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. 2021 Dec:123:107076.
doi: 10.1016/j.addbeh.2021.107076. Epub 2021 Aug 3.

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

Anna E Austin  1 , Kristin Y Shiue  2 , Rebecca B Naumann  2 , Mary C Figgatt  2 , Caitlin Gest  3 , Meghan E Shanahan  4
Affiliations

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

Anna E Austin et al. Addict Behav. 2021 Dec.

Abstract

A synthesis of existing evidence regarding the association of housing stress with later substance use outcomes can help support and inform housing interventions as a potential strategy to address problematic substance use. We conducted a comprehensive search of PubMed, Web of Science, PsycInfo, CINAHL, Social Work Abstracts, and Sociological Abstracts and systematically screened for articles examining housing stress and later substance use outcomes among U.S. adults. Across 38 relevant articles published from 1991 to 2020, results demonstrated an association of homelessness with an increased likelihood of substance use, substance use disorders (SUD), and overdose death. Results regarding the association of homelessness with receipt and completion of SUD treatment were mixed, and one study indicated no association of homelessness with motivation to change substance use behaviors. Several studies did not find an association of unstable housing with substance use or receipt of SUD treatment, while others found an association of unstable housing with intensified SUD symptoms and a decreased likelihood of completing SUD treatment. Overall, while there is evidence of an association of homelessness with later substance use, SUD, and overdose death, results for other forms of housing stress and some substance use outcomes are less consistent. There are several methodological considerations specific to selected measures of housing stress and substance use, study populations, and analytic approaches that have implications for results and directions for future research. Despite these considerations, results collectively suggest that innovative interventions to address housing stress, namely homelessness, may help mitigate some substance use outcomes.

Keywords: Homelessness; Housing; Housing stress; Substance use; Substance use disorder treatment; Substance use disorders.

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Conflict of interest statement

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1.
Fig. 1.
PRISMA diagram.
See this image and copyright information in PMC

References

    1. Asana OO, Ayvaci ER, Pollio DE, Hong BA, & North CS (2018). Associations of alcohol use disorder, alcohol use, housing, and service use in a homeless sample of 255 individuals followed over 2 years. Substance Abuse, 39(4), 497–504. - PMC - PubMed
    1. Austin Anna E., Desrosiers TA, & Shanahan ME (2019). Directed acyclic graphs: An under-utilized tool for child maltreatment research. Child Abuse & Neglect, 91, 78–87. - PMC - PubMed
    1. Ayvaci ER, Obiri O, Pollio D, & North CS (2018). A naturalistic longitudinal study of the order of service provision with respect to cocaine use and outcomes in an urban homeless sample. Epidemiology and Psychiatric Sciences, 27(6), 611. - PMC - PubMed
    1. Baggett TP, Chang Y, Singer DE, Porneala BC, Gaeta JM, O’Connell JJ, et al. (2015). Tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities in a cohort of homeless adults in Boston. American Journal of Public Health, 105(6), 1189–1197. - PMC - PubMed
    1. Baggett TP, Hwang SW, O’Connell JJ, Porneala BC, Stringfellow EJ, Orav EJ, et al. (2013). Mortality among homeless adults in Boston: Shifts in causes of death over a 15-year period. JAMA Internal Medicine, 173(3), 189. 10.1001/jamainternmed.2013.1604. - DOI - PMC - PubMed

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