Substance Abuse in the Homeless PopulationTim Bedell, Chelsea Kaye, Kristie Haalck, & Ashley Huyck

Team 3

IntroductionSubstance abuse is an ongoing problem among the homeless populationAbout one half of the homeless population abuses drugs and/or alcohol.The following presentation analyzes the trends

Looking at culture, environment, and other risk factors

Patterns can indicate where the problems lie and the potential interventions to help remedy the issues.

Demographics of the U.S. Homeless Population

From 2012 to 2013 twenty states reported an increase in homeless population.

After the implementation of the Federal Strategic Plan, homelessness has decreased 6 % from 610,042 in 2013 to 578,424 in 2014.

69% of this population was living in a shelter

26% of the homeless population abuses illicit drugs

67% were 25 years or older

10% 18 to 24 years old

23% were homeless children under the age of 18

StatisticsOn a “single night” in January 2013, New York, Texas, California, Florida, and Massachusetts accounted for more than 50% of the homeless population.

Delaware has the lowest homeless population of 946

49,933 were veterans

116,770 abuse substances

12,247 have a diagnosis of AIDS/HIV

117,084 were severely mentally ill

49% of the homeless population reports being a victim of violence compared to 2% of the general population.

Homeless Population Concentrations in Michigan

National Estimates of Homeless in United States

Point in Time Estimates of Homeless People By Sheltered Status 07-13

Percent of all Homeless People in Each Age Category By Sheltered Status 2013

Homelessness and Drug UseConnections of drug use leading to homelessness and homelessness leading to drug use

Substance abuse and homeless populations at increased risk for blood borne illness such as HIV and Hepatitis C.

Problem for our society in many ways: health care costs, use of valuable time, and negative perception of the homeless population.

Harm reduction basis

Health Related Risk FactorsMental Illness

Attempted Suicide

Suicidal Ideation

Renal Disease

Cold-Related Injuries: hypothermia frostbiteimmersion foot

HIV/AIDS

Poisoning or Drug Overdose

TB

Nutritional Deficiencies

Hepatitis

Death

Cultural Descriptors that Impact Health

Cultural Descriptors Continued

“Culture is especially relevant to the homeless, as it emphasizes the importance of functioning

together as a group”

High prevalence of illicit drug use and heavy drinking

Often do not comply with treatment regimens

Invasion of personal space

Physical environment seen as a crucial threat to their health

Struggle to belong

Mixed race-ethnic-cultural heritage

Social isolation and low self esteem

Environmental Risk FactorsSubstance abuse is viewed as accepted by the homeless population.

Growth and development not prioritySurvival mode

Lack of social network

Drug use is the normDifficult to quit/maintain sobriety

Health Promotion TheoryThe health promotion theory that best fits our program and

health issue is ecological approach.

Substance abuse among the homeless is a complicated and multifaceted issue

This theory address’s many levels and angles to the issue• Intrapersonal- beliefs and values, addictions• Interpersonal- family and friends• Institutional- school programs for homeless youth• Community- programs to aid in quitting• Public Policy- greater attention to illegal drug sales

Plan Goal:  Decrease substance abuse in homeless

Adopt the idea of harm reduction and Housing FirstProviding housing not dependent on sobriety

Educational tools Improve awareness of substance abuse and resources

available

Establish interagency collaboration to offer counseling and medical treatment

Create a job training and career development series fashioned after Boston Public Health Commission

ResourcesThe Coalition for the Homeless of New York City Developed proven strategies to prevent people from

becoming homeless Rental assistance or eviction prevention through grants for

working families. Helps homeless move into affordable and safe housing

using the Housing First method, permanent supportive housing, and federal housing assistance.

Additional services offered: food delivered nightly to preset locations job training for women youth programs crisis services

Health Promotion SettingProvide a safe non-threatening environment

Establish a facility or mobile unit for screening, assessments, and outreach programs

Find their environment Soup kitchens, shelters, the streets

Healthy People 2020One of the main topic’s of concern is substance abuse.Objectives addressed:

• Increase the proportion of adolescents who disapprove of substance abuse

• Increase the proportion of adolescents who perceive great risk associated with substance abuse

• Increase the number of admissions to substance abuse treatment for injection drug use

• Increase proportion of persons who need alcohol and/or illicit drug treatment and received specialty treatment for abuse or dependence in the last year

• Reduce past-month use of illicit substances• Reduce the past-year nonmedical use of prescription drugs

ConclusionTrends show homelessness can lead to drug use and drug use can lead to homelessness

Proven effective methods of harm reduction by providing housing without sobriety terms

Provide easy access to needed services for sobriety

Development resources for jobs

Hopeful for an outcome of decrease in substance use among the homeless

References Boston Public Health Commission (2014).  Job training and education.  Retrieved from http://www.bphc.org/whatwedo/homelessness/homeless-services/Pages/Job-Training-and-Education.aspx

Coalition for the homeless (2014).  Our programs.  Retrieved from http://www.coalitionforthehomeless.org/our-programs/

Henry, M., Cortes, A., Morris, S., Shivji, A., & Buck, K. (2014). The 2014 annual homeless assessment report to congress: U.S. Department of Housing and Urban Development. Retrieved from https://www.hudexchange.info/resources/documents/ahar-2013-part1.pdf

ReferencesHenry, M., Cortes, A., & Morris, S. (2013). The 2013 Annual Homeless Assessment Report to Congress. Retrieved from http://journalistsresource.org/wp-content/uploads/2013/12/AHAR-2013 Part1.pdf

Hudson, C. G. & Vissing, W. M. (2010). The geography of adult homelessness in the US: Validation of state and county estimates. Health and Place, 16(5), 828-837. doi:10.1016/j.healthplace.2010.04.008

Linton, S. L., Celentano, D. D., Kirk, G. D., & Mehta, S. H. (2013). The longitudinal association between homelessness, injection drug use, and injection-related risk behavior among persons with a history of injection drug use in Baltimore, MD. Drug and Alcohol Dependence, 132(3), 457-465. doi: 10.1016/j.drugalcdep.2013.03.009

Law, K. & John, W. (2012). Homeless as culture: How transcultural nursing theory can assist for caring for the homeless. Nurse Education in Practice, 12(6), 371-374. doi:10.1016/j.nepr.2012.04.010

ReferencesMichigan Interagency Council on Homelessness (2013). The State of Homelessness in Michigan. The campaign to end homelessness: 2013 projected homeless counts by region [online image]. Retrieved from http://mihomeless.org/jdownloads/General%20Resources/2013datareport.pdf

National Coalition for the Homeless (2014). Vulnerable to Hate: A Survey of Hate Crimes and Violence Committed Against Homeless People in 2013. Retrieved from http://nationalhomeless.org/wp-content/uploads/2014/06/Hate-Crimes-2013-FINAL.pdf

National Coalition for the Homeless. (2009). Substance abuse and homelessness. Retrieved from http://www.nationalhomeless.org/factsheets/addiction.pdf

North, C. S., Eyrich-Garg, K. M., Pollio, D. E., & Thirthalli, J. (2010). A prospective study of substance abuse and housing stability in a homeless population. Social Psychiatry and Psychiatric Epidemiology, 44(11), 1055-1062. doi: 10.1007/s00127-009-0144-z

ReferencesOffice of Disease Prevention and Health Promotion. (2014). Substance abuse. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/substance-abuse

Pauly, B., Reistc, D., Belle-Isle, L., & Schactman, C. (2013). Housing and harm reduction: What is the role of harm reduction in addressing homelessness? International Journal of Drug Policy, 24(4), 284-290. doi:10.1016/j.drugpo.2013.03.008

US Department of Health and Human Services. (2002). Physical Activity Evaluation Handbook. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/nccdphp/dnpa/physical/handbook/pdf/handbook.pdf

U.S. Department of Housing and Urban Development. (2014). HUD’s 2014 continuum of care homeless assistance programs homeless populations and subpopulations. Retrieved from https://www.hudexchange.info/reports/CoC_PopSub_NatlTerrDC_2014.pdf