Integrating trauma care and housing preparation in substance abuse treatment for homeless men: Preliminary outcomes from the Steps to Safety program

Background: Steps to Safety is a trauma-specific intervention for homeless men with co-occurring substance abuse and mental health disorders entering substance abuse treatment programs and provides an opportunity to support recovery and housing stability. Currently, little is known about effective interventions for this population. Methods: We analyzed baseline (n = 110) and 6 month follow-up (n=80) assessment data on participants in Steps to Safety. Data included socio-demographics and self-reported assessments of mental health symptoms, trauma exposure, general health, housing readiness and social connectedness. This analysis focuses on mental health outcomes. Results: The mean age of participants was approximately 38. More than half (53%) did not finish high school; nearly all (96%) were unemployed prior to entry. The most commonly used substances were alcohol (39%), marijuana (36%) and cocaine/crack (27%). Preliminary data show prevalence of anxiety/tension not due to alcohol or drugs decreased from 58% to 43% at follow up. Other indicators of mental health burden, including serious depression and suicide attempts also decreased. Data show significant decreases in negative survival skills like using drugs (78% to 49%) and isolating oneself (65% to 51%). A small number of positive survival skills increased, including going for a walk (71% to 82%) and relaxation exercises (61% to 67%). Discussion: Integrating trauma care in substance use treatment for homeless men results in improved mental health status and use of positive survival skills. Additional research should examine the extent these improvements are sustained over longer periods and support sustained drug cessation and improved housing stability.