Assessing the impact of a homelessness prevention and rapid rehousing initiative for housing unstable veterans on alcohol-related harms: analysis of linked housing program and health care data

The National Institute on Alcohol Abuse and Alcoholism awarded Western Institute For Veterans Research $1,553,315 on September 1, 2026, under the Alcohol Research Programs (CFDA 93.273) to assess the impact of housing interventions on alcohol-related harms among veterans experiencing homelessness or housing instability.

The project will analyze linked longitudinal data spanning more than a decade, combining participation records from the Supportive Services for Veteran Families (SSVF) program with veteran electronic health records to determine whether housing-focused interventions improve alcohol use outcomes and reduce alcohol-related treatment needs and mortality. The research addresses a documented gap: while prior studies demonstrate that SSVF improves veteran housing outcomes, healthcare costs, and all-cause mortality, the program's specific effects on alcohol use disorder and alcohol-related harms remain unstudied, despite three in five homeless adults reporting a history of alcohol use disorder.

Performance occurs in Salt Lake City, Utah, with a period of performance from September 1, 2026, through August 31, 2029. The award is structured as a Project Grant under the NIAAA Alcohol Research Programs, which supports research to develop fundamental knowledge applicable to improved treatment methods and prevention strategies for alcoholism and alcohol-related problems.

Abstract

Persons who lack stable housing experience a disproportionate burden of alcohol use disorder (AUD). Three in five (60%) homeless adults have a history of AUD, leading to elevated rates of alcohol-related harms (e.g., poisoning and withdrawal, alcohol-related injury, chronic disease, and premature mortality). The lack of stable housing negatively impacts alcohol-related outcomes primarily by causing higher stress, rupturing connections to health-promoting social supports, increasing exposure to risky environments, and creating barriers to accessing both preventative care and AUD treatment. Little is known regarding whether housing interventions could improve alcohol use and related outcomes. The supportive services for veteran families (ssvf) program is the largest program to prevent and end homelessness among veterans in the US. Ssvf is a partnership between the department of veterans affairs (VA) and community-based organizations (referred to as grantees). In this partnership, grantees provide temporary financial assistance and other support services to veterans who are either currently homeless or facing imminent risk of homelessness. In FY 2023, VA provided $712 million in funding to 249 grantees covering every state in the US who delivered services to roughly 80,000 veterans nationwide. Our previous efforts have demonstrated that ssvf has a positive impact on veteran housing, healthcare costs, and all- cause mortality outcomes. However, the impacts of ssvf on alcohol use and alcohol-related treatment and outcomes have not been established. In this study, our team will use a unique, longitudinal, person-level dataset that links both data on participation in ssvf and veteran electronic health record data for more than a decade along with innovative methodological approaches including target trial emulation and natural language processing. In aim 1, we will determine the impact of the ssvf program on unhealthy alcohol consumption among veterans with and without a history of unhealthy alcohol use. In aim 2, we will assess the relationship between ssvf and alcohol-related adverse outcomes-including traumatic injury, alcohol poisoning, cirrhosis, suicidal ideation, and mortality-among veterans with a diagnosis of alcohol use disorder. In aim 3, we will evaluate the impact of ssvf on initiation of medications for alcohol use disorder (maud) and behavioral health interventions, as well as retention on maud. Our findings will provide actionable information to tailor homelessness prevention and rapid rehousing interventions-both within the VA and in the community-based homeless assistance system-to mitigate alcohol-related harms among persons with unstable housing.