Friday, March 11, 2016

Drug addiction and homelessness

Are the homeless all drug addicts?


In 1989, 75% of a particular population group reported being addicted to drugs1. In 2003, the studies said 38% of the homeless regularly used drugs2

Of course, that’s 13 years ago, now. In 2007, two-thirds of homeless reported that substance abuse or alcohol abuse contributed to their becoming homeless3. On the street, substances are widely used, and when you’re on the street with them, it’s very hard to not use substances4.

It’s now 2016. Have things changed since 2009, when the National Coalition for the Homeless wrote about homelessness and drug addiction? Well… yes and no. According to the 2010 Annual Homeless Assessment Report to Congress (2010 AHAR), 26.2% of all sheltered persons who were homeless had a severe mental illness, and 34.7% of all sheltered adults who were homeless had chronic substance use issues. So, the answer would be, "No, it hasn't changed that much."

A relatively recent study, published in JAMA5, says that 17% of homeless deaths in Boston were due to drug overdoses. Around the Seattle area last year, the percentage was much higher. You can read the King County medical examiner’s report on homeless deaths here.

It’s not just a problem for the homeless, but for the entire population. 15% of the population uses drugs (or did in 20066).

And here’s the other thing to be aware of: the statistics change as the homeless population changes. In 2008, a veritable flood of homeless hit the streets because of the economic downturn. These were mostly normal people, dispossessed of homes by rampant greed. Most of them were not substance abusers, but some of them became substance abusers to escape the emotional and psychological trauma of having become homeless. Others became homeless because of their substance abuse and alcoholism.

Still, from my point of view, drugs and alcohol are scourges of the homeless population. Any group that addresses homelessness should be addressing drug and alcohol abuse among them.

Not all homeless abuse drugs and alcohol, but many do.

What is being done about the problem? Without stable housing, treatment is hard to seek. However, there are success stories out there. One person I know in the Seattle area has now been clean and sober for two years and counting. This is at least her third try. She is very persistent. But generally, fewer than 25% of homeless receive treatment for their substance abuse7.

That’s plain enough. What are the conditions that aid in recovery from substance abuse? These seem to be critical8:

  • Housing access. A stable living environment is a critical factor in recovery. Conditional housing that demands abstinence can cripple the recovery process.
  • Well-trained staff. Compassionate, flexible and patient care is required, whereas rigidity can break the recovery process.
  • Client-centered services. A tailored treatment plan usually provides a better pathway to recovery than establishing predesigned benchmarks that do not reflect the realities of the client’s circumstances.
  • Integrated services. Since the homeless often have co-occurring disorders, facilities that have multidisciplinary professional staff members can provide centralized treatment, which is preferable to a fragmented services model that has the client traveling between different centers.
  • Comprehensive services. Addressing the many needs of a homeless person, including survival and social needs, treats the problem of homelessness holistically rather than focusing on one part to the exclusion of other vital parts.

This appears to resemble the Housing First model:

Housing First provides access to mental health treatment. The client participates in support services as long as they need them, but participation in a structured program is not a requirement for clients to keep their housing. Clients must only agree to meet with a member of their ACT team five times a month. Multi-disciplinary Assertive Community Treatment teams (ACT) provide clinical, vocational, and health services that are client-driven. These teams are available on-call 24 hours a day, seven days a week. The team provides most services in the client’s “natural environment,” usually that person’s apartment, neighborhood, or workplace. Regardless of the treatment or service, staff members work collaboratively with each client to articulate goals as defined by the client and to help move that individual toward recovery and a full, meaningful life9.

Given all this, what’s the right thing to do?

Footnotes:
3 Didenko, E. and Pankratz, N. 2007. “Substance Use: Pathways to homelessness? Or a way of adapting to street life?” Visions: BC’s Mental Health and Addictions Journal, 4(1), 9-10. Available from http://www.heretohelp.bc.ca/.
4 Fisher, G.L., ed., and Roget, N.A., ed. Encyclopedia of Substance Abuse Prevention, Treatment, and Recovery. 2009. SAGE Publications, Inc.
6 National Household Survey on Drug Use and Health (NSDUH). “Drugs and Crime Facts: Drug use in the general population.” 2006. http://www.ojp.gov/bjs/dcf/du.htm.
7 “A Comprehensive Approach to Substance Abuse and Homelessness” (http://www.nhchc.org/wp-content/uploads/2012/02/hh-1003.pdf) (Oct. 2003). National Health Care for the Homeless Council. Accessed March 9, 2016.
8 Ibid.