Associations of housing stress with later substance use outcomes: A systematic review

A synthesis of existing evidence regarding the association of housing stress with later substance use outcomes can help support and inform housing interventions as a potential strategy to address problematic substance use. We conducted a comprehensive search of PubMed, Web of Science, PsycInfo, CINAHL, Social Work Abstracts, and Sociological Abstracts and systematically screened for articles examining housing stress and later substance use outcomes among U.S. adults. Across 38 relevant articles published from 1991 to 2020, results demonstrated an association of homelessness with an increased likelihood of substance use, substance use disorders (SUD), and overdose death. Results regarding the association of homelessness with receipt and completion of SUD treatment were mixed, and one study indicated no association of homelessness with motivation to change substance use behaviors. Several studies did not find an association of unstable housing with substance use or receipt of SUD treatment, while others found an association of unstable housing with intensified SUD symptoms and a decreased likelihood of completing SUD treatment. Overall, while there is evidence of an association of homelessness with later substance use, SUD, and overdose death, results for other forms of housing stress and some substance use outcomes are less consistent. There are several methodological considerations specific to selected measures of housing stress and substance use, study populations, and analytic approaches that have implications for results and directions for future research. Despite these considerations, results collectively suggest that innovative interventions to address housing stress, namely homelessness, may help mitigate some substance use outcomes.