Association of substance use characteristics and future homelessness among emergency department patients with drug use or unhealthy alcohol use: Results from a linked data longitudinal cohort analysis

Abstract

Background: Homelessness and substance use are intricately related, and both are prevalent among emergency department (ED) patients. This study examined the longitudinal association of substance use characteristics with future homeless shelter entry among ED patients with any drug use or unhealthy alcohol use. Methods: We present results from a longitudinal cohort study of public hospital ED patients who screened positive for drug use or unhealthy alcohol use and who were not homeless at their baseline (index) ED visit. The primary outcome was homeless shelter entry within 12 months of baseline, ascertained in city homeless shelter administrative data. Primary independent variables of interest were alcohol use severity (AUDIT), drug use severity (DAST-10), and types of drugs used, as reported on baseline survey questionnaires. Results: Analyses included 1,210 ED patients. By 12 months following the baseline ED visit, 114 (9.4%) had entered a homeless shelter. Among patients with the most severe problems related to drug use (DAST-10 score 9–10), 40.9% entered a shelter within 12 months. Past shelter use was the strongest predictor of future shelter entry; once adjusting for historic shelter use the relationship of AUDIT and DAST-10 scores with future shelter entry was no longer statistically significant in multivariable models. Conclusions: ED patients with past year drug use or unhealthy alcohol use had relatively high likelihood of future shelter entry. Risk for homelessness should be addressed in future interventions with this population. Findings illustrate the complexity of relationships between substance use and homelessness.

Keywords:

• Emergency service
• homeless persons
• social determinants of health
• substance-related disorders
• alcohol-related disorders
• poverty

Acknowledgements

The authors would like to thank all of the ED-CARES Research Assistants, and the study Research Stakeholder and Expert Advisory Panel.

Authors contribution

KMD, EJ, JR, and LG conceived of the study. KMD led data collection for the study, with assistance from RY. EJ oversaw data linkage. KMD conducted the analyses, with assistance from TM. RY and NK interpreted the data and conducted the literature review. RY and KMD drafted the article. All authors provided critical feedback. All authors reviewed and approve of the final version.

Disclosure statement

RPM has conducted research and clinical demonstration projects unrelated to the present paper with funding from the NIH (NIAAA, NIDA) and NYC Department of Health and Mental Hygiene. He has received study medication without funding or restrictions from Alkermes for research unrelated to the present paper. JR discloses that he has been an investigator or principal investigator on studies that have received support (financial or medication or both) from Indivior (formerly Reckitt-Benckiser) and from Alkermes and from NIDA/NIH and from NIAAA/NIH. As a principal investigator in NIDA’s Clinical Trials Network he collaborates extensively with organizations that seek to provide help with or promote recovery from addiction. He does not have equity in these entities and is not a paid consultant or advisory board member. He is an employee of New York University and formerly of the Department of Veterans Affairs. He sees none of these activities as presenting a conflict of interest with the present paper. RY, NK, EJ, TM, LG, and KMD report no conflicts of interest.

Additional information

Funding

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health [K23DA039179, PI Doran], the United Hospital Fund (PI Doran), and the Doris Duke Charitable Foundation—NYULMC through the Fund to Retain Clinical Scientists (PI Doran). The funders had no role in the conduct of the research or the writing of the manuscript. The content is solely the responsibility of the authors and does not represent the official views of any funder or agency.