Longitudinal Associations between Homelessness and Substance Use: Investigating Demographic Differences for Young Adults in Treatment.

Objective: To examine prospective, bidirectional associations between homelessness and substance use frequency among young adults receiving substance use treatment in the United States. We also investigated potential differences across demographic subgroups. Methods: Young adults (N = 3717, Mage = 20.1, 28% female, 7.3% sexual/gender minority, and 37% non-Hispanic White) receiving substance use treatment in the U.S. completed assessments at intake, 3 months, 6 months, and 12 months post-intake. Latent growth curve models with structured residuals (LGC-SR) were used to examine cross-lagged associations between homeless days and frequency of substance use and associated problems. Models were stratified by sex, race/ethnicity, and sexual and/or gender minority status. Results: Overall, days spent homeless (µslope= -0.19, p = 0.046) and substance use frequency (µslope1= -6.19, p < 0.001) significantly decreased during treatment, with no significant cross-lagged associations between homeless days and substance use frequency. However, results differed by race and ethnicity. For non-Hispanic White young adults, greater substance use at treatment entry was associated with steeper declines in homeless days between-persons (ϕstandardized = -0.14, p = 0.04). For African Americans, homeless days at treatment entry were associated with greater increases in substance use between-persons (ϕstandardized = 0.29, p = 0.04). No significant differences were found by sex or sexual/gender minority status. Conclusions: Despite overall declines in homelessness and substance use during treatment, these outcomes may unfold differently for non-Hispanic White and African American young adults. More support may be needed for African American young adults reporting homelessness at treatment entry.

A Longitudinal Exploration of How Connections to Staff Facilitate Efficacy and Service Use in Drop-in Centers Serving Youth Experiencing Homelessness.

INTRODUCTION: Youth experiencing homelessness (YEH) benefit from a variety of services to meet their immediate and long-term needs. Drop-in centers are a popular service venue used by YEH. However, the mechanisms responsible for engaging youth in drop-in services are not clear. The current study uses longitudinal data to explore the role of positive staff relationships in increasing youths' knowledge and efficacy to access and subsequently use drop-in center services. METHODS: 731 youth (Mage = 21.8, SD = 2.2, 25.1% female) accessing services at three drop-in centers in Los Angeles, California participated in the study. Surveys were completed at baseline, 1-month, and 3-months later. Path models examined the direct effect of positive relationships with adult staff on service use at the 3-month follow-up, and the indirect effect of service knowledge (assessed at the 1-month follow-up). RESULTS: The direct effect model showed that positive staff relationships at baseline were significantly associated with number of services used at the 3-month follow-up (aIRR = 1.24, 95% CI: 1.00, 1.54). Positive staff relationships were also associated with greater service knowledge at 1-month (b = 0.93, p < 0.001), which in turn was associated with greater service use at 3-months (IRR = 1.15, 95% CI: 1.04, 1.28). The indirect effect of service knowledge was significant (b = 0.13, p = 0.02), suggesting that the association between positive staff relationships and service use was completely mediated by service knowledge. CONCLUSIONS: The current study adds to the literature by demonstrating that positive relationships with staff lead to increased service use by increasing youths' knowledge and efficacy to access services. Efforts should be made to develop positive relationships with YEH in order to engage them in essential services needed to exit homelessness.

Sex differences in poly-victimization among youth experiencing homelessness prior to substance use treatment.

BACKGROUND: Poly-victimization is common among youth experiencing homelessness (YEH) and youth in substance use treatment. To date, studies have not examined poly-victimization among these two intersecting populations. OBJECTIVE: To examine heterogeneity in lifetime victimization experiences among youth reporting homelessness at substance use treatment entry; identify demographic predictors of victimization class membership; and associations between victimization and clinical characteristics at treatment intake. PARTICIPANTS AND SETTING: 1270 adolescents and young adults reporting past 90-day homelessness in a nationwide substance use treatment data set. METHODS: Latent Class Analysis (LCA) and logistic regression were used to examine heterogeneity in poly-victimization experiences, and associations with demographics and clinical characteristics for males and females. RESULTS: Four victimization classes emerged for males, and five victimization classes emerged for females. The prevalence of victimization and trauma characteristics were higher for females, except physical victimization, which was higher for males. Age, race/ethnicity, and sexual minority status were related to poly-victimization class membership, but not consistently across classes. Compared to low or single victimization classes, youth in the poly-victimization class had higher odds of post-traumatic stress disorder, major depressive disorder, and exchange sex (among females); Poly-victimization class membership was not associated with duration of recent homelessness or substance use disorder diagnoses, when compared to low/less complex victimization. CONCLUSION: High rates of lifetime victimization were found for YEH in substance use treatment, with rates generally higher among females. Trauma-informed interventions are needed to address complex victimization experiences and poor mental health among unstably housed youth in treatment.

Comparing the effectiveness of three substance use interventions for youth with and without homelessness experiences prior to treatment.

OBJECTIVE: Many adolescents and young adults receiving substance use treatment have experienced or are at risk for homelessness. It is unknown whether specific treatment approaches are more or less effective for youth experiencing homelessness (YEH) compared to stably housed youth. The present study compared the effectiveness of the Adolescent Community Reinforcement Approach, Motivational Enhancement Therapy combined with Cognitive-Behavioral Therapy (MET/CBT), and Treatment as Usual (TAU) for these two groups. Further subgroup differences were investigated by age, sex, and sexual and gender minority status. METHOD: YEH (n = 855) and a matched sample of stably housed youth (n = 855) were drawn from the Global Appraisal of Individual Needs, a nationwide substance use treatment data set. Multiple-group latent change score modeling was used to examine change in substance use frequency and related problems at baseline, 3-, 6-, and 12-month follow-ups. RESULTS: Results indicated significant declines in substance use frequency and problems during treatment for all intervention groups. The TAU group showed the greatest declines in substance use problems during treatment and the greatest declines in frequency post-treatment. Compared to stably housed youth, YEH entered treatment with greater substance use and problems, and had greater declines in substance use in the MET/CBT group only. Other differences were found by age and sex. CONCLUSIONS: Overall, all three substance use interventions appear to be effective in reducing substance use and related problems. TAU and MET/CBT may be particularly effective for YEH in treatment settings. Implications for future research and practice are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).