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

Session Submission Type: Panel

Abstract

The United States is in the midst of two interrelated crises—the level of housing insecurity has reached record highs and the number of people impacted by substance use disorder (SUD) continues to grow.  Housing insecurity can contribute to poor outcomes for people with SUD by fueling psychosocial stress and creating barriers to harm reduction services, treatment, and recovery. At the same time, a history of SUD can act as a structural barrier to securing and maintaining stable housing, due in part to stigma, discrimination, and the criminalization of substance use.  States and localities have responded to the housing crisis with a range of policies. On one hand, rates of some jurisdictions have enacted punitive policies and procedures that criminalize homelessness, such as bans on outdoor camping. On the other hand, and often at the same time, jurisdictions are testing solutions designed to prevent evictions and house people experiencing homelessness. This panel seeks to explore the health implications of the different trends for people with SUD. 

The first two papers seek to answer fundamental questions about impacts of current approaches to housing policy outcomes for people with SUD. The first, by Alexandra Skinner, looks at the causal effect of eviction on overdose mortality. The second, by Moon and colleagues, uses quasi-experimental evidence from Los Angeles, CA to measure the impact of encampment sweeps on fatal overdoses. 

The subsequent papers address critical questions on how housing-focused interventions may disrupt the natural history of substance use disorder.  Linton and colleagues rely on qualitative interviews of policy makers and people with lived experiences to investigate the pathways through which COVID-19 related housing policies impact substance use disorder in seven Mid-Atlantic counties.  Doran and colleagues test the implementation of overdose prevention policies in permanent supportive housing communities in a stepped wedge randomized control trial. 

The papers will be discussed by Avik Chatterjee who is a physician with Boston Health Care for the Homeless Program.  He is a clinician-researcher who serves as medical director of a clinic at the Southampton Street Shelter, giving him real-world insight into the difficulty patients face navigating service delivery.

Policy Area

• Housing, Community Development, and Urban Policy

Chair

• Kathryn M Leifheit, University of California - Los Angeles

Discussant

• Avik Chatterjee, Boston University

Organizer

• Kathryn M Leifheit, University of California - Los Angeles

Individual Presentations

• Residential eviction proceedings and overdose mortality in Rhode Island - Presenting Author: Alexandra Skinner, Brown University

• Effects of encampment sweeps on overdose mortality among people experiencing homelessness in Los Angeles, California - Presenting Author: Kyle J Moon, Johns Hopkins University

• “Double-edged sword”: the complex implications of pandemic-era housing policies on substance use disorder - Presenting Author: Sabriya Linton, Johns Hopkins University

• Overdose prevention in supportive housing buildings: an intervention to enhance evidence-based practice and policy implementation - Presenting Author: Kelly Doran, New York University