Housing First program reduced alcohol and cannabis use among homeless individuals | Research

The takeaway

After 21 months, homeless individuals in a Housing First program showed significantly better outcomes for alcohol and cannabis use compared to treatment as usual, with additional psychiatric benefits for those with severe mental illness.

Policymakers, social workers, and researchers interested in homelessness, substance use, and Housing First programs.

Significant reductions in alcohol and cannabis use at 21 months

What the researchers found

The Housing First group (n=46) showed significantly lower alcohol and cannabis use at 21 months compared to the treatment-as-usual group (n=41). Among the subgroup with severe mental illness, Housing First participants also showed significant improvements in psychotic symptoms, anxiety, depression, and social relations.

Why it matters

Housing First provides stable housing without requiring sobriety first. This study shows that providing housing stability can itself lead to reduced substance use, challenging the traditional treatment-first approach.

The numbers in context

87 participants total (46 HF, 41 TAU). Significant improvements in alcohol and cannabis use at 21 months. Subgroup with severe mental illness showed improvements across psychotic symptoms, anxiety, depression, and social relations.

How the study worked

Unblinded randomized controlled trial comparing Housing First (HF, n=46) to treatment as usual (TAU, n=41) among people experiencing homelessness. Outcomes measured at baseline, 8, and 21 months using standardized quantitative measures.

What this study cannot tell us

Unblinded design. Relatively small sample. Cannot separate the effect of housing from other support services provided. Single-site study.

How to read the evidence

Randomized controlled trial, though unblinded and with a small sample size.

When this study was published

Published in 2022.

The bigger picture

These findings support the Housing First philosophy that stable housing is a foundation for addressing other challenges like substance use and mental health, rather than a reward for achieving sobriety first.

Questions still open

Which aspects of Housing First drive substance use reductions: housing stability, support services, or both? Would results hold in different cultural contexts?

Common questions

Did participants have to be sober to get housing?

No. Housing First provides stable housing without requiring sobriety as a precondition. This study found that receiving housing first was itself associated with reduced alcohol and cannabis use over 21 months.

Were mental health outcomes also better?

Yes, particularly for participants with severe mental illness, who showed significant improvements in psychotic symptoms, anxiety, depression, and social relations compared to the control group.

Read the original research

Impact of Housing First on Psychiatric Symptoms, Substance Use, and Everyday Life Skills Among People Experiencing Homelessness.

Journal of psychosocial nursing and mental health services, 60(9), 46-55

View on PubMed ↗Publisher’s paper ↗

Citation

Ferreiro, Inés Campo; Cuadra, Maria Assumpta Rigol; Serqueda, Francesca Asensio; Abad, Josep Maria Haro. (2022). Impact of Housing First on Psychiatric Symptoms, Substance Use, and Everyday Life Skills Among People Experiencing Homelessness.. Journal of psychosocial nursing and mental health services, 60(9), 46-55. https://doi.org/10.3928/02793695-20220316-01