Homeless Users Research Articles

“I Stopped Shooting Up When I got Married”: Desistance, Crime, and Love

ABSTRACTThis project studies desistance from substance use and homelessness. In the early 1990s, the New Orleans Homeless Substance Abusers Project (NOHSAP) tested new treatment approaches for homeless substance users. The program ran for three years and enrolled 670 clients. The current project involved finding as many of these individuals as possible and reinterviewing them 25 years later. The methodology for this study consists of follow-up interviews with 50 individuals in a variety of settings, including at their homes and in correctional facilities. The principal finding is that stable, successful romantic relationships incline formerly homeless substance abusers to be sober, stably housed, or both. For persons of this description, successful romantic relationships are an important motivator for desistance.

You Care More for the Gear Than the Geezer? Care Relationships of Homeless Substance Users in London

AbstractCare for homeless people in general and homeless substance abusers in particular has been well explored as a research topic (Fisher and Collins ; Seal ; Desjarlais ; Pleace and Quilgars ; Bevan ; Briggs ). Historically, academics have been interested in care in settings as diverse as families, hospitals, asylums, poorhouses, the criminal justice system and more recently what has been called the ‘community’. In this paper, I want to look at two different dimensions of care in a particular social world of substance using homeless people in London where the people are not always the likely recipients but active providers of care. I understand care in Mol's and Winance's sense as a process of tinkering (Mol ; Winance ). The most dominant form of care is produced by many homeless substance users themselves: they care for drugs. The relationship to ‘their’ substance is often highly intimate and characterized by physical and emotional closeness, commitment and accord. Drugs develop person‐like characteristics and ‘demand’ care, promising intimacy and a sense of self. Dominated by the need to care for drugs in this way, other (human‐to‐human) relationships can become increasingly fragmented and the social net can become hollowed out, instrumental and even violent. Geographies split apart with different logics between public and intimate; sub‐cities emerge. But at the same time as the drug develops into the object of care demanding attention, the responsibility to care can develop a shared dimension. Friendships and love relationships grow based on intimate care which still centre on drugs but go far beyond it in their carefulness and interconnection. This is where geographies merge, connections are made and futures are built.

Outpatient Antibiotic Treatment Outcomes in Vulnerable Populations: Homeless and Current Injection Drug Users

Outpatient Antibiotic Treatment Outcomes in Vulnerable Populations: Homeless and Current Injection Drug Users

Network Approaches to Substance Use and HIV/Hepatitis C Risk among Homeless Youth and Adult Women in the United States: A Review.

During the United States economic recession of 2008–2011, the number of homeless and unstably housed people in the United States increased considerably. Homeless adult women and unaccompanied homeless youth make up the most marginal segments of this population. Because homeless individuals are a hard to reach population, research into these marginal groups has traditionally been a challenge for researchers interested in substance abuse and mental health. Network analysis techniques and research strategies offer means for dealing with traditional challenges such as missing sampling frames, variation in definitions of homelessness and study inclusion criteria, and enumeration/population estimation procedures. This review focuses on the need for, and recent steps toward, solutions to these problems that involve network science strategies for data collection and analysis. Research from a range of fields is reviewed and organized according to a new stress process framework aimed at understanding how homeless status interacts with issues related to substance abuse and mental health. Three types of network innovation are discussed: network scale-up methods, a network ecology approach to social resources, and the integration of network variables into the proposed stress process model of homeless substance abuse and mental health. By employing network methods and integrating these methods into existing models, research on homeless and unstably housed women and unaccompanied young people can address existing research challenges and promote more effective intervention and care programs.

Can persons with a history of multiple addiction treatment episodes and chronic relapse benefit from technology-delivered behavior therapy?

Drug misuse has been identified as a significant problem in homeless populations. This study examines aspects of physical and mental health, perceived quality of life and health service use among homeless illicit drug users and compares these to non-drug users.Participants were recruited through health clinics across Dublin. A questionnaire assessed participants’ drug use, health and well-being, health behaviours and use of health services. Descriptive statistics are presented for the entire cohort and drug users separately. Logistic regression analysis was used to examine the relationship between drug use and (i) multimorbidity, (ii) anxiety and/or depression, (iii) perceived quality of life and (iv) use of health services.Of 105 participants recruited, 35 (33%) were current drug users. Current and previous drug users were significantly more likely to have multimorbidity than those who had never taken drugs (OR 4.86, 95% CI 1.00–23.66). There was no significant difference between drug users and non-drug users in the prevalence of anxiety and/or depression. Drug users were five times more likely than non-drug users to have a low perceived quality of life (OR 5.2, 95% CI 1.7–16.0). Health service utilization was high, although some services were used less by drug users (e.g., dentist and psychiatric outpatient services) while others were used more often (e.g., phoneline services and day care centres).This study highlights the high levels of drug use in this population and the negative impact of drug use on health and perceived quality of life of a homeless population in Dublin.

Health, perceived quality of life and health services use among homeless illicit drug users

IntroductionDrug misuse has been identified as a significant problem in homeless populations. This study examines aspects of physical and mental health, perceived quality of life and health service use among homeless illicit drug users and compares these to non-drug users. MethodsParticipants were recruited through health clinics across Dublin. A questionnaire assessed participants’ drug use, health and well-being, health behaviours and use of health services. Descriptive statistics are presented for the entire cohort and drug users separately. Logistic regression analysis was used to examine the relationship between drug use and (i) multimorbidity, (ii) anxiety and/or depression, (iii) perceived quality of life and (iv) use of health services. ResultsOf 105 participants recruited, 35 (33%) were current drug users. Current and previous drug users were significantly more likely to have multimorbidity than those who had never taken drugs (OR 4.86, 95% CI 1.00–23.66). There was no significant difference between drug users and non-drug users in the prevalence of anxiety and/or depression. Drug users were five times more likely than non-drug users to have a low perceived quality of life (OR 5.2, 95% CI 1.7–16.0). Health service utilization was high, although some services were used less by drug users (e.g., dentist and psychiatric outpatient services) while others were used more often (e.g., phoneline services and day care centres). ConclusionThis study highlights the high levels of drug use in this population and the negative impact of drug use on health and perceived quality of life of a homeless population in Dublin.

Comparison of Homeless and Non-Homeless Problem Drug Users Recruited from Primary Care Safety-Net Clinics

IntroductionThe present study of homeless non-treatment-seeking problem drug users was designed to complement and extend previous studies which focused exclusively on treatment-seeking homeless problem drug users. MethodData were available for 866 primary care patients with drug problems, 30% homeless and 70% housed. ResultsIn the 2years prior to baseline, homeless participants had less chronic medical co-morbidity than problem drug users who were housed yet were significantly more likely to have used emergency department services, to have used them more frequently, and at higher cost. Compared to their housed counterparts, homeless participants were also more likely to have been admitted to specialized chemical dependency treatment and/or detoxification services, to have been arrested for a felony or gross misdemeanor, and to report having psychiatric problems in the prior 30days. ConclusionsAdditional support may be necessary for homeless patients presenting in primary care to benefit from substance abuse treatment given their more severe drug use problems coupled with their co-morbid health, psychiatric, and psychosocial problems.

'We are always in some form of contact': friendships among homeless drug and alcohol users living in hostels.

Homeless drug and alcohol users are one of the most marginalised groups in society. They frequently have complex needs and limited social support. In this paper, we explore the role of friendship in the lives of homeless drug and alcohol users living in hostels, using the concepts of ‘social capital’ and ‘recovery capital’ to frame the analyses. The study was undertaken in three hostels, each in a different English city, during 2013–2014. Audio recorded semi‐structured interviews were conducted with 30 residents (9 females; 21 males) who self‐reported drink and/or drug problems; follow‐up interviews were completed 4–6 weeks later with 22 participants (6 females; 16 males). Data were transcribed verbatim, coded using the software package MAXQDA, and analysed using Framework. Only 21 participants reported current friends at interview 1, and friendship networks were small and changeable. Despite this, participants desired friendships that were culturally normative. Eight categories of friend emerged from the data: family‐like friends; using friends; homeless friends; childhood friends; online‐only friends; drug treatment friends; work friends; and mutual interest friends. Routine and regular contact was highly valued, with family‐like friends appearing to offer the most constant practical and emotional support. The use of information and communication technologies (ICTs) was central to many participants' friendships, keeping them connected to social support and recovery capital outside homelessness and substance‐using worlds. We conclude that those working with homeless drug and alcohol users – and potentially other marginalised populations – could beneficially encourage their clients to identify and build upon their most positive and reliable relationships. Additionally, they might explore ways of promoting the use of ICTs to combat loneliness and isolation. Texting, emailing, online mutual aid meetings, chatrooms, Internet penpals, skyping and other social media all offer potentially valuable opportunities for building friendships that can bolster otherwise limited social and recovery capital.

Design-based inference in time-location sampling.

Time-location sampling (TLS), also called time-space sampling or venue-based sampling is a sampling technique widely used in populations at high risk of infectious diseases. The principle is to reach individuals in places and at times where they gather. For example, men who have sex with men meet in gay venues at certain times of the day, and homeless people or drug users come together to take advantage of services provided to them (accommodation, care, meals). The statistical analysis of data coming from TLS surveys has been comprehensively discussed in the literature. Two issues of particular importance are the inclusion or not of sampling weights and how to deal with the frequency of venue attendance (FVA) of individuals during the course of the survey. The objective of this article is to present TLS in the context of sampling theory, to calculate sampling weights and to propose design-based inference taking into account the FVA. The properties of an estimator ignoring the FVA and of the design-based estimator are assessed and contrasted both through a simulation study and using real data from a recent cross-sectional survey conducted in France among drug users. We show that the estimators of prevalence or a total can be strongly biased if the FVA is ignored, while the design-based estimator taking FVA into account is unbiased even when declarative errors occur in the FVA.

How Institutions Deprive: Ethnography, Social Work, and Interventionist Ethics Among the Hypermarginalized

Hypermarginalized populations, such as homeless drug users with acute health problems, are subject to multiple intersecting adversities that result in social exclusion and chronic suffering. Despite this population's high need for health and social services, institutions provide services that are fragmented and often punitive, contributing to further marginality. In this article, we present a hybrid methodological approach that combines clinical social work and ethnography in a study of intensive case management for HIV-positive indigent adults in Oakland, California. We investigate two primary research questions. First, we consider the challenges this population faces in navigating institutions to meet their basic needs, and we demonstrate how organizational irrationality has severe consequences for this population. Second, we grapple with the question of how to ethically engage hypermarginalized participants in research by presenting a clinically informed intervention that is responsive to individual vu...

La méthamphétamine – un stimulant comme les autres ou un problème plus complexe ?

Methamphetamine (MA) has recently become very popular in the media, due in part to its increasing popularity as well as its psychotropic effects and the negative consequences of its use. Is it a stimulant like any other, or does methamphetamine use lead to specific difficulties in its users? The aim of this article is to provide a brief review of the literature by explaining some of the reasons for its popularity in Canada as well as the physical, dental, psychiatric, cognitive and legal problems associated with its use. MA's popularity: Regarding its popularity, MA has benefitted from multiple factors, namely its low cost for users and manufacturers, its quick and intense psychotropic effects (increased energy, sexual arousal, rapid thinking, sleeplessness, lack of appetite), its easy access, as well as its various methods of ingestion (nasal, oral, injection). MA abuse also results in a multitude of negative effects, both physical and mental. MA's physical effects: In terms of negative physical effects, cardiac problems, skin infections, sexually transmitted (and injection-related) diseases as well as meth mouth are described. MA's mental effects: In terms of mental consequences, two recently published Canadian studies revealing high rates of depression symptoms and of sustained psychotic symptoms in a subgroup of MA users are presented. Studies reporting various cognitive deficits in MA user are also reviewed, including reports of high prevalence of childhood attention deficit and hyperactivity disorder diagnoses among adult MA users. Furthermore, MA abusers are documented as having been highly exposed to trauma in their lives, with many presenting with post-traumatic stress disorder criteria. This manuscript also explores the reasons behind the forensic profiles of individuals using MA, particularly the increased tendency toward violent acts, the high incarceration rates of the homeless users and the high percentage of individuals diagnosed with antisocial personality disorder reported in studies. In terms of user profiles, various methods of ingestion, frequency of use as well as combination with other drugs are described, with a special focus on the frequent polysubstance abuse found in MA users and the reality of bingers. This manuscript describes specific treatments designed for stimulant users such as MA abusers, namely the MATRIX program, as well as modifications piloted for those with comorbid depression. Pharmacological treatments, as well as antioxidant supplements, are also discussed although they have not yielded positive results with humans to date. Overall, our goal in this manuscript is to highlight the complexity of the difficulties faced by MA users as well as the limited ability of currently available treatments to address the multiple needs associated with this complexity.

Social and recovery capital amongst homeless hostel residents who use drugs and alcohol

BackgroundHomeless people who use drugs and alcohol have been described as one of the most marginalised groups in society. In this paper, we explore the relationships of homeless drug and alcohol users who live in hostels in order to ascertain the nature and extent of their social and recovery capital. MethodsData were collected during 2013 and 2014 from three hostels. Each hostel was in a different English city and varied in size and organisational structure. Semi-structured interviews were conducted with 30 residents (21 men; 9 women) who self-reported current drink and/or drug problems. Follow-up interviews were completed after 4–6 weeks with 22 residents (16 men; 6 women). Audio recordings of all interviews were transcribed verbatim, systematically coded and analysed using Framework. ResultsParticipants’ main relationships involved family members, professionals, other hostel residents, friends outside of hostels, current and former partners, and enemies. Social networks were relatively small, but based on diverse forms of, often reciprocal, practical and emotional support, encompassing protection, companionship, and love. The extent to which participants’ contacts provided a stable source of social capital over time was, nonetheless, uncertain. Hostel residents who used drugs and alcohol welcomed and valued interaction with, and assistance from, hostel staff; women appeared to have larger social networks than men; and hostels varied in the level of enmity between residents and antipathy towards staff. ConclusionHomeless hostel residents who use drugs and alcohol have various opportunities for building social capital that can in turn foster recovery capital. Therapies that focus on promoting positive social networks amongst people experiencing addiction seem to offer a valuable way of working with homeless hostel residents who use drugs and alcohol. Gains are, however, likely to be maximised where hostel management and staff are supportive of, and actively engage with, therapy delivery.

“I’m not an alcoholic anymore”: Getting and staying sober without meetings

This project studies desistance from substance abuse and 12-step meetings. In the early 1990s, The New Orleans Homeless Substance Abusers Project (NOHSAP) was created to uncover treatment strategies for homeless substance abusers. The program ran for 3 years with 670 homeless New Orleans individuals going through treatment. This project involved finding these individuals and re-interviewing them (19 years later). The methodology for this study consists of follow-up interviews with 32 individuals in a variety of settings including at their homes and in prisons. Individuals interviewed tended to be sober, but disaffiliated with 12-step meetings.

Positive and negative features of a computer assisted drug treatment program delivered by mentors to homeless drug users living in hostels

This paper explores positive and negative features of computer assisted therapy (CAT) delivered by mentors to homeless drug users (HDUs) living in hostels. Qualitative interviews were conducted with 30 HDUs and 15 mentors (all hostel staff) at the beginning and end of a 12-week CAT program. Findings indicate that successful delivery of the CAT relates to: ‘program features’ (e.g. its accessibility, flexibility, user-friendly interface); ‘delivery context’ (e.g. privacy, having appropriate computing equipment), ‘client characteristics’ (HDUs being recovery-focused and committed to using the program), and ‘mentor support’ (clients having personalized attention from an encouraging and sympathetic other). It is concluded that CATs can be used with HDUs but are unlikely to replace addiction therapists. Rather, they are more likely to be effective when combined with a strong therapeutic relationship. Services using CATs with HDUs need to provide staff training, support, and time to maximize the potential benefits.

Homeless Drug Users and Information Technology: A Qualitative Study with Potential Implications for Recovery from Drug Dependence

Background: Having access to information and communication technologies (ICTs) is a prerequisite to meaningful participation in society. Objectives: This paper seeks to: i. explore the engagement of homeless drug users (HDUs) with ICTs and ii. discuss the findings with reference to recovery from drug dependence. Methods: The study design was qualitative and longitudinal, involving data collected in 2012–13 via 52 semi-structured interviews with 30 homeless drug users (25 men; five women). Participants were recruited from 17 hostels in two English cities. Interview data were analyzed using Framework. Results: HDUs had access to ICTs, used ICTs, and wanted to engage with them more. Experiences of digital exclusion were a function of participants’ inability to afford ICTs, the relatively cheap and poor quality technology available to them, limited knowledge about ICTs, and lack of support in using them. That HDUs were often unable to take full advantage of technology because they had nobody to explain what their devices could do or to show them how they worked was ironic given that using ICTs to (re)establish and maintain relationships were functions of technology that HDUs particularly liked. Conclusions: The physical, human, cultural, and social capital of HDUs influenced their access to, and use of, ICTs. Equally, ICTs were themselves an important recovery resource. Services and others should endeavor to provide HDUs with easy access to good quality technology, as well as offers of support and education so that all individuals have the knowledge and confidence to make optimum use of the technology that is available to them.

Patterns of use and perceptions of drug addicts in Greece about “shisha” (a new synthetic drug) at economic crisis era

Purpose – This paper aims to research the prevalence of a new drug which appeared at the era of economic crisis in Greece, called “shisha.” Shisha, a rather cheap form of crystal meth, has spread fast among drug users in Greece with the deepening of the economic crisis. The present paper is concerned with the socio-demographic characteristics of drug users who choose this type of drug and reveals the conditions under which this drug is used. In addition, perceptions of drug users about the specific drug are also explored. Design/methodology/approach – In total, 148 drug users took part in this study. Of these 73 percent were men and 27 percent women. The average age of participants was approximately 37 years. All participants in the study were interviewed face-to-face on the basis of a structured brief questionnaire with closed and open-ended questions. Findings – The data suggests that the majority of drug users who use “shisha” are mainly heroin users (63.2 percent) and they use this new drug as a second choice to heroin. Shisha can be found in the center of Athens and it is usually smoked through a glass pipe. The cost for buying the drug is relatively low (two to three euros) and the drug is produced in small illegal labs. Most participants argued that shisha is linked to violent and aggressive behavior, loss of weight, insomnia, sexual arousal and a psychotic state that may cause death. The drug is made out of a form of crystal meth produced by amphetamines and liquid acids found in batteries liquids. Practical implications – This drug is mainly used by homeless drug users in the center of Athens. Its exact synthesis cannot be identified given the fact that drug users use various recipes to produce it. Taking the drug is extremely dangerous for the health of the users. Originality/value – Research of the use of a new drug linked to the economic crisis in Greece. Researchers in this paper approached street drug users who are highly unlikely to seek help from health or other types of treatment providers.

Understanding homelessness, mental health and substance abuse through a mixed-methods longitudinal approach

This manuscript outlines the multiple methods utilized in a long-term follow-up of a non-traditional population: Homeless substance abusers in New Orleans. This article addresses qualitative mental health research by outlining steps taken to explore both qualitative and quantitative data sources. By way of qualitative and quantitative methods, this research examines the life course of a sample of New Orleans homeless substance abusers from the time they entered into treatment (1991) until the present and observes the quality of their social bonds and their long-term outcomes. By making use of mixed methods, this research gives a more thorough understanding of mental health, specifically examined through homelessness and substance abuse.

Prevalence of HIV infection and the correlates among homeless in Tehran, Iran

ObjectiveTo determine the prevalence of HIV infection among homeless men and women and the related risk behaviors in Tehran, Iran. MethodsIn 2007–2008, Tehran municipality stacked up 10672 homeless men and women for assessment of HIV and began collaboration with Iranian Research Center for HIV/AIDS (IRCHA) departments to conduct HIV infection prevalence surveys in homeless populations. The results were analyzed for associations with demographic information, family support, status of drug abuse and relation with family and friends. ResultsOverall HIV prevalence was 1.7% (95% confidence interval 1.4–1.9). Factors independently associated with HIV infection included history of using drugs [AOR 8.15 (4.86–13.67)], older age [AOR 1.80 (1.08–2.99) for 40–55 yr], occupation [AOR 1.64 (1.19–2.24) for unemployed], and no relation with family [AOR 1.82 (1.30–2.54)]. ConclusionsThis study supports the idea that injection drug use is contributing to the increased spread of HIV among Iranian homeless. Harm reduction programs should be expanded, particularly among homeless injection drug users.

The use of computer-assisted therapy by homeless drug users living in hostels: An explorative qualitative study

Aims: To explore the use of computer-assisted therapy (CAT) by homeless drug users (HDUs) living in hostels in order to assess the likely acceptability of online treatment for this population. Methods: Repeat semi-structured interviews with 30 HDUs (25 men; 5 women) who agreed to participate in a 12-week mentor-assisted online drug treatment programme: Breaking Free Online (BFO). Interviews were transcribed, coded and analysed using Framework. Findings: Prior to the first BFO session, HDUs’ hopes and goals were seldom confined to reducing their drug consumption. Most described broader recovery and wellbeing aims, and many wanted BFO to improve their computing skills. Nearly all participants expressed positive feelings about the programme after both their first and last session, with clients highlighting BFO's accessibility, flexibility, interactive capabilities and user-friendly interface. Negative comments related to structural barriers that prevented the programme from being used as intended. After the last BFO session, only four clients reported reduced substance use, but other personal, psychological, educational and social benefits were identified. Conclusions: There is potential for using CAT programmes, such as BFO, with HDUs living in hostels. However, evaluations might need to assess a range of recovery indicators in order to gauge any evidence of treatment success.

A Qualitative Exploration of the Spatial Needs of Homeless Drug Users Living in Hostels and Night Shelters

Qualitative data were deployed to explore the spatial needs of homeless drug users staying in hostels and night shelters. Findings indicated that Fitzpatrick and LaGory's four categories of spatial need (‘privacy’, ‘personal space’, ‘social interaction’, ‘safe and defensible spaces’) all had good analytical purchase. However, three further need categories (‘institutional support’, ‘amenities and standards’, ‘spatiotemporal structures and boundaries’) were identified. While hostels and night shelters met the spatial needs of some homeless drug users, there was considerable scope for improvement; indeed, failure to meet spatial needs could result in increased drug use, risky injecting practices, worsening health and a return to the streets. Our seven-fold categorisation of spatial needs requires further empirical study but could potentially inform other place-based approaches to health.