Substance Use and Social Stability of Homeless Youth: A Comparison of Three Interventions

A high prevalence of substance use has been observed among homeless youth. Substance use among homeless youth is associated with a wide range of physical and psychological problems, and is one of the contributing factors for running away from home. Thus, substance use treatment is usually a priority in homeless youth interventions. Most studies of homeless youth’s substance use focuses on the effects of the social environment on substance use. However, knowledge of the effects of homeless youth’s substance use on their social environment is more limited. Research suggests that homeless youth’s substance use shapes their social environment, particularly with reference to social stability represented as employment, school attendance, and stable housing, such that homeless youth’s substance use and social stability may co-occur over time. As no prior studies have examined the co-occurrence of substance use and social stability among homeless youth, the first goal of the present study was to investigate the longitudinal co-occurring trajectory of substance use and social stability. Additionally, knowledge about how interventions influence the co-occurrence of substance use and social stability is limited. Thus, the second goal of the present study was to examine the longitudinal effects of three empirically-supported interventions, the Community Reinforcement Approach (CRA), Motivational Enhancement Therapy (MET), and case management (CM), on the co-occurrence of substance use and social stability.

The sample consisted of 270 homeless youth and young adults who were recruited from a homeless youth drop-in center in Central Ohio. Participants were randomly assigned to one of the three intervention conditions: CRA, n = 93, MET, n = 86, or CM, n = 91, and assessed at baseline, 3, 6, and 12 months post-baseline. A parallel process-latent class growth analysis identified four subgroups. The largest group (n=86) exhibited increased social stability paired with low stable substance use. The second largest group (n=80) exhibited increased social stability paired with decreased substance use. Sixty-eight participants remained unchanged in their substance use and social stability. The rest of the participants (n=36) exhibited increased substance use paired with unchanged social stability. Findings showed that CRA was more effective in improving substance use and social stability simultaneously compared to MET and CM, and further, CM is more effective than MET. The findings underscore the significance in identifying subgroups of homeless youths that vary in problem severity in terms of their substance use and social stability, and offer evidence regarding the comparative effects of three empirically-supported interventions.