“Double-edged sword”: the complex implications of pandemic-era housing policies on substance use disorder

• In Event: The Intersection of Housing Insecurity and Substance Use Disorder—defining the crisis and identifying policy solutions

Abstract

Introduction/Background: Few studies have evaluated the impacts of population‑level housing policies on behavioral health outcomes. The COVID‑19 pandemic created a natural experiment for examining such policies—particularly eviction moratoria and emergency rental assistance. Elucidating whether and how these policies shaped substance use outcomes can inform how population-level housing assistance programs are designed in the future.  

Purpose/Research Question: This study investigated how eviction moratoria and emergency rental assistance impacted people who have substance use disorder (SUD) at the height of the COVID-19 pandemic. Barriers and facilitators to accessing and benefitting from these policies were also explored. 

Data: Qualitative data for this study came from 116 semi-structured interviews conducted between January and July 2024. 

Research Design and Methods: Purposive sampling and multiple community-based recruitment strategies were used to recruit adults with recent histories of substance use disorder (SUD) and housing instability (n=63), and SUD and housing providers and policy officials (n=53). All participants were recruited from seven urban and rural Mid‑Atlantic counties with high rates of overdose deaths. Participants completed semi-structured interviews by zoom or in-person. Interviews captured participants’ perspectives on the impacts of eviction moratoria and emergency rental assistance on behavioral health and related outcomes, challenges and successes with implementation of these policies, and recommendations for future eviction prevention and other housing policies in the future. The constant comparison method was used to identify themes, and trustworthiness was enhanced through respondent validation, and member checking with an advisory board. 

Results/Findings: The impacts of these policies were mixed.  Some participants reported greater housing and financial security, reduced stress, improved behavioral health treatment engagement, and benefits to recovery. Others reported increased substance use due to “freed‑up” funds and reduced access to supportive services, and decreased availability of rental units. Interviews also revealed widespread gaps in knowledge about these policies, and major implementation challenges, including illegal evictions, abrupt policy terminations without “off ramps”, burdensome application processes, strict and discriminatory eligibility criteria, and unsafe or informal rental arrangements lacking oversight.  Recommendations emphasized stronger outreach, relaxed eligibility criteria, case‑management support for people navigating housing and behavioral health systems, stronger regulation of landlord practices, reduced institutional and structural stigma, and inter‑sector coordination. 

Conclusion/Implications: Among this multi-state sample of people with lived experience and the health and housing professionals who serve them, pandemic housing policies led to mixed impacts ranging from improved stability and behavioral health outcomes to increased substance use and reduced access to services. Findings from this study, and participants’ experiential insights, identify several opportunities for future housing assistance programs and policies to better support the well-being of people with SUD, such as offering tailored outreach and case management services in tandem with housing assistance, ensuring that programs and policies are administered and implemented in ways that are compassionate and non-stigmatizing, and eliminating the silos that exist between housing and behavioral health sectors.

Author

• Sabriya Linton, Johns Hopkins University
  Presenting Author