Abstract
Background: Cocaine use is highly prevalent among homeless populations, yet little is known about how it is financed. This study examined associations of income sources with cocaine use and financing of drugs in a longitudinal evaluation of a homeless sample. Methods: A homeless sample was recruited systematically in St. Louis in 1999–2001 and longitudinally assessed annually over two years using the Diagnostic Interview Schedule and the Homeless Supplement, with urine drug testing. Results: More than half (55%) of participants with complete follow-up data (N = 255/400) had current year cocaine use. Current users spent nearly $400 (half their income) in the last month on drugs at baseline. Benefits, welfare, and disability were negatively associated and employment and income from family/friends, panhandling, and other illegal activities were positively associated with cocaine use and monetary expenditures for cocaine. Conclusions: Findings suggest that illegal and informal income-generating activities are primary sources for immediate gratification with cocaine use and public entitlements do not appear to be primary funding sources used by homeless populations. Policy linking drug testing to benefits is likely to have little utility, and public expenditures on measures to unlink drug use and income might be more effectively used to fund employment and treatment programs.
Highlights
Members of homeless populations by definition lack sufficient income to maintain secure housing.substance use and abuse are highly prevalent in homeless populations [1,2,3,4], implying that sources of funding must be available for obtaining substances of abuse
Philadelphia found that alcohol and drug use disorders were associated with income from odd jobs and illegal activities [10]
A multisite study of social security income recipients revealed that urine samples were 28% more often positive for cocaine in the first ten days of the month compared to the rest of the month, suggesting a temporal relationship between cocaine use and availability of income [16]
Summary
Members of homeless populations by definition lack sufficient income to maintain secure housing. Studies of street-involved youth have found that risky (illegal or quasi-legal) income-generating activities (e.g., sex work, salvaging/recycling, solicitation of donations for small services, panhandling, drug dealing, theft, and other criminal activities to generate income) are highly prevalent and are further associated with drug use [11,12,13] These findings are consistent with research on the relationship of income and drug use in more general populations. A multisite study of social security income recipients revealed that urine samples were 28% more often positive for cocaine in the first ten days of the month compared to the rest of the month, suggesting a temporal relationship between cocaine use and availability of income [16] The findings from this limited body of research suggest the need for further exploration of the relationship between drug use and its financing in homeless populations whose financial resources are ostensibly limited. This study examined associations of income sources with cocaine use and monetary expenditures for drugs in a longitudinal evaluation of a systematically recruited sample of homeless people assessed annually over two years
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