Motivation for change and psychological distress in homeless substance abusers

Velasquez, Mary M.; Crouch, Cathy; Sternberg, Kirk von; Grosdanis, Irene

doi:10.1016/s0740-5472(00)00133-1

Cited by 39 publications

(32 citation statements)

References 14 publications

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“…One interpretation of these results is that drug/alcohol-user treatment involvement and child care responsibilities may act as motivational ''cues'' to increase the seeking of helpful entitlements. Because there is a paucity of research on homelessness, substance misuse, and access to Medicaid and food stamps, there is little research with which to compare our findings; nevertheless, they are in line with numerous studies documenting that homelessness and substance misuse have negative effects on access to health and medical services (Arno et al, 1996;Duchon et al, 1999;Klein et al, 2000;O'Toole et al, 1999;Sachs-Ericsson et al, 1999;Smith et al, 2000;Velasquez et al, 2000;Wenzel et al, 1996).…”

Section: Discussionsupporting

confidence: 74%

“…In fact, studies have shown that homelessness is associated with poor access to, and utilization of social and health care services (Klein et al, 2000;Smith et al, 2000), low motivation to treatment (Velasquez et al, 2000), poor treatment prognosis (Wenzel et al, 1996), underutilization of ambulatory medical services and extreme dependence on emergency hospital visits (Arno et al, 1996;Duchon et al, 1999;O'Toole et al, 1999;Sachs-Ericsson et al, 1999), and delayed initiation of highly active antiretroviral therapy (HAART) following AIDS diagnosis . Consequently, homeless people consume more medical resources than domiciled individuals (Nyamathi et al, 2000;Rosenheck and Seibyl, 1998;Salit et al, 1998) and have higher mortality rates (Barrow et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

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Homelessness, Substance Misuse, and Access to Public Entitlements in a Soup Kitchen Population

Nwakeze

Magura

Rosenblum

et al. 2003

Substance Use & Misuse

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The study examined the effects of homelessness on access to public entitlements (Medicaid and food stamp programs) in a soup kitchen population. Data were collected between 1997 and 1999 from a sample of 343 adults at two soup kitchen sites in New York City. Five hypotheses, focusing on the effects of housing status (literal homelessness, unstable housing, and domiciled), frequency of drug/heavy alcohol use, drug/alcohol-user treatment history and childcare responsibilities on access to Medicaid and food stamp programs were tested. Multiple logistic regression analysis indicated that both literal homelessness and unstable housing were associated with less access to Medicaid and food stamps. Other significant findings were: current drug/alcohol-user treatment experience was associated with greater access to both Medicaid and food stamps, frequency of drug/heavy alcohol use was associated with less access to Medicaid only, and caring for children was associated with greater access to food stamps only. These findings support the crucial role of housing status in mediating access to entitlements, and the importance of drug/alcohol-user treatment involvement as a cue to seeking entitlements. The need to reduce health disparities through active and sustained outreach programs designed to enhance homeless persons' access to Medicaid and food stamp programs was discussed.

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Section: Discussionsupporting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Homelessness, Substance Misuse, and Access to Public Entitlements in a Soup Kitchen Population

Nwakeze

Magura

Rosenblum

et al. 2003

Substance Use & Misuse

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“…Homeless and vulnerably housed persons suffer from a high prevalence of chronic physical and mental illness, substance abuse, and mortality [1], [2], [3], [4], [5]. In relation to physical and mental health care they experience numerous barriers in accessing necessary health care and adhering to medications, and have lower life expectancy [6], [7], [8].…”

Section: Introductionmentioning

confidence: 99%

Substance Use and Access to Health Care and Addiction Treatment among Homeless and Vulnerably Housed Persons in Three Canadian Cities

et al. 2013

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IntroductionWe examined the prevalence of substance use disorders among homeless and vulnerably housed persons in three Canadian cities and its association with unmet health care needs and access to addiction treatment using baseline data from the Health and Housing in Transition Study.MethodsIn 2009, 1191 homeless and vulnerably housed persons were recruited in Vancouver, Toronto, and Ottawa, Canada. Interviewer administered questionnaires collected data on socio-demographics, housing history, chronic health conditions, mental health diagnoses, problematic drug use (DAST-10≥6), problematic alcohol use (AUDIT≥20), unmet physical and mental health care needs, addiction treatment in the past 12 months. Three multiple logistic regression models were fit to examine the independent association of substance use with unmet physical health care need, unmet mental health care need, and addiction treatment.ResultsSubstance use was highly prevalent, with over half (53%) screening positive for the DAST-10 and 38% screening positive for the AUDIT. Problematic drug use was 29%, problematic alcohol use was lower at 16% and 7% had both problematic drug and alcohol use. In multiple regression models for unmet need, we found that problematic drug use was independently associated with unmet physical (adjusted odds ratio [AOR] 1.95; 95% confidence interval [CI] 1.43–2.64) and unmet mental (AOR 3.06; 95% CI 2.17–4.30) health care needs. Problematic alcohol use was not associated with unmet health care needs. Among those with problematic substance use, problematic drug use was associated with a greater likelihood of accessing addiction treatment compared to those with problematic alcohol use alone (AOR 2.32; 95% CI 1.18–4.54).ConclusionsProblematic drug use among homeless and vulnerably housed individuals was associated with having unmet health care needs and accessing addiction treatment. Strategies to provide comprehensive health services including addiction treatment should be developed and integrated within community supported models of care.

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“…Studies have documented that between 29 and 75 % of homeless populations use alcohol and/or illicit drugs. 1,2 Homeless individuals who use substances are more likely to drop out of treatment programs, 3 have higher rates of post-treatment relapse, 4 premature mortality, 5 chronic physical illness, and longer durations of homelessness. 6 Recently, Housing First has been shown to be effective among homeless individuals with active substance use disorders.…”

Section: Introductionmentioning

confidence: 99%

Daily Substance Use and Mental Health Symptoms among a Cohort of Homeless Adults in Vancouver, British Columbia

et al. 2012

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Substance use can be a barrier to stable housing for homeless persons with mental disorders. We examined DSM-IV symptoms among homeless adults (N0497), comparing those who reported daily substance use (DSU) with non-daily substance users. Multivariable linear regression modeling was used to test the independent association between DSU and symptoms using the Colorado Symptom Index total score. DSU was independently associated with higher symptoms (beta03.67, 95 % CI 1.55-5.77) adjusting for homelessness history, age, gender, ethnicity, education, marital status, and mental disorder sub-type (adjusted R 2 00.24). We observed a higher prevalence of DSU in our sample than has been previously reported in a Housing First intervention. DSU was also independently associated with more DSM-IV symptomatology. We have an opportunity to observe this cohort longitudinally and examine if there are changes in substance use based on treatment assignment and commensurate changes in housing stability, community integration, health status, and quality of life.

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Motivation for change and psychological distress in homeless substance abusers

Cited by 39 publications

References 14 publications

Homelessness, Substance Misuse, and Access to Public Entitlements in a Soup Kitchen Population

Homelessness, Substance Misuse, and Access to Public Entitlements in a Soup Kitchen Population

Substance Use and Access to Health Care and Addiction Treatment among Homeless and Vulnerably Housed Persons in Three Canadian Cities

Daily Substance Use and Mental Health Symptoms among a Cohort of Homeless Adults in Vancouver, British Columbia

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