This study examined what is important to dual diagnosis clients regarding housing, what types of housing they prefer, and what factors led to their housing. As expected, the majority of clients preferred living in their own apartment or house. However, housing preferences were not static, and over half of the clients reported that their housing preferences had changed over time, often relating these changes to their recovery. As clients felt themselves progressing, many wanted different types of housing, ‘depending on where you’re at in your stages of recovery or wellness with your mental health would dictate how your thoughts are about caring where you want to stay’ (supervised client 12).
Interviews revealed that almost all clients wanted some form of independent housing in the future, and one fourth aspired to live with a future significant other or family member. This was in contrast to the relatively isolated lives described by clients currently living in independent housing, consistent with previous findings (Friedrich et al., 1999
; Siegel et al., 2006
). This has implications for supported housing programs- increasing socialization may need to be a focus for clients living independently. Although nearly all clients wanted independent housing in the future, many described needing supervised housing at some point in their recovery. Many clients talked about how supervised housing provided structure and support that was helpful in their recovery. Clients who reported they had never wanted supervised housing acknowledged and in some cases, extolled the benefits of supervised housing especially ‘for starting out’ (supervised client 5). This has implications for the residential continuum model, which moves clients from supervised to increasingly independent settings (Ridgway & Zipple, 1990
Supported housing programs that exclude group living arrangements (Hogan & Carling, 1992
; Rog, 2004
) may ignore the possible benefits of supervised housing. Research has shown dual diagnosis clients can benefit from supervised housing (Brunette, Mueser, & Drake, 2004
; Goldfinger et al., 1999
). In the current study, over half of the clients in supervised housing clearly talked about how they preferred supervised housing right now and despite their stated future preference for independent living, many clients were very satisfied living in supervised housing. Our findings suggest that an array of housing options may be needed. As other researchers have pointed out (Friedrich et al., 1999
), giving clients a choice means ensuring housing alternatives exist. As the supply of low-cost independent housing and government funding for social programs diminish, the value of other housing alternatives should be considered.
One surprising finding was that clients in both supervised and apartment housing reported enjoying the amount of independence, ownership, and space their living situation provided. These similarities were unexpected given the finding that clients associate supervised and apartment housing with different housing characteristics. It may be that there are fewer actual differences between the two types of housing than sometimes assumed. Also notable is that SROs, although often considered independent housing, were viewed by clients as less than adequate and inferior to apartment housing. There were a limited number of SRO cases in this study, but future studies that evaluate independent housing may find it useful to make a distinction between apartments and SROs.
The residential programs in this study can be characterized as “damp” housing and it is unclear whether the results would generalize to “dry” housing where strict rules on substance use are enforced. Some clients had negative experiences with supervised housing and envisioned all group housing as living with roommates and having strict rules- many believed they could only have their own room, kitchen, and bathroom in independent housing. As in this study, supervised housing units can vary greatly on these features, but clients often do not realize this. Corrigan et al. (2008)
presents a typology of various residential arrangements that may be useful for providers presenting options to clients. However, the specific features of housing should also be carefully discussed with clients beyond presenting them categorically as the categories may not be so distinct.
Clients often did not have a rational decision-making process in selecting housing. Most times, decisions regarding housing were based on suggestions from treatment providers. Because we did not interview treatment providers, we do not know their perspective. But the influence of treatment providers may be important in light of previous findings that what treatment providers see as good for clients is often at variance with what clients want (Holley et al., 1998
; Piat et al., 2008
). Shared decision-making has been found to be crucial in increasing treatment adherence and endowing patients with responsibility for their outcomes (Deegan & Drake, 2006
). It follows that shared decision-making should be incorporated in housing services so that clients are involved and feel responsible for their placements. Clients often did not know or understand housing options, including the different programs, funding, and housing types available to them. As a result, housing decisions were often left to the discretion of treatment providers who were privy to this information. One way to possibly remedy this is to have treatment providers conduct regular interviews with clients and family members where housing information can be mutually exchanged.
There are numerous areas for further study. This study focused exclusively on adults with dual diagnoses, and whether these results generalize to clients without a substance use disorder has yet to be determined. Further investigation is needed on recovery-related preferences and experimental approaches testing the utility of stage-wise housing placements should be explored. Another important question for future study is how to balance client preference with client need, particularly in light of some difficulties with insight (Goldfinger et al., 1999
; Schutt & Goldfinger, 2000
) . Also, given the variation in the kinds of supervised housing, studies should examine what constitutes the most effective structure for which client.
This study had several limitations, including limited data on the background characteristics of participants. Extensive residential histories were not gathered and reports of current housing experiences may be dependent upon past experiences, e.g., some clients may have never lived in independent housing before. Quantitative measures of stage of recovery would have also added another level of analysis. The basic demographics of the study sample are roughly similar to other studies of this population in Chicago (Rollins, O'Neill, Davis, & Devitt, 2005
) and in national housing studies (Lipton, Siegel, Hannigan, Samuels, & Baker, 2000
; Rosenheck, Kasprow, Frisman, & Liu-Mares, 2003
), but the housing in this study may not be representative of housing in other areas. Nonetheless, our findings show the potential of housing programs and light the path for further questions and inquiry.