Housing status, social support networks and substance misuse

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Housing status, social support networks and
substance misuse
Centre for Housing Research University of St
Andrews

• Dr Iain Atherton
• Dr Maria Stuttaford
• Professor Joe Doherty

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Overview

• Research question
• Methods
• Results
• policy implications

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Housing ready vs Housing First

• Housing Ready
• Substance misusing/mental health
• Once stabilised, then house
• Housing First (Tsemberis et al, 2004)
• Housing
• Services available - no compulsion

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Outcomes of Housing First

• Outcomes
• Higher service use
• Stability of accommodation
• Declining drug use for those with co-morbidities
• Greater service engagement (though proportions
  substance misusing largely unchanged)

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Whats missing?
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Social networks

• Positives
• Friendship
• Practical support
• Negatives
• Initiation of substance misusing
• Perpetration of substance misusing
• Prevention of exit from substance misusing

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Methods

• Small scale longitudinal qualitative study
• 11 participants
• 22 in-depth interviews
• recruitment through service providers/drop in
  centres
• Interviews attempted every 4-5 weeks
• Participatory observation of hostels/service
  providers

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(No Transcript)
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Findings(1) Initiation of substance use
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Interviewee

• Alix
• Age early 30s
• Housing status
• Currently in stable accommodation on methadone
• Previously homeless and using heroin

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• I started using heroin cause Id let one of my
  friends stay with me because theyd nowhere else
  to stay and Id never seen it before in my
  lifedidnt ever wanttobe anywhere near it, but
  because, well I let my friend stay, they brought
  it into my house and then it was like, just try
  this, so I tried it and then you end up with a
  habit so thats how I ended up using.

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• I started using heroin cause Id let one of my
  friends stay with me because theyd nowhere else
  to stay and Id never seen it before in my
  lifedidnt ever wanttobe anywhere near it, but
  because, well I let my friend stay, they brought
  it into my house and then it was like, just try
  this, so I tried it and then you end up with a
  habit so thats how I ended up using.

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Findings(2) Perpetuation of substance using
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Interviewee

• Matt
• Age late 20s
• Housing status
• Homeless (living with friends)
• Substance misusing regularly using heroin

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• Right, well, I stay with a friend just noo emI
  get up in the morning, well I get wakened up in
  the morning with my friend, and hes got
  ahanding me a needle wi kit in it, ken, for
  mabreakfast really

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• Right, well, I stay with a friend just noo emI
  get up in the morning, well I get wakened up in
  the morning with my friend, and hes got
  ahanding me a needle wi kit in it, ken, for
  mabreakfast really

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Interviewee

• David
• Age mid-30s
• Housing status
• Hostel
• Substance misuse
• Currently not using heroin after years of use

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• I share a flat up the stair, with two other
  people. And one, two in fact are drug users.
  With me trying to come off drugsits in my face
  all the time, ken what I meanbasically. Ninety
  percent of people in here use. They either do
  drugs or drink, one of the twodont think there
  is a straight person in here.

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• I share a flat up the stair, with two other
  people. And one, two in fact are drug users.
  With me trying to come off drugsits in my face
  all the time, ken what I meanbasically. Ninety
  percent of people in here use. They either do
  drugs or drink, one of the twodont think there
  is a straight person in here.

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Notes from an interview

• Elspeth
• Service Provider

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• Geography figures prominently at one point in
  our conversation. Without any prompting, The
  service provider suddenly claims that nobody
  will cease substance misuse whilst continuing to
  live in their home town, especially in the ex
  mining community area.
• its too hard remaining in the same community
  to stop drug using

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• Geography figures prominently at one point in
  our conversation. Without any prompting, The
  service provider suddenly claims that nobody
  will cease substance misuse whilst continuing to
  live in their home town, especially in the ex
  mining community area.
• its too hard remaining in the same community
  to stop drug using

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(3) Prevention of exit
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• Elspeth the service provider-
• Such a strategy relocating is not always
  successful she quotes an example where the
  individuals concerned linked into new local drug
  networks. Similarly, relocating is difficult
  where a person cannot access drugs, something
  that would enforce immediate stopping a step
  that would be problematic and is often counseled
  against.

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• Elspeth the service provider-
• Such a strategy relocating is not always
  successful she quotes an example where the
  individuals concerned linked into new local drug
  networks. Similarly, relocating is difficult
  where a person cannot access drugs, something
  that would enforce immediate stopping a step
  that would be problematic and is often counseled
  against.

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• David-
• my treatment officer gives me a weekly bus
  passto get me out of here, because Ive told
  them what its like here. To get me out so Im
  not in a position to get drugs, you know what I
  mean.

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• David-
• my treatment officer gives me a weekly bus
  pass to get me out of here, because Ive told
  them what its like here. To get me out so Im
  not in a position to get drugs, you know what I
  mean.

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Interviewee

• Paul
• Age mid-30s
• Housing status
• Recently made homeless now in hostel
• Substance misusing
• Drug free for two months

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• Iain- would you have been able to get away from
  drugs without making that move?
• Paul- Nuh. said without any hesitation and
  quite assertively
• Iain- What would have happened if you hadnt
  been evicted but you still got all this support?
• Paul- I reckon I would have still been the
  same, because I dont think Ive got the strength
  to say to my mates, beat it, your no coming back
  here, ken sort of like I dont know why because
  they are my mates but at the end of the day
  theyre, theyre no ma mates if you know what I
  mean, ken because basically theyre using ma
  house as somewhere to have a jagI dont think
  Id be able to do it maselfbut with the support
  that Ive gotbeen able to move, get a change of
  life, you know.

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• Iain- would you have been able to get away from
  drugs without making that move?
• Paul- Nuh. said without any hesitation and
  quite assertively
• Iain- What would have happened if you hadnt
  been evicted but you still got all this support?
• Paul- I reckon I would have still been the
  same, because I dont think Ive got the strength
  to say to my mates, beat it, your no coming back
  here, ken sort of like I dont know why because
  they are my mates but at the end of the day
  theyre, theyre no ma mates if you know what I
  mean, ken because basically theyre using ma
  house as somewhere to have a jag I dont think
  Id be able to do it maselfbut with the support
  that Ive gotbeen able to move, get a change of
  life, you know.

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Policy

• Prevent homelessness
• Assisting with daily geographic mobility
• Geographically sensitive housing programmes
• Caution with hostel use (Wright et al. 2005)
• Location of re-housing
• Relocation?

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Conclusion

• Housing First might have more effect if linked
  to helping people to rebuild their social networks