Interventions for people who are homeless and use drugs: overview of reviews
Citation: Miler JA, Carver H, Masterton W, Parkes T, Maden M, Jones L, Sumnall H. What treatment and services are effective for people who are homeless and use drugs? A systematic ‘review of reviews’. PloS One. 2021;16(7):e0254729.
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding sources: Health Research Board (Ireland).
What is this? People who experience homelessness are at high risk of using drugs and related harms and may face several barriers to accessing support and related treatment.
In this overview, the authors searched for systematic reviews of the effects of interventions on housing, substance use and treatment engagement for people who experience homelessness or are in vulnerable housing. They did not restrict their searches by date or language of publication and did the most recent search in October 2020. They included 25 reviews.
What was found: Integrated care between services and programs when supporting people with various needs appeared to be associated with better health outcomes and some evidence showed that harm reduction strategies were associated with decreased substance-related risk behaviours.
Case management (particularly critical time intervention, and intensive case management) has shown positive outcomes on substance-related risk behaviours, housing and mental health outcomes.
Peer support interventions were associated with fewer days spent homeless and decreased return to homelessness and may have an effect on substance use outcomes.
Housing interventions (e.g., Housing First) were associated with an improvement in housing stability and the retention of individuals.
Due to the high heterogeneity of the existing evidence, the effects of interventions targeting both homeless and substance use populations are uncertain, as are the short-term effects of housing interventions on health and wellbeing.
Implications: The authors of the review concluded that a ‘one size fits all’ approach does not exist for people experiencing homelessness and using drugs because of the heterogeneity of the population group, and that the most effective approaches should be the ones that address individual needs and consider holistically health, housing and drug use. They called for further research to determine the appropriate duration of treatment, ensuring that funding is adequate to support the potential longevity of the intervention.
Other considerations: The authors of the review discussed their findings in the context of socioeconomic status, social capital, homelessness, housing and substance use.
This summary was prepared by Yasmeen Saeed, checked by Cristián Mansilla, and finalized by Mike Clarke.