What Substance Abuse Treatments Work for Homeless Youth?

A young woman blows dandelion seeds.

A Comparison of Three Interventions for Homeless Youth Evidencing Substance Use Disorders: Results of a Randomized Clinical Trial” (abstract). Natasha Slesnick, Xiamei Guo, Brittany Brakenhoff, and Denitza Bantchevska. Journal of Substance Abuse Treatment, Vol. 54 (2015).

What it’s about: Slesnick, Guo, Brakenhoff, and Bantchevska wanted to identify effective interventions to help homeless youth who use drugs. In this study, they randomly assigned 270 homeless youth who visited a drop-in center to one of three treatments: the community reinforcement approach, or CRA, motivational enhancement therapy, or MET, and case management.

The researchers looked at each intervention's effects on drug use among the participants, who ranged in age from 14 to 20. They also evaluated whether and how each treatment approach impacted the youth's housing, mental health, and victimization outcomes after three months, six months, and one year.

Why read it: Research tells us that homeless youth experience high rates of drug use, mental health problems, and physical and sexual victimization compared to their housed peers. Previous research led by Natasha Slesnick showed CRA to be more effective than “treatment as usual” in reducing drug use among homeless youth. This study explores how CRA compares to two other evidence-based treatment approaches, MET and case management, in effectively reducing drug use and associated problems over time.

Biggest takeaways from the research: The authors found that more than half of participants showed significant improvements across multiple outcomes, regardless of the intervention they received. Specifically, all three treatments were linked with the following:

  • Less-frequent alcohol and drug use, on average, by homeless youth over a 12-month period.
  • Overall reduced harm from drug use.
  • Fewer episodes of homelessness and symptoms of depression.

Young women showed better outcomes than young men, and youth who had experienced physical abuse in childhood showed poorer outcomes than others. Neither age nor ethnicity seemed to affect the treatments' effectiveness, the authors found.

Based on these findings, the authors suggest that homeless youth with drug problems can still be engaged in treatment, even if they are not actively seeking help or do not receive housing services. Drop-in centers may reasonably use any of the three interventions from the study to serve homeless youth effectively, they write, including case management, which is not specifically focused on drug use. Moreover, drop-in centers already using case management may find it financially beneficial to stick with their current services, rather than switching to a more costly approach.

Additional references: Look for more articles about homeless youth and substance use in NCFY’s research library.

Read our Q&A with Natasha Slesnick on providing evidence-based teatments for homeless youth, or this research summary examining homeless young people's attitudes toward alcohol and drugs.

Publications discussed here do not necessarily reflect the views of the National Clearinghouse on Families and Youth, the Family and Youth Services Bureau, or the Administration for Children and Families.

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