Homelessness among problem drug users: prevalence, risk factors and trigger events

Abstract

The present paper uses data from a prospective cohort study of 877 problem drug users entering treatment in Scotland to extend knowledge of homelessness and drug misuse in three important respects: First, the prevalence of homelessness among problem drug users is investigated; secondly, key risk factors for homelessness among problem drug users are identified; and thirdly, trigger events associated with movements into or out of homelessness by problem drug users over time are explored. Data were collected during two waves of interviewing which were conducted 8 months apart. Thirty-six per cent of problem drug users entering treatment were homeless at either or both interviews, a prevalence rate that is at least seven times greater than among the general population. Whilst many of the risk factors found to be associated with homelessness are common to homeless people in general, at least one homelessness risk factor - recent drug injection [OR = 1.40; 95% confidence interval (CI) = 1.01-1.96]- is clearly specific to those who take drugs. Movements into homelessness among problem drug users were associated with recently losing residency of children (OR = 2.28; 95% CI = 1.27-4.08), other recent family problems (OR = 1.88; 95% CI = 1.21-2.94) and worsening general health (OR = 2.17; 95% CI = 1.15-4.09). Movements out of homelessness were associated with not having recent family problems (OR = 0.43; 95% CI = 0.24-0.79). The findings provide empirical support for the good practice guidelines now being published by various UK Government departments, but also suggest that the relatives of problem drug users should be offered increased assistance to help them deal with the many stresses that having a drug-dependent family member can bring.

Injecting drug use and unstable housing: Scope for structural interventions in harm reduction

“…The prevalence of problem drug use among the homeless in the UK has been estimated at seven times that than for the general population 33 .…”

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

“…39,97 The leaving rates from NSP and OST came from a Welsh cohort study. 39 Conversely, the recruitment rates to these states were obtained through calibration.…”

Housing Instability among People Who Inject Drugs: Results from the Australian Needle and Syringe Program Survey

“…[17][18][19] With evidence to support both theories, the presence of either homelessness or substance use clearly predisposes an individual to the other. 16,20 Indeed, substantial evidence documents many risk factors common to both. 18,21 Life experiences highly prevalent among both homeless populations 21 and dependent drug users 22 include childhood adversity, subsuming poor relationships with parents, neglect, physical and sexual abuse, and being forced or placed into care out of the home, [23][24][25][26] experiences which themselves contribute to the risk of concurrent and future mental health problems [27][28][29] ; early economic disadvantage; school expulsion and lack of academic qualifications 30 ; inadequate social networks; and offending behavior and incarceration.…”

“…58 Despite the scale of the issue and the targets set, many gaps remain in our knowledge of homelessness in Australia. Notably in this context, information on the prevalence of drug use among homeless people is substantial and clearly demonstrates a strong relationship, 10,12,14,15,17,59 yet data on homelessness among problem drug users are less readily available, having been collected only among restricted samples of drug users, such as those seeking treatment, 20 or participants of studies of HIV prevalence, incidence, and risk behaviors and risk reduction interventions. 34,48,[51][52][53] Since 1995, the Australian NSP Survey (ANSPS) has provided annual point prevalence estimates to monitor patterns of BBV infection and risk behaviors among needle and syringe program (NSP) clients.…”