The Impact of Criminal Justice Involvement and Housing Outcomes Among Homeless Persons with Co-occurring Disorders.

The relationship between criminal justice involvement and housing among homeless persons with co-occurring disorders was examined. Program participants assisted in moving to stable housing were interviewed at baseline, six months, and discharge. Those who remained homeless at follow-up and discharge had significantly more time in jail in the past month than those who were housed. However, criminal justice involvement was not significantly related to housing status at the six month follow-up or discharge. Findings suggest that housing people with complex behavioral health issues reduces the likelihood of further criminal justice involvement.

Case Management Models in Permanent Supported Housing Programs for People With Complex Behavioral Issues Who Are Homeless.

OBJECTIVE: The purpose of this article is to examine two evidence-based models of case management for people with co-occurring disorders and histories of chronic homelessness and to better understand their roles in permanent supported housing. Critical Time Intervention and Assertive Community Treatment are examined in terms of key elements, how they assist in ending homelessness, as well as the role they play in an individual's recovery from co-occurring disorders. METHODS: Participants in two supported housing programs were interviewed at baseline and 6 months. One program used Critical Time Intervention (n = 144) and the other used Assertive Community Treatment (n = 90). Staff in both programs were interviewed about their experiences and fidelity assessments were conducted for each program. RESULTS: Both programs operated at high levels of fidelity. Despite similar criteria for participation, there were significant differences between groups. Critical Time Intervention participants were older, were more likely to be male, were more likely to be homeless, and reported greater psychiatric symptoms and higher levels of substance use (all p's < .001). Separate outcome analyses suggested that each program was successful in supporting people to transition from homelessness to stable housing; 88.6% of Assertive Community Treatment participants were homeless at baseline, while at 6 months 30% were homeless (p < .001), and 91.3% of those in the Critical Time Intervention were homeless at baseline, while 44.3% were homeless at 6 months (p < .001). Participants in the Critical Time Intervention program also showed significant decreases in alcohol use, drug use, and psychiatric symptoms (all p's < .01). The preliminary results suggest that each case management model is helpful in assisting people with complex behavioral health needs and chronic homelessness to move to stable housing. CONCLUSIONS: Permanent supported housing seems to be an effective way to end homelessness among people with co-occurring disorders. Further research is needed to determine which case management models work most effectively with supported housing to help policy makers and program directors make informed decisions in developing these programs.

Implicit alcohol cognitions in risky drinking nicotine users with and without co-morbid major depressive disorder.

OBJECTIVE: Alcohol consumption, nicotine use, and major depressive disorder (MDD) are highly co-morbid. The negative reinforcement model of addiction would suggest that smokers may consume alcohol to relieve negative affective symptoms, such as those associated with MDD and withdrawal from nicotine. Over time, these behaviors may become so strongly paired together that they automatically activate a desire to use alcohol, even in the absence of conscious or deliberate intention. This study examined implicit alcohol cognitions in 146 risky drinking nicotine users (n=83) and non-users (n=63), to help uncover cognitive mechanisms that link drinking, nicotine use, and depression together. We proposed that nicotine users with a history of MDD would have stronger implicit motivations to drink than non-nicotine users without MDD. METHOD: Participants were assessed on lifetime MDD (n=84) or no MDD (n=62), and then completed an Implicit Association Task designed to test the strength of associations between alcohol pictures and "approach" words. RESULTS: Regression analyses showed that implicit alcohol-approach attitudes were stronger among risky drinking nicotine users than non-users. Alcohol-approach motivations were also stronger among risky drinking nicotine users compared to non-users with a history of MDD; nicotine use was unrelated to implicit alcohol cognitions for risky drinkers without MDD. CONCLUSIONS: Implicit cognitive processes may be targeted in behavioral and pharmacological treatments in risky drinking nicotine users, particularly those with depression comorbidity.

Testing the Conjoint Influence of Impulsivity and Drinking Restraint on Alcohol Use Consequences in College Student Drinkers.

OBJECTIVES: Impulsivity and drinking restraint play a role in excessive drinking patterns and related negative consequences. Two domains of drinking restraint include preoccupation with thoughts of drinking (CEP) and attempts to control drinking (CBC), which differentially predict varying alcohol use outcomes in clinical and non-clinical samples. However, findings do not replicate across clinical, dependent samples and risky drinking young adults. This study examined the moderating role of dispositional impulsivity on the association between drinking restraint and alcohol consequences among college students to help clarify inconsistencies in the literature. METHODS: Data were collected from a sample of college student drinkers (N = 393) on drinking behavior in the past 90 days, alcohol-related problems, dispositional impulsivity, and drinking restraint. RESULTS: The association between CBC and alcohol consequences was significantly stronger for those higher than lower in dispositional impulsivity, after controlling for the effects of alcohol consumption. No such relationship was found for those high in trait temptation. CONCLUSIONS: Alcohol consequences are greater among those who attempt to control their drinking and who act rashly and without consideration of future consequences; those who are high on trait temptation show no such relationship.