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Am J Public Health. 2013 Dec;103 Suppl 2:S282-8. doi: 10.2105/AJPH.2013.301302. Epub 2013 Oct 22.

Substance-use disorders and poverty as prospective predictors of first-time homelessness in the United States.

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Ronald G. Thompson Jr, Melanie M. Wall, and Deborah S. Hasin are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY. Melanie M. Wall, Eliana Greenstein, and Deborah S. Hasin are with the New York State Psychiatric Institute, New York. Bridget F. Grant is with the Laboratory of Epidemiology and Biometry, Division of Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD.



We examined whether substance-use disorders and poverty predicted first-time homelessness over 3 years.


We analyzed longitudinal data from waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions to determine the main and interactive effects of wave 1 substance use disorders and poverty on first-time homelessness by wave 2, among those who were never homeless at wave 1 (n = 30,558). First-time homelessness was defined as having no regular place to live or having to live with others for 1 month or more as a result of having no place of one's own since wave 1.


Alcohol-use disorders (adjusted odds ratio [AOR] = 1.34), drug-use disorders (AOR = 2.51), and poverty (AOR = 1.34) independently increased prospective risk for first-time homelessness, after adjustment for ecological variables. Substance-use disorders and poverty interacted to differentially influence risk for first-time homelessness (P < .05), before, but not after, adjustment for controls.


This study reinforces the importance of both substance-use disorders and poverty in the risk for first-time homelessness, and can serve as a benchmark for future studies. Substance abuse treatment should address financial status and risk of future homelessness.

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