Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis

Am J Public Health. 2004 Apr;94(4):651-6. doi: 10.2105/ajph.94.4.651.


Objectives: We examined the longitudinal effects of a Housing First program for homeless, mentally ill individuals' on those individuals' consumer choice, housing stability, substance use, treatment utilization, and psychiatric symptoms.

Methods: Two hundred twenty-five participants were randomly assigned to receive housing contingent on treatment and sobriety (control) or to receive immediate housing without treatment prerequisites (experimental). Interviews were conducted every 6 months for 24 months.

Results: The experimental group obtained housing earlier, remained stably housed, and reported higher perceived choice. Utilization of substance abuse treatment was significantly higher for the control group, but no differences were found in substance use or psychiatric symptoms.

Conclusions: Participants in the Housing First program were able to obtain and maintain independent housing without compromising psychiatric or substance abuse symptoms.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Analysis of Variance
  • Choice Behavior*
  • Continuity of Patient Care / organization & administration
  • Diagnosis, Dual (Psychiatry)* / psychology
  • Female
  • Follow-Up Studies
  • Harm Reduction*
  • Humans
  • Ill-Housed Persons / psychology*
  • Ill-Housed Persons / statistics & numerical data
  • Male
  • Middle Aged
  • Models, Organizational
  • Outcome Assessment, Health Care
  • Patient Participation
  • Persons with Mental Disabilities / psychology*
  • Persons with Mental Disabilities / rehabilitation
  • Persons with Mental Disabilities / statistics & numerical data
  • Program Evaluation
  • Public Housing / standards*
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / prevention & control
  • Substance-Related Disorders / psychology
  • Surveys and Questionnaires
  • Time Factors