Trends in Substance Use Treatment Admissions among the Homeless in the United States: 2005-2015

Abstract

Substance abuse is a significant public health problem among the homeless population in the United States. In this study, we sought to investigate the recent patterns of substance abuse among homeless people in the United States and estimate the prevalence of co-occurring mental illness in this population, using the substance use treatment episode data set for admissions (TEDS-A) during 2005 through 2015. Males and non-Hispanic Black Americans constituted a disproportionately high percentage of the admissions. Five substance groups accounted for 98.1% of primary substances reported between 2005 and 2015: alcohol (46%), opiates (24.6%), cocaine/crack (13%), methamphetamine (MA) (8.5%) and marijuana/hashish (6%). Though there was a decline in the proportion of admissions that reported alcohol abuse, alcohol was the most frequently reported substance of abuse at admission, while opioids (heroin and non-heroin opiates) were the most common illicit drug reported. Admissions due to opioid abuse showed a rising trend during the study period, increasing from 19.8% in 2005 to 30.3% in 2015. The proportion of admissions that reported current intravenous drug use also showed a marked increase from 17.4% in 2005 to 28.7% in 2015. The age of initiation to substance use reported for most admissions was 12- 17 years and the most common primary substance reported in this age group was marijuana. We observed certain age effects on the type of substance abused in chi square analysis that was statistically significant (p < 0.0001). Our result suggests that marijuana was the preferred substance of abuse among adolescents aged 12-17 years, and with a transition from adolescence to adulthood, young people (18-34 years old) preferred to abuse other illicit drugs, notably opioids. As individuals moved into middle age and older, alcohol became the most commonly abused substance. Approximately one third of admissions of homeless people had a diagnosis of a mental illness in addition to a substance use problem. Substance abuse remains a significant problem among the homeless population in the United States. The changing pattern of substance abuse implies that more psychosocial and healthcare needs may arise. This has important implications in policy and service delivery designs to meet the growing needs of the homeless population. Healthcare service delivery design must inculcate a coordinated and integrated approach that emphasizes treatment of homeless people with substance abuse disorders and co-occurring mental illness in order to halt this growing menace.