Substance Abuse,Homelessness, Developmental Decision-Making and Spirituality: A Women's Health Issue

ABSTRACT

A qualitative methodology was used to examine the relationship between homeless women's spirituality, substance abuse, moral reasoning and developmental decision-making. Findings indicated that a lack of development in spirituality and the ability to make decisions in childhood is related to homeless, addicted women's inability to maintain abstinence and achieve social independence. Spirituality impacted decisions to abstain from substance abuse and increased the women's social independence. Findings suggest that treatment needs to incorporate spirituality, family of origin, and the development of skills for independent decision-making. The authors propose that childhood maltreatment, homelessness and substance abuse impede spiritual development. Therefore, substance abuse treatment needs to include a focus on spirituality and moral reasoning in the recovery process.     

Social control correlates of arrest behavior among homeless youth in five U.S. cities

This study identified homelessness, substance use, employment, and mental health correlates of homeless youths' arrest activity in 5 cities. Two hundred thirty-eight street youth from Los Angeles, Austin, Denver, New Orleans, and St. Louis were recruited using comparable sampling strategies. Ordinary least squares (OLS) regression results reveal that being arrested for criminal activity is associated with length of homelessness, history of juvenile detention and incarceration, receiving income from theft, substance abuse, and mental illness. Arrests are also associated with interactions between lack of formal employment income and receiving income from theft and between drug and alcohol abuse/ dependency. Understanding the health and situational factors associated with homeless youths' delinquent activity has implications for providing more comprehensive health, mental health, and substance abuse services.     

Homelessness and Substance Abuse: Which Comes First?

Abstract

The present paper uses a social selection and social adaptation framework to investigate whether problematic substance use normally precedes or follows homelessness. Clarifying temporal order is important for policy and program design. The paper uses information from a large dataset (n=4,291) gathered at two services in Melbourne, supplemented by 65 indepth interviews. We found that 43% of the sample had substance abuse problems. Of these people, one-third had substance abuse problems before they became homeless and two-thirds developed these problems after they became homeless. We also found that young people were more at risk of developing substance abuse problems after becoming homeless than older people and that most people with substance abuse issues remain homeless for 12 months or longer. The paper concludes with three policy recommendations.     

Characteristics of homeless alcohol and drug abusers identified through an assertive outreach program

Differences between substance abusers and non-abusers, and among abmers of alcohol, drugs, or both substances, were investigated for 1166 persons identified as homeless or at risk of homelessness by an assertive outreach program in a moderate size city. The 603 self-reported substance abusers included disproportionate numbers of male, Black, unmarried, and currently homeless persons with a history or symptoms of mental illness, who expressed a primary need for assistance dealing with the social service system. Type of abuse was associated with demographic characteristics, length of homelessness, mental illness status, and primary expressed needs. An accurate picture of subgroup differences can aid design and delivery of services for the homeless.     

Risk Factors for Homelessness Among Lesbian, Gay, and Bisexual Youths: A Developmental Milestone Approach

Lesbian, gay, and bisexual (LGB) youths are over-represented in the homeless population. To examine why some LGB youths become homeless, this report compares homeless and non-homeless LGB youths. Of the 156 LGB youths, 48% reported ever being homeless (i.e., running away or being evicted from home). Results indicate that sexual orientation awareness and the initiation of sexual behavior occurred earlier in homeless than in non-homeless LGB youths and predated the first homeless episode. Substance use was more frequent and first occurred at an earlier age in homeless as compared to non-homeless LGB youths; however, substance use occurred subsequent to first homelessness. Childhood sexual abuse was associated with homelessness; and, early sexual orientation development was related to homelessness among youths without a history of sexual abuse. Findings suggest that interventions should help youths cope with their unfolding sexual orientation and work to prevent or address the consequences of sexual abuse.     

Modeling initiation into drug injection among street youth

This study aimed at examining the predictors of initiation into drug injection among street youth using social cognitive theory framework. A prospective cohort study based on semi-annual interviews was carried out. Psychosocial determinants referred to avoidance of initiation. Other potential predictors were: sociodemographic characteristics, relationships with injectors, parent's substance misuse, drug use patterns, homelessness, survival sex, sexual abuse. Independent predictors were identified using Cox proportional hazards regression models. Among the 352 participants, high control beliefs about avoidance of initiation was protective while younger age, daily alcohol consumption, heroin use, cocaine use, and survival sex all increased risk of initiation. Preventive strategies targeting street youth should both enhance youth's control beliefs and actual control over their substance use and improve their life conditions.     

Characteristics of Homeless Alcohol and Drug Abusers Identified Through an Assertive Outreach Program

Differences between substance abusers and non-abusers, and among abusers of alcohol, drugs, or both substances, were investigated for 1166 persons identified as homeless or at risk of homelessness by an assertive outreach program in a moderate size city. The 603 self-reported substance abusers included disproportionate numbers of male, Black, unmam'ed, and currently homeless persons with a history or symptoms of mental illness, who expressed a primary need for assistance dealing with the social seIVice system. Type of abuse was associated with demographic charaeten'stics, length of homelessness, mental illness status, and primary expressed needs. An accurate picture of subgroup differences can aid design and delivery of services for the homeless.     

Substance abuse and child welfare: clear linkages and promising responses

Parental substance abuse is a significant factor in many of the families served in the child welfare system. This article examines: (1) the prevalence of substance abuse among families involved with the child welfare system; (2) the impact of substance abuse on child welfare practice; (3) how both the Adoption and Safe Families Act of 1997 and welfare reform legislation intensify the need to address parental substance abuse effectively; and (4) promising strategies for addressing these families' needs.     

Life Experiences and Vulnerabilities of Homeless Women: A Comparison of Women Unaccompanied Versus Accompanied by Minor Children,and Correlates With Children’s Emotional Distress

The histories and service needs of 2 groups of homeless women, those unaccompanied by minor children (n = 46) and those accompanied by minor children (n = 22), were compared, on the basis of their responses to a biennial survey of homeless people in a midsize city in the southeast United States. Mothers of children aged 2-10 also completed a measure of stress symptoms for their children (n = 20). Irrespective offamily status group, problems such as substance abuse, history ofmental illness, health problems, chronicity of homelessness, and crime victimization tended to cluster together. The findings also suggest that declining and/or inadequate levels ofpublic benefits, Temporary Assistance to Needy Families, and Medicaid-funded health care in particular, have adversely affected the 2 groups, particularly families with children. The young children in this sample experienced elevated levels ofstress, and significant associations were found between children’s stress levels and certain riskfactors oftheir mothers. Implications for service delivery are discussed.     

Lost in transition: Illicit substance use and services receipt among at-risk youth in the child welfare system

This study examined the use of mental health and substance abuse services among adolescents in the child welfare system (CWS) who reported use of illicit substances. 1004 adolescents age 11–15 years at baseline were followed for 5–7 years, over five waves of data collection. Shortly after the investigation for maltreatment (baseline), 69.1% of youths using illicit substances received mental health and/or substance abuse outpatient specialty services. By the last follow-up, during the transition to adulthood, only 21.5% of young adults using illicit substances received outpatient specialty services. Youth who used illicit substances were more likely to receive outpatient and inpatient specialty services than non-users at the time of contact with the CWS (mostly baseline), but this difference faded over the follow-up period. By 5–7 years follow-up, there was no significant difference in specialty services receipt for illicit substances users versus non-users. Predictors of outpatient service use at most waves were having Medicaid, mental health needs, and having recently seen a school counselor or primary care physician. Among illicit substance users transitioning to adulthood, African American youths were less likely to receive outpatient specialty services than White youths. These findings reveal a need for more attention to illicit substances use among youth in the CWS, better cross agency integration, and special attention to the needs of transition-age youth to better connect them with services as they age out of the CWS.     

Life Experiences and Vulnerabilities of Homeless Women: A Comparison of Women Unaccompanied Versus Accompanied by Minor Children, and Correlates with Children's Emotional Distress

The histories and service needs of 2 groups of homeless women, those unaccompanied by minor children (n = 46) and those accompanied by minor children (n = 22), were compared, on the basis of their responses to a biennial survey of homeless people in a midsize city in the southeast United States. Mothers of children aged 2–10 also completed a measure of stress symptoms for their children (n = 20). Irrespective of family status group, problems such as substance abuse, history of mental illness, health problems, chronicity of homelessness, and crime victimization tended to cluster together. The findings also suggest that declining and/or inadequate levels of public benefits, Temporary Assistance to Needy Families, and Medicaid-funded health care in particular, have adversely affected the 2 groups, particularly families with children. The young children in this sample experienced elevated levels of stress, and significant associations were found between children's stress levels and certain risk factors of their mothers. Implications for service delivery are discussed.     

Homelessness in Ottawa County Michigan: The “Gap” Population

Abstract

Homelessness has gained increasing attention since the 1980s in the United States. And the numbers of individuals and families experiencing homelessness are growing, with a 20,000 person, or 3% increase, from 2008 through 2009 (“State of Homelessness,” 2011). In spite of persistent investigation and activism on how to prevent and end homelessness, there is not agreement on what causes homelessness or how to stop it (McNamara, 2009). What is apparent, however, is that the homeless population is not homogenous. Therefore, the standard models of service, whether from governmental or non-governmental organizations (NGOs), end up neglecting the needs of portions of the population of people who face homelessness. Governmental and non-governmental service providers have recognized the existence of the unique sub-populations of people who are homeless and are attempting to understand and meet the needs of people outside the prevailing understanding of homelessness. This project works with a collaborative of such service providers through a multiple methodological approach to generate better understanding on the two key areas necessary to create models of service for people who are in the “gap” subsector of the homeless population. First, investigation was undertake to learn systematically who is included in the “gap” population among the homeless community, or, in other words, what traits those who continue to cycle in and out of homelessness, and thus are part of this “gap” population, share. Secondly, the project explores what organizations are currently serving these people, and how are they doing so. In other words, this project also ask what are the trends or practices that exist nationally and locally for serving people who fall into this category of homelessness? Findings suggest central traits including mental illness, substance abuse and a history of incarceration as factors spanning members of the “gap” population. Though there are caveats and practices to be avoided, these people are surviving or even thriving through the service primarily of faith-based non-governmental organizations, unfettered by the policy and funding constraints of governmental entities.     

Risk and resilience among young adults experiencing homelessness: A typology for service planning

PurposeThis study examined risk and resilience indicators in a sample of young adults experiencing homelessness to identify subgroups with different service needs.MethodsData came from a 2014 survey of homeless young adults (age 18–24) in Houston (n = 374). Participants self-reported risk and resilience indicators which were used to fit a latent class model.ResultsA four-class solution was the best fit. Group-1 (n = 73), had high adult support and low trauma. Group-2 (n = 60) had low trauma but low adult support. Group-3 (n = 151), had high trauma exposure, high rates of mental health problems and low substance use. Group-4 (n = 90), had high rates across all risk variables.ConclusionTrauma, adult support, and substance use were key distinguishing features to inform screening and service planning.     

Recruitment,enrollment & data collection with victims of elder abuse and neglect identified from police incident reports

ABSTRACT

This study evaluated the success of researcher-generated recruitment, enrollment, data collection, and safety protocols for field research with victims of elder abuse and neglect (EAN) identified from police incident reports in terms of their success including cost-effectiveness, ability to generate a representative sample, and safety. After reviewing 492 police incident reports involving victims age 65 years or older to identify cases of EAN 62 victims were identified. Mail, phone, and in-person recruitment strategies were used. After 259 recruitment attempts, 52 (84%) eligible victims were contacted, of which 24 (46%) consented to participate. Phone calls were the least expensive mechanism to produce a successfully enrolled participant. Findings from a regression show completion of a research interview could not be predicted by victim, suspect, or offense characteristics, indicating that the recruited victims likely represent the population they were drawn from. No safety or adverse events occurred.     

The Emerging Problems of Alcohol and Substance Abuse in Late Life

Treatment of substance abuse among older adults will become increasingly important as the number of aged Americans increases. The abuse of psychoactive substances is a major contributor to excess morbidity, mortality, and homelessness among persons of all ages and socioeconomic strata regardless of race or ethnicity. Alcohol and tobacco account for the majority of substance abuse-related death and disability in the United States; the former through cerebrovascular and hepatic disease, accidents and violence, the latter through chronic pulmonary disease and malignancy. Patterns of substance abuse in late life are substantially different from those observed among younger adults. However, treatment may be less challenging. Effective diagnosis and treatment requires a nonpunitive, supportive, but persistent approach. This means the capacity to collect a substance intake history and the ability to formulate a treatment plan or referral strategy to an addiction specialist or residential treatment setting. It is also important for the practitioner to manage negative feelings toward patients who decline treatment or who are chronic abusers.     

Does a Baby Help Young Women Transition Out of Homelessness? Motivation,Coping, and Parenting

Homeless young women experience high levels of stress, challenges to mental health, substance use and abuse, and a lack of housing or of secure housing. This article explores one of the findings from a longitudinal qualitative study designed to follow homeless young women for a 2-year period as they make efforts to transition out of homelessness. Our objective was to determine the assets used by these young women as they survived on the street and to transition out of homelessness. The authors found that one of the primary reasons discussed for leaving homelessness was becoming pregnant and having a baby. However, most of the mothers reported increasing levels of stress as the baby became a toddler. They described themselves as using “soft drugs” as a mode of coping with this stress.     

The Emerging Problems of Alcohol and Substance Abuse in Late Life

Treatment of substance abuse among older adults will become increasingly important as the number of aged Americans increases. The abuse of psychoactive substances is a major contributor to excess morbidity, mortality, and homelessness among persons of all ages and socioeconomic strata regardless of race or ethnicity. Alcohol and tobacco accountfor the majority of substance abuse-related death and disability in the United States; the former through cerebrovascular and hepatic disease, accidents and violence, the latter through chronic pulmonary disease and malignancy. Patterns of substance abuse in late life are substantially different from those observed among younger adults. However, treatment may be less challenging. Effective diagnosis and treatment requires a nonpunitive, supportive, but persistent approach. This means the capacity to collect a substance intake history and the ability to formulate a treatment plan or referral strategy to an addiction specialist or residential treatment setting. It is also important for the practitioner to manage negative feelings toward patients who decline treatment or who are chronic abusers.     

Sociodemographic and maternal behaviors in younger and older pregnant adolescents

Sociodemographic and maternal behaviors were examined in a group of 295 (59%) younger adolescents 10–17 years of age, and compared to a group of older adolescents over 18 (n=203, 41%). Younger adolescents were more likely to be single, of minority group status, family dependent, and poor users of contraceptives. Older adolescents had higher rates of substance abuse, treated psychiatric problems, and abortion histories. Both groups reported parental drinking problems, parental divorce, and poverty. Health indicators did not show differences between groups, although older adolescents had higher than national average low birth weight babies. The age of first pregnancy was markedly lower for the younger than older teen. These findings support the need for prevention strategies in treatment programs.