The effect of benzodiazepine prescription on patients receiving chronic opioid therapy

Obtaining housing associated withachieving abstinence afterdetoxification in adults with addiction

Tae Woo Park, Christine Maynié-François, Richard Saitz

Boston University Schools of Medicine and Public Healthand Boston Medical Center

Background

• Addiction is common in homeless persons

•Approximately half of homeless adults have substanceuse disorders

• Homelessness associated with poor prognosis

•Increased morbidity

•Increased mortality

•High health service use

Background

• Detoxification often point of entry to addictiontreatment for homeless substance users

• Impact of housing on achieving abstinenceafter detoxification is unclear

Objective

• To study the prospective association betweenhousing and later abstinence in a cohort ofadults with substance dependence post-detoxification

Hypothesis

• Obtaining housing is associated with a greaterprobability of later abstinence in homeless adultswith substance dependence compared tocontinuous homelessness

Data source

• Secondary analysis of randomized clinical trialthat compared integrated addiction, medicaland mental health care with usual separatecare

•No effect of integrated care on abstinence at 12months (primary outcome)

Study design

• Cohort study

•Data collected prospectively

•Analyses and hypothesis completed afterdata collected

• Study period: 12 months

Study population

• Adults with alcohol and/or drug dependence(CIDI-SF) and recent heavy alcohol or druguse

• Screened at inpatient detoxification unit (74%of the whole RCT population, N = 416)

• Exclusion criteria: pregnancy, cognitiveimpairment, lack of English or Spanish fluency

Main independent variable

• Housing status (at baseline and 6 months)

•Continuously homeless

•Homelessness defined as any night on the street or in ashelter in the past 3 months

•Continuously housed

•Homeless to housed

•Housed to homeless

Outcomes

• 30-day abstinence from heavy drinking,stimulants and opioids at 12 months assessedby the Addiction Severity Index

Analysis

• Logistic regression model

• Adjusted for:

◦Socio-demographics

◦Age, sex, race

◦Physical and mental health measures

◦SF-12 PCS, PHQ-9

◦Addiction characteristics

◦Both alcohol and drug dependence, ASI drug andalcohol composite scores, past addiction treatment

Results

Baseline characteristic

Total (n=416)

Age (SD)

36 (10)

Male gender (%)

White race (%)

Both alcohol and drug dependence (%)

Addiction Severity Index – alcohol (SD)

0.45 (0.35)

Addiction Severity Index – drug (SD)

0.32 (0.14)

PHQ-9 ≥ 10

Any addiction treatment past 3 months (%)

SF-12 Physical Component Summary (%)

42 (8)

Results

Housing status (n=350)

Continuously homeless

Continuously housed

Housed to homeless

Homeless to housed

Association between housing statusand abstinence

Housing status (n=338)

Odds ratio*

95% CI

P-value

Continuously homeless (ref)

1.00

N/A

Continuously housed

1.26

0.70-2.26

0.44

Housed to homeless

1.41

0.51-3.88

0.51

Homeless to housed

1.85

1.04-3.30

.04

*Adjusted for socio-demographics, physical and mental health measures, and addictioncharacteristics

Conclusion

• Among adults with substance dependenceundergoing detoxification, those whotransitioned from homelessness to beinghoused were more likely to achieve abstinence12 months later compared to thosecontinuously homeless

Limitations

• Examined housing status at only 2 time points

• Results may be confounded by unmeasureddifferences between those who gained housingand those that did not

Implications

• Provision of housing might improve addictionoutcomes in patients with substancedependence leaving detox

Acknowledgments

NIH/NIAAA R01 AA010870 and NIH/NIDA R01DA010019, Addiction Health Evaluation And DiseaseManagement (AHEAD) Study, PI Saitz