Slowing the revolving door: stabilization programs reduce homeless persons' substance use after detoxification

This study examined whether homelessness predicted earlier resumption of substance use after detoxification, and sought evidence concerning the impact of post-detoxification stabilization programs among homeless and nonhomeless individuals. Kaplan-Meier plots and proportional hazards models were used to determine the association between homelessness, stabilization program use, and recurrent substance use in a prospective cohort of persons entering inpatient detoxification (n = 470). Among 254 persons available at 6 months, 76% reported recurrent substance use. Homeless persons not using stabilization programs experienced the highest hazard of return to substance use after detoxification, Hazard Ratio (HR) 1.26, 95% CI (0.88, 1.80). Homeless persons using these programs had the lowest rate of return to substance use: HR 0.61, 95% CI (0.40, 0.94). A similar impact of stabilization programs was not seen among nonhomeless subjects. Post-detoxification stabilization programs were associated with improved outcomes for homeless addicted persons. This treatment modality may slow the "revolving door" phenomenon of relapse after detoxification among homeless persons. (C) 2003 Elsevier Inc. All rights reserved.