s) vary from 1997 – 2007, published online: 9 January 2010. Little to no information was provided about the representatives enrolled in the study. The study specifies it was researched in order to address the spaces in knowledge base by acquiring the ratios of substance abuse and the use of treatment plans among the homeless population, which the study was completed in New York City. Three qualitative interviews were completed with representatives at 0-, 6-, and 12-months that were started 1 month proceeding the entry program. Telephonic contact was made to the participants monthly for follow up. It is described the nurses or case managers were interviewed few weeks after the participant interviews. Then a second case manager was interviewed 6 months later, depending if that specific client had not left the program. Data collection from the case managers was taken over a period of 2 years from 2005-2007. Questions asked to the case managers were, the information known and collected of the dual diagnosis of participants, and outcome for that participant’s future. The overall study was completed by 4 graduate students who were well versed in dual diagnosis populations from previous research they had conducted. The study identifies the participants were likely to have a generalized to real –life setting, the methods, materials, and setting of the study were the real world being examined. The information was derived from individual interviews, observations, case manager interviews, agency intake records, and interviewer observation. Out of 83 participants in the study, 75 (90%) completed the study from beginning to end. Other participants either moved away or had no way to be reached due to disconnected phone, or were institutionalized. This could have impacted the study in a negative way by decreasing the number of participants. Also, the relevance of two analytical appearance in the research study findings was gender and race. The national survey of women having lower substance abuse rates was not apparent in this study. What was apparent in the study is there was strong evidence to conclude that HF participants/clients have less likelihood to relapse with substance abuse when in comparison to the TF participants. And also the HF participants have a lower chance to discontinue treatment plans. This proves by the researchers that there is evidence to prove homeless individuals with mental health diagnosis can thrive and be stable in the community (Gladwell, 2006; Nelson et al. 2007; Padgett 2007; Padgett et al. 2006).