Available online 3 January 2026, 113022

Housing insecurity increases risk of overdose death among people who use drugs

mHealth app use was associated with less drug use at 30 days

Over time, app use led to reduced cravings and perceived burdensomeness

Over time, messaging the app eCoach improved health literacy

mHealth is a promising tool to improve health outcomes in highly vulnerable patients

People with substance use disorders (PwSUD) who experience housing insecurity have disproportionate overdose deaths. Digital interventions may improve care among PwSUD, but evidence specifically for housing-insecure PwSUD, who face unique barriers, remains limited.

We examined the efficacy of a mHealth tool (uMAT-R) among people who have misused substances and reported current housing insecurity. Substance use, cravings, access to basic needs, social disconnection, and digital literacy were assessed at baseline and 1 month and compared by uMAT-R use. Generalized estimating equations were employed to assess the efficacy of the intervention.

Participants who logged into uMAT-R were less likely to report other non-opioid illicit drug use (aOR (95%CI): 0.49(0.29, 0.85)). Similarly, those who messaged the e-coach were less likely to report using opioids (aOR(95%CI): 0.39(0.21, 0.73)) or other illicit drugs (aOR (95% CI): 0.53(0.30, 0.92)) during past 30-days. Significant interaction effects were found in uMAT-R use by time in cravings (Coef (95%CI): -2.11(-4.07, -0.17)) and perceived burdensomeness (Coef(95%CI): -2.62 (-4.91, -0.36)). Messaging an e-coach by time was significantly associated with improved health literacy (Coef (95%CI): 0.61(0.05, 1.18)) and decreased thwarted belongingness (Coef(95%CI): -0.36 (-0.71, -0.02).

Our preliminary findings suggest that people who have misused substances and experience housing insecurity may benefit from uMAT-R, which was associated with improved recovery outcomes. Future research is needed to examine the unique barriers experienced by this population and how mHealth tools can be used to provide tailored, equitable access to supportive resources to reduce barriers and promote long-term recovery.

housing insecurity

Substance Use

mHealth

Digital Intervention

© 2026 The Authors. Published by Elsevier B.V.