Health Care Utilization and Service Needs of Homeless Substance Users

Homeless adults who use alcohol or drugs are at high risk of accidents, injury, victimization, and physical health problems. In this study, we examine how such variables as current entitlement benefits (e.g., Medicaid and /or Medicare), physical health and mental health status, demographics, and other factors, including length of homelessness, account for hospitalization and use of emergency-room and substance-use detoxification services in the preceding three years. Data for this study are based on 1,000 randomly surveyed adults residents (848 male, 152 female) of the New York City shelter system.¹ Alcohol and drug use was determined from multiple scales and will be analyzed and presented accordingly. These measures include a lifetime measure of problem-drinking based on the Short Michigan Alcoholism Screening Test; two scales measuring symptoms of dependence on both alcohol and drugs in the last year; lifetime treatment history and detoxification for alcohol and drug use; and use by type of substance (heroin, amphetamines, barbiturates, etc.) in the preceding five-year period (five-, three-, one-year, and six months). Treatment needs are measured by respondent and interviewer ratings of 20 service needs, including substance-use treatment. Logistic regression results reveal significant relationships of past and recent alcohol use/ dependence with medical, psychiatric, and substance treatment hospitalization and detoxification in the preceding three years. Entitlements were significantly associated with psychiatric inpatient stay and substance-use detoxification in the preceding six months. Finally, homeless adults with substance-use histories self-reported and were interviewer-rated as having significantly more service needs than those without substance-use histories. Implications of study findings will be presented in relationship to improving access to treatment services for homeless persons.