Substance use disorder service use and experiences among Veterans in permanent supportive housing

Substance Use Disorders (SUDs) are prevalent among homeless persons and affect housing stability. Little is known about SUD service use and experiences among Veterans housed through the Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program, which provides housing subsidies and supportive services. We aimed to examine SUD service use and treatment experiences among HUD-VASH Veterans with SUDs.

We analyzed VA Electronic Health Records of HUD-VASH Veterans with SUDs housed between 10/1/2017-9/30/2021 (n = 42,182). We examined sociodemographic and clinical characteristics, SUD service use (e.g., outpatient, inpatient, residential), and quality of care (e.g., evidence-based pharmacotherapy, psychosocial treatment, care continuity). A subsample of 43 participants participated in interviews about substance use, recovery goals, and treatment experiences; qualitative data were analyzed using rapid qualitative methods.

Nearly half of participants used outpatient SUD services (47.3%); and 0.5% received an evidence-based psychosocial treatment as operationalized in VA administrative data. Quality metrics showed 19.7% with alcohol use disorder and 42.9% with opioid use disorder received evidence-based pharmacotherapy. Qualitative findings emphasized the importance of SUD treatment readiness, a range of treatment access points, and misaligned patient and provider goals contributing to negative treatment experiences.

Although SUD service use is prevalent among HUD-VASH participants, some services may not reflect evidence-based guidelines or match participants' preferences. In delivering SUD services to this group, our data underscore the importance of readiness, treatment access, and patient-provider alignment. Ensuring SUD services are well suited to the goals of homeless-experienced persons can enhance this population's recovery and housing stability.