BIRMINGHAM, AL — Among people recovering from drug and alcohol addiction, those who remain homeless are likely to experience much less improvement in mental health compared to those who are housed, according to a study published in the June issue of Medical Care.

The study, led by researchers at the University of Alabama at Birmingham (UAB), also suggests that length of homelessness, lack of social support. medical problems and psychiatric illness contribute to the mental health status of recovering addicts.

“This study shows that inferior mental health status among the chronically homeless reflects the combined impact of multiple factors we often overlook, such as chronic or acute medical problems as well as inferior social support from family and friends,” said Stefan Kertesz, M.D., assistant professor in the Division of Preventive Medicine and primary researcher on the project. “These findings also hint at the possibility that housing status itself might help to account for the poor mental health seen among chronically homeless and transitionally homeless patients.”

Kertesz and colleagues at Boston University’s Clinical Addictions Research and Education unit analyzed data from 274 individuals addicted to alcohol or drugs who had begun detoxification therapy. Patients were classified into three groups: chronically homeless, housed patients, and those with short-term periods of homelessness known as “transitionally homeless.” All were followed for 2 years. Kertesz and his collaborators reported that failure to improve in overall mental health status was strongly associated with each patient’s housing status.

“We were alarmed to find that while housed persons with addictions had substantial improvements in their mental health status over the next 2 years, the chronically homeless never caught up,” Kertesz said. “At the final observation, the chronically homeless had very substantially worse mental health than the housed, with the transitionally homeless in between.”

“This research has helped to expose complex factors that can explain differences in mental health,” said Max Michael, M.D. dean of the UAB School of Public Health. “It shows how simple questions about how long someone has been homeless can help clinicians and policymakers understand what kinds of problems are likely to require attention.”

Kertesz suggests that these findings indicate that chronic homelessness identifies an especially needy subgroup with a combination of pressing vulnerabilities that go well beyond addiction alone and reinforces the importance of taking duration of homelessness into account.

“One desirable outcome of this study should be to disarm the stereotype that addiction alone can explain the misery that we see out there on the streets,” he said. “Housing, social support, and non-addictive medical problems are extremely important contributors to health status in this population.”

Kertesz, who has provided primary care to homeless patients since 1996, suggests his study could help clinicians as well. “It can be difficult to assess all possible needs the first time I meet a homeless patient,” he said. “However, a single question about the duration of homelessness can help caregivers anticipate the range and depth of vulnerabilities that require attention.”

This study was funded through support from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.