Clinical correlates of homelessness and cannabis use among U.S. low-income veterans.

OBJECTIVES

Homelessness and cannabis use may interconnect in complex ways. This study used a nationally representative sample of low-income U.S. veterans to investigate histories of homelessness and cannabis use, and their associations with clinically relevant variables.

METHOD: Of 1031 veterans, 235 were categorized into three separate groups: history of lifetime homelessness but no lifetime cannabis use (HLS; n = 27 13.2%), no HLS but lifetime history of cannabis use (CU; n = 174, 73.2%), and both homelessness and cannabis use (HLS + CU; n = 34, 13.6%). Group-stratified bivariate and multivariate analyses were employed.

RESULTS

CU was related to residence in states where cannabis was legalized. Compared to CU and HLS, HLS + CU was more strongly associated with arrests, poor subjective health status, and more drugs used. Compared to CU only, HLS + CU was more strongly associated with higher trauma burden, current posttraumatic stress disorder and generalized anxiety disorder, suicidal behavior, history of arrest, and eviction. Compared to HLS only, HLS + CU was more strongly associated with current gambling. HLS + CU was associated with polydrug use, with stimulants being particularly common. Most veterans with HLS + CU reported receiving support from VA programs and services focused on homelessness.

CONCLUSION

Our findings suggest that homelessness may be more strongly associated with trauma-related and psychiatric concerns, whereas cannabis use may be more strongly associated with substance use and addictive behaviors. These results suggest the importance of integrated, trauma-informed, behavioral and substance use interventions targeting veterans with both histories of homelessness and cannabis use.