Substance use outcomes among homeless clients with serious mental illness: comparing Housing First with Treatment First programs

Community Ment Health J. 2011 Apr;47(2):227-32. doi: 10.1007/s10597-009-9283-7. Epub 2010 Jan 9.


The Housing First (HF) approach for homeless adults with serious mental illness has gained support as an alternative to the mainstream "Treatment First" (TF) approach. In this study, group differences were assessed using qualitative data from 27 HF and 48 TF clients. Dichotomous variables for substance use and substance abuse treatment utilization were created and examined using bivariate and logistic regression analyses. The HF group had significantly lower rates of substance use and substance abuse treatment utilization; they were also significantly less likely to leave their program. Housing First's positive impact is contrasted with the difficulties Treatment First programs have in retaining clients and helping them avoid substance use and possible relapse.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Case Management
  • Diagnosis, Dual (Psychiatry)*
  • Female
  • Humans
  • Ill-Housed Persons / psychology*
  • Ill-Housed Persons / statistics & numerical data
  • Male
  • Mental Disorders / rehabilitation*
  • Mental Disorders / therapy
  • Mental Health Services / statistics & numerical data
  • Middle Aged
  • New York
  • Outcome Assessment, Health Care
  • Public Housing
  • Qualitative Research
  • Severity of Illness Index
  • Substance-Related Disorders / therapy*
  • Young Adult