(Permission has been kindly provided by Parity to reproduce the content of this information sheet)
Although there has been continued research into the nature and extent of alcohol and other drug (AOD) use among homeless persons in Australia (such as the various “Project I” research papers such as Keys et al, 2006, and Mallett et al, 2005), there are still serious gaps in understanding the range of issues related to drug use among homeless people in Australia. This information sheet will briefly outline some of the deficiencies in the current knowledge-base and propose suggestions for future research. It is held that gapsexist in current understanding of homeless and drug use in four main respects:
Firstly, a major gap still exists in our understanding of the AOD disorders experienced by different homeless groups. The majority of studies carried out in Australia still tend to target specific regions (mainly metropolitan centres in Sydney and Melbourne) and particular client groups (principally adult males), with relatively few studies addressing homeless youth, Indigenous people, women, families and those with a mental illness. Studies on AOD use amongst homeless people in regional areas are clearly needed, as are studies of AOD use from homeless persons of different cultural backgrounds. There is still a dearth of research into the challenges faced by different types of AOD use, with heroin use being the main type of drug use studied (e.g., Bessant et al., 2003; Rowe, 2005). Heroin users, however, have different issues to deal compared to those who are predominantly alcohol and cannabis users. These issues relate not only to the varying physiological effects of the drugs in question and their related risks (such as blood-borne viruses in the case of injecting users), but the varying social contexts associated with different types of drugs. The culture that surrounds heroin use among those living (and working) on the streets, for example, is substantially different from that which surrounds the consumption of alcohol. The reality is that approaches to AOD service provision to different user groups differ in important ways, and understanding these variations is therefore important for providing effective support services.
Before tackling differences among homeless groups in terms of the AOD use, however, researchers will need to be able to better define who they consider ‘homeless’ and what level of AOD use they deem to be ‘harmful’. There are complications presented, for example, by different definitions of homelessness and AOD disorders. For example, classifications of primary, secondary and tertiary homelessness (Chamberlain & Mackenzie, 2003) represent only one way of classifying homelessness, as do classifications of AOD disorders such as AUDIT and DSM-IV criteria. Different classifications can lead to different estimates of the extent and nature of AOD disorders, and so an understanding of the classificatory systems employed needs to be fully understood when examining prevalence statistics. This is not merely a classification issue, for homeless policies and services are guided by determinations on who is eligible for assistance and who is not based on such definitions. It is important that those who fall outside the standard categories do not miss out on relevant assistance, particularly if they are prime candidates for falling into the critical categories. It may well be the case that those who are not yet identified with acute disorders or primary homelessness, but are viewed as ‘at risk’ of either, may benefit immensely from early assistance — perhaps more so in some cases than those whose conditions have become acute and chronic.
While researchers have increasingly been examining pathways into homelessness and drug dependence, they have not paid enough attention to the definitions that frame the end - points (i.e. the states of ‘homelessness’ or ‘dependence’) that they have investigated. Consequently, some paths that may be worthy of investigation inevitably get overlooked, such as those individuals that drift in and out of homelessness and/or engage in light or intermittent drug use.
A related problem has been the failure of studies to trace the pathways of homeless people out of drug use. There is a very poor understanding of the factors that lead people to give up their habits, or the characteristics of resilience that enable some homeless people to avoid AOD disorders altogether. Comprehensive evaluations of treatment programmes are far and few between, and even less is known about those who gain control in managing their disorders through their own means. The lessons that may be learnt from various success stories may hold the key to figuring out best practices for effectively tackling AOD disorders among the homeless. Currently, what constitutes best practice is poorly understood in Australia. The tendency of researchers to focus only on those cases where things have gone wrong constitutes a limited approach to the problem.
Finally, there has been a lack of understanding of overseas experiences in dealing with drug use among the homeless. The relevance of overseas models, including those in the United Kingdom and the United States, are deemed mostly unsuitable to the Australian context, given the different demographic and policy environments characteristic of these countries. Nevertheless, this does not rule out that important ideas and lessons do not flow from the international experience. After all, it is clear that the problem of AOD use amongst homeless people is a worldwide phenomenon, given its almost universal occurrence, particularly in Western nations. While the solutions may differ from country to country due to the different cultural and policy contexts, there are also elements that may be applicable to the Australian situation and valuable lessons to be learnt. A comprehensive examination of the relevance of strategies and programmes overseas to the Australian context is needed.
This is just a cursory outline of some of the gaps in the current knowledge of drug issues among the homeless in Australia and suggestions for further areas of research. Hopefully, in the years to the come, our knowledge-base for understanding these issues will continue to improve through more integrated, targeted research. In particular, it is hoped that more extensive consultation will take place between researchers and practitioners, so that the challenges and success stories of service providers around Australia can be better understood and provide a firm evidence base for AOD treatment and harm-reduction strategies for homeless people.
Bessant, J. Coupland, H,. Dalton, T,. Maher, L., Rowe, J, & Watts, R. (2003). Heroin users, housing and social participation: attacking social exclusion through better housing. Australian Housing and Urban Research Institute.
Chamberlain, C. & Mackenzie, D. (2003) Counting the Homeless. Canberra: ABS.
Keys, D., Mallett, S., & Rosenthal, D. (2006). Giving up on drugs: Homeless young people and self-reported problematic drug use.
Mallett, S, Rosenthal, D., & Keys, D. (2005). Young people, drug use and family conflict: Pathways into homelessness, Journal of Adolescence, 28: 185–199.
Rowe, J. (2005). Laying the Foundations: addressing heroin use among the ‘street homeless’, Drugs: education, prevention and policy, 12(1): 47–59.