(21) Leveraging Community in Addiction Recovery for Permanent Supportive Housing Residents

Background: People experiencing homelessness have increased rates of substance use and face significant mortality due to overdose. Housing stability is associated with decreased substance use, but individuals transitioning into permanent supportive housing are still heavily influenced by substance use among social network members. Community First! Village (CF!V) is a permanent supportive housing community in Austin, Texas that houses over 250 residents. Sobriety is not mandatory, and self-identified alcohol and drug use among residents at CF!V increased 16% and 8% respectively from 2019 to 2020. In response, CF!V residents, research team members, and community stakeholders formed the Wellness Advisory Board (WAB) to assess substance use rates and develop community interventions to promote recovery.

Objective: To report substance use rates of a population of formerly chronically homeless individuals currently housed in a permanent supportive housing community in order to design replicable community-level interventions to better support a culture of recovery and wellness.

Methods: Utilizing community-based participatory research methodology, a survey collecting mixed-methods data was developed with and approved by the WAB to evaluate trends in substance use rates, recovery assets, and a culture of recovery in the community. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) instrument was utilized to trend current and past 3-month substance use categorized into low, moderate, and high risk status. The Brief Assessment of Recovery Capital (BARC-10) instrument was used as a quantitative assessment of recovery capital and perceived support. Data was analyzed using Stata, and presented to the WAB to collaboratively identify community interventions. Surveys will be repeatedly administered to the same sample of residents in subsequent stages to evaluate the effectiveness of these interventions in promoting recovery over time.

Results: A total of 104 residents (n=104) were surveyed across all housing blocks of CF!V. Respondents were 68% male, 69% white and 24% black with an average age of 58 years. Baseline ASSIST scores revealed that 91% of respondents met criteria for at-risk use of tobacco, alcohol, or illicit substances, with 26% of respondents reporting use categorized as “high-risk.” 74% of respondents had a BARC-10 score exceeding 47, the threshold score that demonstrates predictive validity with sustained remission from substances. Compared to their use when they were experiencing homelessness, 110 responses indicated decreased use of any of the following substances after moving to CF!V: alcohol, marijuana, cocaine, methamphetamine, and/or synthetic cannabinoids. 21 responses reported increased use of these substances since moving in, with over half (n=11) attributed to stimulant use.

Conclusions: A significant portion of CF!V residents met high-risk criteria for substance use within the last 3 months despite high levels of recovery assets that suggest a high potential for sustained recovery. Our results suggest that transitioning to a permanent housing community was associated with decreased substance use in the majority of respondents. However, a significant subset of respondents reported increased substance use, predominantly driven by increased stimulant use. Future efforts of the WAB will be focused on addressing the impact of stimulant use among social networks within residents of CF!V. Overall, our goal is to close the feedback loop between recovery service organizations and the individuals using those services to create replicable models for similar housing communities.

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Fine DR, Dickins KA, Adams LD, De Las Nueces D, Weinstock K, Wright J, Gaeta JM, Baggett TP. Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018. JAMA Netw Open. 2022 Jan 4

Rhoades H, La Motte-Kerr W, Duan L, Woo D, Rice E, Henwood B, Harris T, Wenzel SL. Social networks and substance use after transitioning into permanent supportive housing. Drug Alcohol Depend. 2018 Oct 1

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