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.