Access to inpatient or residential substance abuse treatment among homeless adults with alcohol or other drug use disorders

OBJECTIVES. We conducted a theoretically guided study of access to inpatien t or residential treatment among a probability sample of homeless adults wi th alcohol or drug use disorders in Houston, Texas. METHODS. This study used a cross-sectional, retrospective design with data collected from a multistage random sample of 797 homeless adults age 18 or older who were living in Houston shelters and streets in 1996. Structured, face-to-face interviews produced screening diagnoses for alcohol and drug u se disorders, treatment use data, and candidate predictors of treatment use . Logistic and linear regression analyses were performed on the subset of 3 26 homeless persons with either alcohol or drug use disorder. RESULTS. 27.5% of persons with substance use disorder had accessed inpatien t or residential treatment during the past year. Controlling for additional need factors such as comorbidity, persons having public health insurance a nd a history of treatment for substance problems had greater odds of receiv ing at least one night of treatment. Contrary to expectation, contact with other service sectors was not predictive of treatment access. Schizophrenia and having a partner appeared to hinder access. Greater need for treatment was associated with fewer nights of treatment, suggesting retention diffic ulties. CONCLUSIONS. This study adds to previous findings on access to health care among homeless persons and highlights a pattern of disparities in substance abuse treatment access. Health insurance is important, but enhancing acces s to care involves more than economic considerations if homeless persons ar e to receive the treatment they need. Referral relationships across differe nt service sectors may require strengthening.