Maintaining Recovery with Contingent Housing Payments: A Pilot Program for Women with Children Who Completed Residential Substance Use Disorder Treatment
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Abstract
Housing insecurity is a critical social driver of health, strongly associated with increased risk of substance use, adverse medical and psychiatric outcomes, and legal and employment instability. These risks are particularly acute during pregnancy and parenting times of life, where housing instability exacerbates maternal stress and adversely affects infant and early childhood health. Patients who have completed residential substance use disorder treatment often have limited options regarding housing as they are often reintroduced to low-income environments and experience discrimination associated with their substance use problems. This pilot project evaluated the impact of a structured housing voucher intervention on housing stability and substance use–related outcomes among perinatal patients and mothers following discharge from residential substance use disorder treatment. Participants (n = 12) were enrolled in a voucher-based housing payment program for up to 12 months that provided rental assistance alongside integrated medical, psychiatric, substance use disorder treatment, and case management services. Monthly assessments were conducted to evaluate housing status, mental and physical health, legal and employment outcomes, and substance use outcomes. Our results indicated that participants showed reductions in housing insecurity and little substance use over the course of their participation in the study. Improvements were also observed in legal and employment domains, as well as in self-reported mental health indicators. These findings underscore the critical role of housing interventions in promoting sustained recovery and maternal–child well-being. Further investigation in larger, randomized samples is warranted to establish generalizability and inform policy implementation.
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References
2. Trost SL, Busacker A, Leonard M, et al. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 38 U.S. States, 2020. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2024
3. Han, B., Compton, W. M., Einstein, E. B., Elder, E., & Volkow, N. D. (2024). Pregnancy and Postpartum Drug Overdose Deaths in the US Before and During the COVID-19 Pandemic. JAMA psychiatry, 81(3), 270–283. https://doi.org/10.1001/jamapsychiatry.2023.4523
4. Austin, A. E., Shiue, K. Y., Naumann, R. B., Figgatt, M. C., Gest, C., & Shanahan, M. E. (2021). Associations of housing stress with later substance use outcomes: A systematic review. Addictive behaviors, 123, 107076. https://doi.org/10.1016/j.addbeh.2021.107076HWANG, S., TOLOMICZENKO, G., KOUYOUMDJIAN, F., & GARNER, R. (2005). Interventions to Improve the Health of the Homeless: A Systematic Review. American Journal of Preventive Medicine, 29(4), 311–311. https://doi.org/10.1016/j.amepre.2005.06.017
5. Joint Center Housing for Housing Studies of Harvard University. (2024). The state of the nation’s housing. https://www.jchs.harvard.edu/sites/default/files/reports/files/Harvard_JCHS_The_State_of_the_Nations_Housing_2024.pdf
6. Gu, K.D., Faulkner, K.C. & Thorndike, A.N. Housing instability and cardiometabolic health in the United States: a narrative review of the literature. BMC Public Health 23, 931 (2023). https://doi.org/10.1186/s12889-023-15875-6
7. DiTosto, J. D., Holder, K., Soyemi, E., Beestrum, M., & Yee, L. M. (2021). Housing instability and adverse perinatal outcomes: a systematic review. American journal of obstetrics & gynecology MFM, 3(6), 100477. https://doi.org/10.1016/j.ajogmf.2021.100477
8. Green, J. M., Fabricant, S. P., Duval, C. J., Panchal, V. R., Cahoon, S. S., Mandelbaum, R. S., ... & Matsuo, K. (2023). Trends, characteristics, and maternal morbidity associated with unhoused status in pregnancy. JAMA Network Open, 6(7), e2326352-e2326352.
9. Pantell, M. S., Baer, R. J., Torres, J. M., Felder, J. N., Gomez, A. M., Chambers, B. D., ... & Jelliffe-Pawlowski, L. L. (2019). Associations between unstable housing, obstetric outcomes, and perinatal health care utilization. American journal of obstetrics & gynecology MFM, 1(4), 100053.
10. Tsai, J. (2020). Is the housing first model effective? Different evidence for different outcomes. American Journal of Public Health, 110(9), 1376.
11. Herriott, A. L. (2024). “I just want the best for him.” Pregnancy in the context of substance use disorders: Perspectives of postpartum women. Birth, 51(1), 81-88.
12. Frazer, Zane, Krystle McConnell, and Lauren M. Jansson. "Treatment for substance use disorders in pregnant women: Motivators and barriers." Drug and alcohol dependence 205 (2019): 107652.
13. Klaman, S., Andringa, K., Horton, E., Jones, H., 2019. Concurrent opioid and alcohol use among women who become pregnant: historical, current, and future perspectives. Subst. Abuse 13, 1–7.
14. Mazel, S., Alexander, K., Cioffi, C., & Terplan, M. (2023). Interventions to Support Engagement in Addiction Care Postpartum: Principles and Pitfalls. Substance abuse and rehabilitation, 14, 49–59. https://doi.org/10.2147/SAR.S375652
15. Schiff, D. M., Nielsen, T., Terplan, M., Hood, M., Bernson, D., Diop, H., Bharel, M., Wilens, T. E., LaRochelle, M., Walley, A. Y., & Land, T. (2018). Fatal and Nonfatal Overdose Among Pregnant and Postpartum Women in Massachusetts. Obstetrics and gynecology, 132(2), 466–474.
https://doi.org/10.1097/AOG.0000000000002734
16. Metz, T. D., Rovner, P., Hoffman, M. C., Allshouse, A. A., Beckwith, K. M., & Binswanger, I. A. (2016). Maternal deaths from suicide and overdose in Colorado, 2004–2012. Obstetrics & Gynecology, 128(6), 1233-1240.
17. Smid, M. C., Schauberger, C. W., Terplan, M., & Wright, T. E. (2020). Early lessons from maternal mortality review committees on drug-related deaths-time for obstetrical providers to take the lead in addressing addiction. American journal of obstetrics & gynecology MFM, 2(4), 100177. https://doi.org/10.1016/j.ajogmf.2020.100177
18. Mattocks, K. M., Clark, R., & Weinreb, L. (2017). Initiation and engagement with methadone treatment among pregnant and postpartum women. Women's Health Issues, 27(6), 646-651.
19. Schauberger, C. W., Borgert, A. J., & Bearwald, B. (2020). Continuation in treatment and maintenance of custody of newborns after delivery in women with opioid use disorder. Journal of Addiction Medicine, 14(2), 119-125.
20. Guo, X., Slesnick, N., & Feng, X. (2016). Housing and Support Services with Homeless Mothers: Benefits to the Mother and Her Children. Community mental health journal, 52(1), 73–83. https://doi.org/10.1007/s10597-015-9830-3
21. Slesnick, N., Zhang, J., Feng, X., Mallory, A., Martin, J., Famelia, R., Brakenhoff, B., Yilmazer, T., Wu, Q., Ford, J., Holowacz, E., Jaderlund, S., Hatsu, I., Luthy, E., Chavez, L., Walsh, L., & Kelleher, K. (2023). Housing and supportive services for substance use and self-efficacy among young mothers experiencing homelessness: A randomized controlled trial. Journal of substance abuse treatment, 144, 108917. https://doi.org/10.1016/j.jsat.2022.108917
22. McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., ... & Argeriou, M. (1992). The fifth edition of the Addiction Severity Index. Journal of substance abuse treatment, 9(3), 199-213.
23. Farero, A., Sullivan, C. M., López-Zerón, G., Bowles, R. P., Sprecher, M., Chiaramonte, D., & Engleton, J. (2024). Development and validation of the housing instability scale. Journal of Social Distress and Homelessness, 33(1), 142-151.
24. Gerber E, Gelberg L, Rotrosen J, Castelblanco D, Mijanovich T, Doran KM. Health-related material needs and substance use among emergency department patients. Substance Abuse. Published online August 2019:1-7. Doi: https://doi.org/10.1080/08897077.2019.1635960
25. Lin C, Cousins SJ, Zhu Y, et al. A scoping review of social determinants of health’s impact on substance use disorders over the life course. Journal of Substance Use and Addiction Treatment. 2024;166:209484-209484. Doi: https://doi.org/10.1016/j.josat.2024.209484
26. Fleury MJ, Cao Z, Grenier G, Huỳnh C. Predictors of Frequent Emergency Department Use and Hospitalization among Patients with Substance-Related Disorders Recruited in Addiction Treatment Centers. International Journal of Environmental Research and Public Health. 2022;19(11):6607. Doi: https://doi.org/10.3390/ijerph1911660
27. Zhang X, Wang N, Hou F, et al. Emergency Department Visits by Patients with Substance Use Disorder in the United States. Western Journal of Emergency Medicine. 2021;22(5):1076-1085. Doi: https://doi.org/10.5811/westjem.2021.3.50839
28. de Andrade, D., Elphinston, R. A., Quinn, C., Allan, J., & Hides, L. (2019). The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review. Drug and alcohol dependence, 201, 227-235.
29. Shadloo, B., Baheshmat, S., Rostam-Abadi, Y., Shakeri, A., Gholami, J., & Rahimi-Movaghar, A. (2022). Comparison of self-reported substance use with biological testing among treatment-seeking patients with opioid use disorder. Journal of substance abuse treatment, 134, 108555.