The epidemiology of alcohol, drug, and mental disorders among homeless persons.

This article describes recent research on the prevalence of alcohol, drug, and mental (ADM) disorders and the characteristics of homeless substance abusers and persons with mental illness. Methodological problems in homelessness research are reviewed, particularly in relation to definitions of homelessness and sampling- and case-ascertainment methods. Prevalence rates of ADM disorders are much higher in homeless groups than in the general population. As is true of homeless people in general, homeless substance abusers and mentally ill persons are characterized by extreme poverty; underutilization of public entitlements; isolation from family, friends, and other support networks; frequent contact with correctional agencies; and poor general health. Knowledge of these disadvantages should be used to advocate for better services to prevent homelessness and support homeless people.     

Behavioral economics of drug self-administration and drug abuse policy.

The concepts of behavioral economics have proven useful for understanding the environmental control of overall levels of responding for a variety of commodities, including reinforcement by drug self-administration. These general concepts are summarized for application to the analysis of drug-reinforced behavior and proposed as the basis for future applications. This behavioral agenda includes the assessment of abuse liability, the assay of drug-reinforcer interactions, the design of drug abuse interventions, and the formulation of drug abuse public policy. These separate domains of investigation are described as part of an overall strategy for designing model projects to control drug use and testing public policy initiatives.     

Internet access and use among homeless and indigent drug users in Long Beach, California.

There has been a growing interest in using the Internet to access a variety of populations for prevention education and health care. It is not clear that this is viable for homeless and other marginalized populations. The purpose of this study was to describe Internet access and use among a sample of homeless and indigent drug users. A brief questionnaire was developed to assess computer ownership, use, email, and Internet access and use. Participants were recruited through a community-based human immunodeficiency virus (HIV) prevention program. 265 participants completed the questionnaire. While 55% had ever used a computer in their lifetime, only 25% had ever owned a computer, 24% had ever had their own email account, 33% had access to a working computer in the last 30 days, 10% had sent or received email in the last 30 days, and 19% had surfed or accessed information on the Internet in the last 30 days. Logistic regression predicting lifetime use of a computer showed predictive factors of having completed high school (Odds Ratio [OR] = 4.5; 95% Confidence Interval [CI] = 2.41, 8.38) and number of days used amphetamines in the last 30 days, per 5 days of use (OR = 1.64; 95% CI = 1.18, 2.27). Inversely related were age, per 5 years of age (OR = 0.78; 95% CI = 0.65, 0.93) and number of days used marijuana in the last 30 days, per 5 days of use (OR = 0.97; 95% CI = 0.76, 0.99). Very low access and usage suggest that Internet-based public health education models be reexamined for this population. The association with amphetamine use may indicate a facilitating effect of amphetamine by heightening awareness and increasing wakefulness.     

Crime,drug abuse,mental illness,and homelessness

In this project, 345 homeless persons were interviewed during the period from May, 1985 to May, 1986 in Richmond, Virginia. Data reveal that current afflictions (e.g., hallucinations) are related to major life events in the past (i.e., psychiatric hospitalizations). Further, certain experiences prior to adulthood (e.g., drug use) predict these major life events (e.g., crime). Thus, the data support a general “drift down” hypothesis as a useful explanation of homeless for future theory development. Some policy implications are given.     

Effects of psychosocial and situational variables on substance abuse among homeless adults

Finding direct and indirect influences of salient psychosocial and situational variables on problem substance use among homeless people is important in designing evidence-based, effective, and relevant interventions for this special population. A stress-coping paradigm in conjunction with situational items specialized for homeless people was used to explore predictive relationships in a sample of homeless adults (N = 664) among (a) psychosocial variables of self-esteem, social support, positive and negative coping, and emotional distress, (b) situational variables of homelessness history and quality of recent housing, and (c) outcomes of alcohol use, injection drug use (IDU), and non-IDU. Lower self-esteem predicted greater emotional distress, lower positive coping, greater negative coping, and more alcohol use. Social support predicted less emotional distress and more positive coping. Chronic homelessness predicted more emotional distress, less positive coping, greater alcohol use, and IDU. Poor housing was associated with more alcohol use and IDU. Substance abuse interventions among the homeless should have a dual focus that includes attention to psychological issues and negative coping patterns while also addressing situational, environmental factors, including encouraging provision of permanent supportive housing.     

The use of the MacAndrew Alcoholism Scale in detecting substance abuse and antisocial personality

We evaluated the hypothesis that characterological factors, particularly antisocial personality, influence scores on the MacAndrew Alcoholism Scale (MAC). Using the Washington University research criteria to establish diagnoses, the following subgroups were defined: subjects who received no psychiatric diagnoses; subjects who received diagnoses other than alcoholism, drug dependence, or antisocial personality; and subjects who received a diagnosis of alcoholism, drug dependence, and/or antisocial personality, alone or in combination with other psychiatric diagnoses. The highest MAC scores were obtained by subjects diagnosed as having antisocial personality without alcoholism or drug dependence and subjects diagnosed with antisocial personality, drug dependence, and alcoholism. Alcoholics without antisocial personality or drug dependence, and subjects with other psychiatric diagnoses scored lowest. Although higher MAC scores were obtained by males, MAC scores greater than 24 correctly classified the greatest number of males and females as alcoholic, drug dependent and/or antisocial. These findings are interpreted as consistent with MacAndrew's reinterpretation of the scale as assessing a dimension of personality, rather than solely a tendency to addiction.     

Discriminators of suicide thoughts and attempts among homeless veterans who abuse substances

Six hundred homeless military veterans who abused substances were examined to determine what factors discriminate between nonsuicidal veterans, those who had suicidal thoughts, and persons who had attempted suicide. Several factors were considered based on attachment theory, including caregiver attachment, sexual abuse, physical abuse, resilience, self-efficacy, and self-esteem. Suicide attempters were discriminated from others by psychiatric comorbidity, early abuse, severity of substance abuse, and longevity of drug use. In contrast, the discriminators between nonsuicidal homeless substance abusers and others were elements of attachment and commitments such as marriage, employment, and religiosity. Some implications of the findings for intervention are discussed.     

The relationship between childhood sexual abuse and sexual health practices of homeless adolescents

This study explored the gender differences in sexual self-concept, personal resources for sexual health, safe sex behaviors, and risky sexual behaviors among homeless adolescents with and without histories of sexual abuse. Data for this secondary analysis were collected in 2003 to 2004 in the first phase of a larger repeated-measures sexual health intervention study; 371 homeless youth between 16 and 23 years of age (M = 19.26, SD = 1.83) were recruited from a street outreach center. The majority (64.6%) of participants were males. Self-report instruments were completed at the outreach center via audio computer-assisted self-interview (A-CASI) format. It was found that female participants were better off than males on numerous measures of sexual health behaviors and attitudes. Sexually abused participants had significantly less future time perspective (p = .05), fewer sexual self-care behaviors (p = .04), and less social support than nonabused participants (p = .01) and almost significantly more sexual risk-taking (p = .08). However, no significant differences were found between abused and nonabused participants on sexual self-concept, self-efficacy or intention to use condoms, safe sex behaviors, AIDS knowledge, assertive communication, or self-efficacy to perform testicular/ breast self-exams. Overall, participants who did not report a history of sexual abuse had significantly more sexual health resources and engaged in fewer sex-risk behaviors than those who reported having been abused. These differences have notable implications for screening adolescents for a history of sexual abuse. Adolescents who report sexual abuse should receive risk counseling and be screened regularly for the development of sexual risk behaviors.     

Comorbidity of drug abuse treatment

Research has suggested that comorbidity, the concurrence of substance abuse disorders with other psychiatric disorders, may have prognostic value and important implications for the treatment of substance abuse. Knowledge of the prevalence of comorbid disorder is important because it will enable treatment services to be appropriately configured and designed for clinical drug treatment populations. The form and duration of comorbidity may be influenced by a variety of factors, which include the class of drug being abused, the duration of drug use, the individual sensitivity to drug effects, and whether the drug effects are acute or due to withdrawal or residual conditions. This paper addresses three important scientific questions: (1) What is the prevalence of comorbid disorders in a drug abuser population? (2) What is the stability of psychiatric diagnoses in a drug abuser population? (3) Does the existence of a comorbid disorder influence the outcome of drug abuse treatment?     

Child psychopathology risk factors for drug abuse: overview.

Introduces the special section on Child Psychopathology Risk Factors for Substance Use Disorders. This article summarizes important principles, the current literature, contributions to this section, and issues for future research. Psychopathological conditions are strongly associated with substance use disorders, and some childhood psychopathological conditions may constitute precursors to this comorbidity. Conduct disorder constitutes a strong risk factor for substance use disorders, and bipolar disorder, although more rare, may also constitute a significant risk. Data for other child psychiatric conditions are mixed or lacking; however, important subgroups may be at risk and merit further attention. Underlying characteristics, such as temperament and self-regulation, merit further study as possible explanatory variables. Such studies hold the key for targeting and improving preventive and therapeutic interventions.     

Homeless women with children. The role of alcohol and other drug abuse.

For some women with children, alcohol and other drug use may be an important risk factor for homelessness because it may interfere with a woman's capacity to compete for scarce resources such as housing, employment, or services. The impact of various policy decisions on homeless women, their dependent children, and the family unit is considered, including women's right to privacy, criminalization of drug use, and scarcity of appropriate treatment programs for homeless women.     

Alcoholic subtypes and the MacAndrew Alcoholism Scale.

Forty-five alcoholics in treatment (29 males and 16 females) who reported substantial alcohol dependence but scored in the nonalcoholic range on the MacAndrew Alcoholism Scale (MAC) were matched with 45 alcoholics who reported a similar degree of alcohol dependence and obtained alcoholic-range scores on the MAC. Results reveal that high MAC alcoholics were characterized by gregariousness, social drinking, belligerence and aggression while drinking, and a high degree of alcohol-related legal problems. Low MAC alcoholics appeared to be a different or less distinctive type of alcoholic; although they were less outgoing and preferred not to drink with others, they experienced a wide range of serious alcohol-related consequences. Low MAC alcoholics were not more likely to have a history of nonsubstance use psychiatric diagnosis and treatment. Cloninger, Bohman, and Sigvardsson's (1981) alcoholic typology was related to MAC scores: There was a greater likelihood that high-MAC alcoholics were Type II and low MAC alcoholics Type I.     

Changes over time among homeless young people in drug dependency, mental illness and their co-morbidity

A cross-national survey was conducted among 358 recently homeless young people in Melbourne and Los Angeles. Drug dependence and mental illness were assessed at baseline, 6 and 12 months. At each time point, participants were classified as no condition, drug dependent, having a mental illness or dual condition. Low levels of drug dependence or mental illness or both were reported at each data point. Most young people were classified as neither drug dependent nor having mental illness at baseline and remained so for the 12-month period and few remained drug dependent, or had continuing mental illness or both. Half to two-thirds of young people classified as having one or both conditions were subsequently reclassified as "no condition". There was no evidence of a consistent pathway from either drug dependence or mental illness to co-morbidity. Most young people reported an absence of mental illness and/or drug dependence at each time point. Improvement from one or both conditions at each transition suggests it may be more effective to provide interventions to address drug dependence and mental health problems to young people early in their experience of homelessness.     

Alcoholism,Chemical Dependency and the Lesbian Client

No abstract available for this article.     

Gender differences in predictors of suicidal thoughts and attempts among homeless veterans that abuse substances

This study of 315 male and 310 female homeless military veterans in a V.A. inpatient program designed to treat substance abusers, many of whom also suffer psychiatric disorders, was designed to examine gender differences in factors associated with the odds of having suicidal thoughts, and of attempting suicide, in comparison to being nonsuicidal. A maximum likelihood estimation multinomial logistic regression showed childhood and current sexual and physical abuses, depression, fearfulness, relationship problems, limited social support, and low self-esteem was more strongly associated with suicidal thoughts and attempts for women than for men veterans. Extent of alcohol and other drug abuse, aggression, resilience, self-efficacy, combat exposure, combat-related PTSD, and work problems were more strongly associated with suicidal thoughts and attempts for men than for women. Implications of these findings for V.A. programs are discussed.