Homeless Dually Diagnosed Veterans’ Service Preferences: Do Needs Explain Wants?

Consumer preferences are a key influence on help-seeking behavior, but may be discordant with clinical need. We analyze the service preferences of formerly homeless Veterans diagnosed with substance abuse and psychiatric problems, after enrollment in a 9-month randomized trial of peer support and living in a VA-supported housing program. Prior research suggests that service preferences will reflect self-assessed treatment needs and personal resources, but may not concur with clinically assessed need. We test these predictions at baseline (N=167), mid-project (N=151), and final follow-up (N=141). At each time, preferences for alcohol, drug, and mental and physical health treatment were associated independently with indicators of self-assessed problem severity, and often with recent symptoms of dual diagnosis, but the experience of mental health problems in the last 30 days independent of substance abuse problems tended to reduce interest in receiving help for alcohol and drug problems. Clinician assessment of Veteran need for services at baseline predicted interest in treatment for help with alcohol problems at the final follow-up, but otherwise was not associated with treatment interests. Higher levels of current social support also predicted more interest in alcohol and drug treatment, but were not associated independently with interest in treatment for mental health or physical health problems. Sociodemographic characteristics were not associated independently with interest in treatment for the health problems. The roles of social support and mental health further help identify those amenable to treatment and those needing special efforts to encourage treatment or to find alternatives to socially-oriented treatment.