Literature Review

The Dangers of Substance Use Among the Homeless

Addiction is a multi-faceted dependency on a certain drug or substance. Homelessness is a global issue with colossal implications. Within the current Gerontology literature, numerous articles and studies have attempted to show exactly what the causes of homelessness are. This issue is compounded by the poverty of being homeless. Along with this, homeless people tend to have mental disorders that further aggravate the issue. However, this issue should not be stigmatized but rather met with solutions for housing, social security, and intervention. It is especially dangerous for the homeless who, without support from anyone, become addicted. According to the lancet, cognitive impairment was found to be common among homeless adults and maybe a trans-diagnostic problem that impedes rehabilitative efforts in this population. Individual factors include poverty, family problems, and mental health and substance misuse problems. The availability of low-cost housing is thought to be the most important structural determinant for homelessness. Homeless people have higher rates of premature mortality than the rest of the population, especially from suicide and unintentional injuries, and an increased prevalence of a range of infectious diseases, mental disorders, and substance misuse. High rates of non-communicable diseases have also been described with evidence of accelerated aging. Within the current Gerontology literature, numerous articles and studies have attempted to show exactly what the causes of homelessness are.

 

Homelessness and Women

In the day and age we live in now there are so many women who end up in the streets, because of substance abuse. I know you might be thinking, “why get addicted to something that’s harmful?”, or “why not get help?”. Well, guess what, majority of the time it is not the fault of the person, for getting hooked on something. Nearly all addicts believe in the beginning that they can stop using drugs on their own, but most try to stop without treatment. Although some people are successful, many attempts result in failure to achieve long term abstinence/sobriety. Research has shown that long term drug abuse results in changes in the brain that persist long after a person stops using drugs. These drug-induced changes in brain function can have many behavioral consequences, including an inability to exert control over the impulse to use drugs despite adverse consequences, which are the defining characteristics of addiction. Drug abuse is the recurrent use of illegal drugs, or the misuse of prescription or over the counter drugs with negative consequences. The two terms, drug abuse or substance abuse can be defined as the use of chemical substances that lead to an increased risk of problems and an inability to control the use of the substance. Although drug and substance abuse do differ from addiction it sometimes can be mistaken for one another. Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her. Although the initial decision to take drugs is voluntary for most people, the brain changes that occur over time challenge an addicted person’s self-control and hamper his or her ability to resist intense impulses to take drugs. Most often, an individual who regularly abuses drugs, even if they do not meet the criteria for a diagnosis of drug addiction, has already lost control over their drug use. Drug and substance abuse can result in broken families, destroyed careers, death due to negligence or accident, domestic violence and physical abuse, and child abuse. Drugs contain chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs cause this disruption: by imitating the brain’s natural chemical messengers and by overstimulating the “reward circuit” in the brain. Homelessness developed as a national issue in the 1870s. Many homeless people lived in rising urban communities, such as New York City. Into the twentieth century, the Great Depression of the 1930s caused an overwhelming pandemic of neediness, yearning, and homelessness. There were 2,000,000 relocating over the United States. During the 1960s, the deinstitutionalization of patients from state mental emergency clinics, as indicated by the doctor’s medicinal libraries on the utilization of pharmaceuticals, was a hastening factor that seeded the number of inhabitants in individuals that are destitute. The first study, that I came across on google scholar is called, “Relative contributions of parent substance use and childhood maltreatment to chronic homelessness, depression, and substance abuse problems among homeless women: mediating roles of self-esteem and abuse in adulthood”. The objective of this study is to use the dormant variable methodology, which would investigate but at the same time studies the relative effects of childhood abuse and early parental substance abuse on later chronic homelessness, depression, and substance abuse problems in a sample of homeless women. This study also would explore how self-esteem and recent violence can affect the difference between childhood predictors and dysfunctional outcomes. The example comprises of 581 vagrants dwelling in covers or calm living focuses in Los Angeles (54% African-American, 23% Latina, 22% White, mean age=33.5 years). Different pointer inert factors filled in as indicators and results in auxiliary models. Youth misuse was shown by the sexual, physical, and obnoxious attack. The results were that the youth misuse straightforwardly anticipated later physical maltreatment, interminable vagrancy, gloom, and less confidence. Parent substance utilize legitimately anticipated later substance use issues among the ladies. Later physical maltreatment anticipated ceaseless vagrancy, sadness, and substance use issues. More prominent confidence anticipated less discouragement and less substance use issues. Youth misuse additionally had critical backhanded consequences for melancholy, constant vagrancy, and medication and liquor issues intervened through later physical maltreatment and confidence. In spite of the fact that there was a solid connection between youth misuse and parent medicate use, youth misuse was the more unavoidable and pulverizing indicator of useless results. Youth misuse anticipated a more extensive scope of issues including lower confidence, more exploitation, more misery, and ceaseless vagrancy, and in a roundabout way anticipated medication and liquor issues. The intervening jobs of later physical maltreatment and confidence propose remarkable influence that focuses on change through strengthening preparing and confidence improvement in vagrants. The second study that I came across is called, “Traumatic Transitions: Homeless Women’s Narratives of Abuse, Loss, and Fear”. In this study awful encounters among 21 ladies dwelling in spending lodgings in the wake of lodging relocation. Surrounded in women’s activist and combined injury hypotheses, the motivation behind this examination was to investigate kinds of injury and difficulty preceding and during lodging at spending inns. In this subjective examination, account and all-out substance investigation approaches were led to distinguish basic topics over ladies’ stories. Discoveries uncovered injury accounts of physical and psychological mistreatment, youth abuse, misfortune, budgetary misuse, sexual terrorizing, expulsion nervousness, natural pressure, wrongdoing presentation, and methodical oppression. Injury educated intercession approaches for social work practice are laid out to advance ladies’ strengthening. Endorsement for this subjective, exploratory examination was acquired through Georgia State University and the University of Georgia Institutional Review Boards. Members were occupied with 60-to 90-min private meetings utilizing a semistructured talk with direct. Wide addresses urged ladies to share their anecdotes about close to home encounters previously and during spending lodging stays, for example, “Inform me concerning conditions that made the need to live at an inn,” “What do you like about living here?” “What difficulties have you encountered since living here?” All meetings were directed nearby at different inns where members lived. Every respondent was paid US$25 compensation after an educated assent was given. Sound recorded meetings were translated verbatim and put away in secret key ensured electronic documents. Respondents in this examination ran in age from 19 to 64, with a normal age of 42. African American ladies (76%) dwarfed Caucasian American (19%) and Latin American ladies (5%) in the example. Six ladies were either hitched or drawn in and lived with their accomplices at the inn. Six ladies were separated, isolated, or bereaved. Nine ladies depicted themselves as single and never wedded. Forty-eight percent of ladies went with youngsters at the lodging, kids’ ages ranged from 1 to 18. The normal room rental charge was US$220 every week. The normal lodging remain was 32 weeks. Be that as it may, most ladies (67%) lived at the lodging for about four months or less. All ladies in the example portrayed agitated or fierce home situations before inn living. In their accounts, physical and psychological mistreatment, kid abuse, misfortune, monetary misuse, and sexual terrorizing were basic injury topics before cycling all through vagrancy. The third study I came across is called, “How Can We Stay Sober?” Homeless Women’s Experience in a Substance Abuse Treatment Center”. In this study presents discoveries from an exploratory, subjective assessment of a concentrated outpatient treatment program for vagrants recouping from substance reliance issue. Organized meetings of seven current program customers and three alumni of the program were directed to learn how customers keep up their temperance notwithstanding meeting the exceptional difficulties of being destitute. In view of these meetings, there are four fundamental concerns talked about: absence of correspondence between specialist organizations, irregularity in work force during recuperation, irregularity in backslide approaches, and customers feeling not well arranged to live in “this present reality” after program consummation. Overall, the clients in this study said they profited by the program and announced they are as of now still in recuperation. Our meetings with present and previous customers did anyway distinguish four customer concerns exhibited here: absence of correspondence between specialist organizations, irregularity in faculty during recuperation, irregularity in the utilization of office approaches identified with customer backslide, and saw the viability of the IOT program to get ready customers to re-coordinate into the network after program fulfillment. The arrangement of compelling IOT administrations for vagrants is a significant connection in the substance misuse recuperation administrations continuum of care. The consequences of our customer interviews educate a concise survey regarding the First Steps for Women IOT program and recommendations for program upgrade. Hypothetical systems concerning substance maltreatment among vagrants, including the pressure and adapting worldview of Lazarus and Folkman (1984), just as the wellbeing looking for worldview of Schlotfeldt (1981), demonstrate the basic significance of engaging ladies. Confidence is all around saw as one of the more basic components of getting vagrants to take part in and complete a recuperation program. Setting up confidence inside the setting of a positive and unsurprising social condition is upheld in treatment writing as a methods for enabling the ladies inside an IOT program to never again take part in evasion adapting conduct, for example, medication and liquor misuse (SAMSHA 2006). The treatment writing proposes proficient staff assume a significant job in advancing strengthening by connecting with ladies in their recuperation and making a steady remedial milieu (Hser et al. 2001; Martin et al. 2000). This recommends expanding consistency in staffing may have a huge positive effect on customer achievement. Substance reliance among homeless women presents both treatment and specialist co-ops with numerous difficulties. For treatment suppliers, challenges incorporate how to address essential issues for nourishment and asylum before tending to the plenty of physical and mental indications related with substance reliance. One solution for solving or decreasing the amount of homeless women on the streets can be Federal housing programs are one of the best housing based answers to decrease homelessness. The two biggest government housing programs are open housing and bureaucratic housing vouchers, known as Housing Choice Vouchers or Section 8 vouchers. Housing vouchers permit low-salary families to lease humble market-rate housing of their decision and furnish an adaptable housing vouchers are exceptionally fruitful at decreasing family homelessness and in guaranteeing that these families remain steadily housed out of the asylum framework.

 

Homeless Men

The first study, Factors associated with substance use in older homeless adults: Results from the HOPE HOME Study, is a non-experimental, qualitative study which shows trends among the homeless, elderly population of Oakland, California. Trends such as substance use, and early morality are present. They begin, “Approximately 1% of the [American] population experiences homelessness…with an estimated 600,000 Americans homeless nightly. Homelessness is defined by the Federal Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009, which defines as homeless: people who lack a fixed, regular residence (i.e. sleeping outdoors, in an emergency shelter, or in a place not meant for habitation), and those who are at imminent risk of losing their housing in the next 14 days”, and “With the aging of the homeless population and the changes in substance use in older adults, little is known about the prevalence of substance use disorders in older homeless adults. There are few community-based samples of substance use in homeless adults since NSHAPC [National Survey of Homeless Assistance Providers and Clients, 1999 survey], and none specifically examining older homeless adults.” This study was conducted by a population-based sampling of homeless individuals aged 50 and older in Oakland, CA. It was approved by the University of California in San Francisco. Some Eligibility criteria included: English speaking, age 50 or over, and homeless based on the HEARTH criteria [lacked a fixed residence, resided in a place not typically used for sleeping, or at risk of losing housing within fourteen days.] This work was funded by the National Institute on Aging at the National Institutes of Health. The funding sources had no role in the preparation, review, or approval of the manuscript. The authors declare that they have no conflicts of interests.                                                                                                                                       The interviews included questions on demographics (age, gender, and race/ethnicity). Whether the interviewee had completed high school or received a GED certificate. If they had served in active duty military, if they had used homeless services in the last 6 months (shelters and free and low-cost meal programs). Interviewees were asked when they first became homeless, if their current episode of homelessness lasted for a year or more, and if they had a history of sexual abuse or physical abuse. Questions from the National Survey of Homeless Assistance Providers and Clients (NSHAPC) were used to gauge the severity of substance abuse. Interviewees were asked what substances they used, when, and for how long. It states, ”Based on the National Health and Nutrition Examination Survey (NHANES), we asked participants to report whether a health care provider had told them that they had diabetes, emphysema or chronic obstructive pulmonary disease (COPD), asthma, stroke, coronary artery disease or a heart attack, congestive heart failure, cirrhosis, or cancer. We asked participants whether they had tested positive for HIV infection or had ever been told they had AIDS.” Interviewees were also evaluated for PTSD and depression.                                                                                                      Drug usage was assessed using the questions from the World Health Organization’s Alcohol, Smoking, and Substance Involvement Screening Test. The time frame was of the previous six months. We categorized AUDIT scores as: low severity (0-7), moderate severity (8–15), and high severity (16+).                                                                                                                                      The results were as follows: the HOPE HOME participants had a median age of 58 years. They continue, “Over three-quarters, (77.1%) were male, and (79.1%) African American; (21.7%) were veterans. Approximately a third (32.6%) had PTSD symptoms and 38.3% had major depressive symptoms; (22.3%) had both depressive and PTSD symptoms. Approximately two-thirds (67.1%) were homeless for at least a year. Almost a third (31.2%) had ever been suspended or expelled from school. Almost all participants (98.4%) used homeless services in the last 6 months. About a third (33.3%) experienced physical abuse as a child, while (13.2%) experienced sexual abuse as a child.”                                                                                                            Almost two-thirds of the sample, (63.1%) had used an illicit substance in the last 6 months, and (64.6%) had moderate or greater severity symptoms for at least one illicit drug, with (14.5%) reporting severe symptoms. For illicit drugs, the drugs most commonly used in the last 6 months included cannabis with (48.0%), cocaine with (37.7%), opioids with (7.4%), and amphetamines with (7.1%). The three most commonly reported drugs with moderate or greater severity symptoms were cocaine (43.1%), cannabis (39.1%), and opioids (12.9%). For participants with ASSIST-defined moderate or higher severity illicit drug symptoms, 91.6% had used an illicit substance in the last six months. Some issues with this survey was that the sample was mainly African American, and a narrow age.                                                                                    The second article was titled The Causes of Death Among an Urban Homeless Population Considered by the Medical Examiner, highlights how exactly substance abuse has a detrimental effect on the elderly homeless. This report is based on data from the Office of the Chief Medical Examiner (OCME) for a small homeless population in Alberta, Canana. The time interval was analyzed from January 1, 2007 to December 31, 2009. They state, “One hundred and thirty-two deaths were reported. Most deaths that could be classified were attributed to drug and alcohol use/abuse and to natural causes.” This was a non-experimental, qualitative study. Although people who are homeless in Canada are entitled to equal health care, there are numerous of implicit barriers to that. They list “Problems with access and treatment compliance have been associated with a lack of contact points [telephone, mailing/email addresses] for follow-up, inadequate transportation to ambulatory care settings, financial barriers, mental health/substance abuse problems, and difficulty in storing medications…” Lack of shelter and health care, along with mental/drug issues, make homeless people die at faster rates than the average population. Because of lack of shelter and health care, compounded with mental/drug problems, “Deaths among homeless people occur at rates significantly higher than the general population.” The main cause of this paper was to analyze the cause of the deaths of homeless, “In order to be able to design programs to address the needs of chronically ill and seriously ill people who are homeless… ”Because of the various conflicts between homeless and medical institution, treatment is not always an option. “Existing health care and hospice facilities may be reluctant to accept homeless patients due to behavior and lifestyle concerns (e.g., alcohol and substance abuse), and for their part, people who are homeless may not trust the health care system and its institutions…as a consequence, homeless people die in environments that may not have appropriately met their care needs or their preferences.” The OCME investigated one hundred and thirty-two deaths. The age of the deceased ranged between 18 and 89 years, with a mean age of 46. Drug and alcohol-related illnesses caused the highest number of deaths. Eighty-three percent of the deaths were among men. These deaths were not only the result of overdoses, but were also the consequences of long-term substance use/abuse leading to more chronic, substance-related comorbid conditions.” These small number of studies have shown us that the homeless hold unique fears about death and dying. “These include fears of dying alone and undiscovered, having their remains disposed of without ceremony, receiving inadequate health care or being treated disrespectfully by health care professionals, and not having their wishes respected.” Some issues with this study are the inherent limitations as it is only based on a single urban setting. It is limited in size and scope. Moreover, it did not consider causes of death for those people who were able to find a residence shortly before their deaths, or those who were hospitalized at the time of their death. Potential future research could seek to close the gap of trust between the homeless and medical institutions, and to gather the unique perspectives of the homeless. “In the absence of specialized palliative care and hospice services for people who are homeless…a significant number of homeless people face death without the benefit of a stable home-like environment. Care from mainstream health care institutions may not be suitable or acceptable to this population overall.” Compassion is needed for the homeless and elderly that receive none.

 

Examining mortality among formerly homeless adults enrolled in Housing First: An observational study

 

In the third study we can see lack of healthcare is one factor that contributes to a higher mortality rate in the homeless, it is also an overview of the Housing First program. It starts, “Adults who experience prolonged homelessness have mortality rates 3 to 4 times that of the general population…communities including New York City and Philadelphia have enacted surveillance systems to monitor and address mortality in this population…Injuries, substance abuse, heart disease, liver disease, and ill-defined conditions have been reported as accounting for the vast majority of deaths among individuals experiencing homelessness.” Housing First seeks to correct homelessness by providing immediate access to permanent housing, and community-based opportunities.  They continue.

To date, however, there has been no research on premature mortality among formerly homeless adults who have enrolled in HF. In the United States, this gap in the literature exists despite research that suggests chronically homeless adults constitute an aging cohort; nearly half are aged 50 years old or older the present study explored mortality among formerly homeless adults who moved into housing as part of an HF program in Philadelphia, PA. We examined death rates and causes of death among HF participants. We then compared HF participant mortality to two groups: members of the general population and the homeless population. We also compared the causes of death and characteristics of decedents in the HF program to a sample of adults identified as homeless at the time of death through formal review We conducted analyses to examine mortality among HF participants from several perspectives. First, we calculated all-cause and cause-specific mortality rates, expressed as deaths per 100,000 person-years of observation, for the entire study cohort. Second, we used survival analysis methods to assess the risk and predictors of death following HF participants’ move to housing. We estimated hazard functions and Kaplan-Meier survival curves to conduct descriptive analyses of the timing and occurrence of death following move to housing and fitted a Cox proportional hazards regression model to assess the relationship between HF participants’ demographic characteristics (gender, race and age) and risk of death following move to housing. We used administrative records from the HF program to identify a cohort of 292 formerly homeless individuals who moved into a housing unit between September 2008, when the HF program first began operations, and October 2013. These values were adjusted for race using direct standardization, with the Philadelphia general population serving as the standard population. We calculated 95 % confidence intervals for these rate ratios using established methods. We obtained mortality data for the Philadelphia general population (2008–2013) from the CDC Wide-ranging Online Data for Epidemiologic Research compressed mortality files regarding underlying cause of death.

To date, however, there has been no research on premature mortality among formerly homeless adults who have enrolled in HF. In the United States, this gap in the literature exists despite research that suggests chronically homeless adults constitute an aging cohort; nearly half are aged 50 years old or older. To begin to address this gap, the present study explored

mortality among formerly homeless adults who moved into housing as part of an HF program in Philadelphia, PA. We examined death rates and causes of death among HF participants. We then compared HF participant mortality to two groups: members of the general population and the homeless population. We also compared the causes of death and characteristics of decedents in the HF program to a sample of adults identified as homeless at the time of death through formal review process in Philadelphia. Fourth, we compared mortality rates in our sample of HF participants to mortality rates of individuals experiencing homelessness as reported in prior studies. To achieve this, we identified published studies that provided mortality rates or information from which such rates could be calculated. We only included studies that

were conducted in North America Finally, we compared the causes of death and characteristics of decedents in the HF program with information on individuals identified as homeless at their time of death in Philadelphia using data from a report by the City of Philadelphia’s Homeless Death Review Team.

Finally, we compared the causes of death and characteristics of decedents in the HF program with information on individuals identified as homeless at their time of death in Philadelphia using data from a report by the City of Philadelphia’s Homeless Death Review Team. Homeless status in the report is determined using the U.S. Department of Housing and Urban Development’s definition of homelessness, which considers individuals to be homeless if they are residing in an emergency shelter or in a place not meant for human habitation

Table 1 presents the characteristics of the 292 individuals in the overall HF participant cohort and decedents. The mean age at move to housing was 51.3, and roughly 80 % of the study cohort was between the ages of 45 and 74 at move to housing. The study cohort was predominantly male (70 %) and African American (68 %). The median duration of follow-up was 3.2 years, resulting in 1045 person-years of observation. Forty-one deaths occurred during the study period, with a mean age at death of 57.2 years. The majority of decedents were male (78 %) and African American (59 %). As shown in Table 2, the crude mortality rate for the study cohort was 3916.1 deaths per 100,000 person- years. Disease of the circulatory system was the leading cause of death, accounting for 29.3 % of deaths in the study cohort. Cancer accounted for 22 % of deaths, whereas drugs or alcohol caused approximately 10 % of deaths. Kidney and respiratory disease caused about 5 % of deaths each, with diabetes, HIV, injury, and liver disease each accounting for about 2 % of deaths. Figure 1 presents the estimated hazard function for death following HF participants’ move to housing.

Table 4 presents the comparison between the 41 HF participants who died during the first 6 years of the program’s operation and the homeless decedents identified by the City of Philadelphia’s Homeless Death Review Team during an overlapping 2-year time period. The majority of decedents in both the HF and homeless groups were between the ages of 45 and 64 at their time of death, although there were proportionally more decedents younger than 45 in the homeless group. Among those in the HF group, 78 % died from natural causes, compared to 49 % in the homeless group. This included 22 % of HF participants as opposed to 7 % in the homeless group who died from cancer. Among homeless adults, 40 % died from an accident, which was significantly more than the 12 % of HF participants who died from an accident. An infectious disease other than HIV caused more than 1 in 10 homeless deaths and hypothermia caused an additional 6 % of deaths; neither of these factors contributed to the death of HF participants. This study is the first to our knowledge to examine mortality among formerly homeless participants in an HF program. Overall, the results from this study are consistent with prior research on early mortality among populations that have experienced long-term homelessness [1, 20, 22] and suggest that adverse health outcomes associated with homelessness persist even after individuals obtain housing. Importantly, we found that risk of death among HF participants residing in housing was highest during the period immediately following their initial entry into housing. On one hand, this may reflect particularly heightened vulnerability and poor health in a certain segment of individuals who die shortly after entering housing. On the other hand, this finding may indicate that the period of transition into housing is one of elevated risk, during which it is of great importance to help individuals access needed health care and other services that may help prevent potentially avoidable deaths. Drug or alcohol usage accounted related deaths accounted for nearly twenty six percent of the deaths from the homeless in Philadelphia.

Homeless Veterans

Addiction to drugs should not be stigmatized and shamed upon but rather should be viewed as a mental illness as it is one. This issue should be taken seriously and offered counseling, support and any other form of help. Many who live on the streets struggle with this problem, and they unfortunately cannot get the help they need due to healthcare problems. “Changes in the American workforce and a general economic recession have resulted in the loss of employment opportunities, especially among low-wage workers. As a result, more individuals and families are living in poverty and at risk of losing their housing,” stated the American Addiction Center. This is a problem considering as people lose jobs, they will also lose housing along with healthcare. The result leads to homelessness which can then lead to drug use.

The homeless veteran population has been increasing throughout the years due to many reasons; some of which can be lack of support, a traumatic event that leads to mental health problems, adjusting back to society. These reasons can lead to drug use among these individuals which puts their health at risk. Opioid use is common among the U.S veterans as they are trying to cope with either a physical pain or in some cases psychological pain. Using addictive opioids can lead to overdose which results in death; and withdrawal sequence is even harder. Why is it that the people who served to protect our country suffer like this on the streets, yet no one does anything about it? To overcome drug abuse and to avoid overdosing the homeless need counseling and proper help rather than to be pushed aside and ignored.

The homeless population continues to grow as the time passes. “Almost 50,000 Veterans were homeless on one night in January 2014” (Ditchter, 2016). 50,000 homeless veterans were on the streets due to unsafe shelters. Homeless shelters may seem like a better alternative than the street but they’re not. In many cases people get abused or mistreated in these shelters, there are many who will steal while some on is asleep. Therefore, many chose to stay on the streets rather than the shelters as they feel safer on the streets. This however becomes a problem especially over the cold season as one might die from hypothermia. Furthermore, once homeless and on the street many resorts to drugs use to ease the pain. In the case of homeless veterans, the need to use drugs could also be psychological. The risk of biopsychosocial challenges is common among the homeless veterans. These challenges are linked with behavior that can put a person at elevated risk of overdose (OD).  “U.S. military veterans face many biopsychosocial (BPS) challenges post-service that may elevate risk for opioid-related overdose including physical pain, mental health concerns and social stressors” (Bennett, 2019). The result of mental health challenges and stress can lead to overuse of opioids which can lead to OD.

There were 218 participators who were enlisted via sampling. They finished a baseline assessment in twenty-two opioid-related overdose risk behaviors which measured their past thirty-day opioid engagement this was measured on the Opioid Risk Behavior Scale (ORBS).  “Analyses examined associations between ORBS scores and hypothesized demographic, biological/physical, psychological and social predictors. Incident rate ratios estimated the expected relative difference in ORBS score associated with each predictor” (Bennett, 2019). The results from the past thirty-days showed an estimate of 4.72 OD risk behaviors in participants. This was due to many reasons such as: bad living conditions in the homeless shelter, mental health problems, physical pain, painful and stressful life and surviving on the streets.

A study compared comorbidities and nursing home measures of homeless veterans, veterans at risk of being homeless, or veterans who had stable housing in the prior year.  Before the community nursing home admissions, the younger homeless veterans were at n = 3355; 62.5 years [SD = 10.3 years]. The stably housed veterans came at n = 64 884; 75.3 years [SD = 11.9 years]. To make the study accurate the study adjusted for demographic differences, homeless veterans showed that they were more likely to be diagnosed with alcohol abuse ARR = 2.18; 95% confidence interval [CI] = 2.05-2.31; and drug abuse at (Adjusted relative risks ARRs)  ARR = 3.03; 95% CI = 2.74-3.33. the data for mental health condition was at ARR = 1.49; 95% CI = 1.45-1.54, dementia at ARR = 1.14; 95% CI = 1.04-1.25. Trimorbidy was at ARR = 2.57; 95% CI = 2.40-2.74, in comparison to veterans who were stably housed nursing home users. “Homeless veterans were more likely to be admitted to a nursing home from a hospital (ARR = 1.13; 95% CI = 1.08-1.17) and remain in the nursing home 90 days after admission (ARR = 1.10; 95% CI = 1.04-1.16), but were less likely to die in the facility (ARR = 0.72; 95% CI = 0.67-0.78) compared to stably housed veterans.” (Halladay, 2019). This study illustrates that homeless veterans are safer in the community nursing homes and they were more likely to live if overdosed rather than the stabile housed individuals. We can conclude that with proper care and people around to take care of homeless veterans with substance problems can be safer and more likely to live and survive of risks.

Another study was conducted to research 27,403 Veterans who were screened for homelessness or being at risk of homelessness from November1, of 2012 and January 31, 2013.  “During 2013, AORs were calculated using a mixed-effects logistic regression to estimate the likelihood of patients’ receipt of VHA homeless or social work services based on demographic and clinical characteristics” (Ditchter, 2016). Within six months most of the patients received services post-screening, the prediction was diversified by gender.  It was found that for women, a diagnosis of drug abuse and psychosis predicted receipt of service. If they were unmarried, they had an increased probability of using services that screened positive for homelessness. Furthermore, if they were diagnosed with PTSD (post-traumatic stress disorder) their probability of receiving services for at-risk women was increased. For men, it was found that being unmarried, younger, having a medical or behavioral health condition, not being service-connect/Medicaid-eligible predicted receipt of services. The major goal of the U.S Department of Veterans Affairs’(VA’s) is to prevent homelessness among the Veterans, like rehouse those who have lost their homes or to identify at-risk Veterans and connect them with homeless prevention services. “Consistent with the Housing First approach, the HSCR is intended to link Veterans with services of their choosing that directly support housing stability” (Ditchter, 2016).

The solution to help the homeless is Housing First, their main priority is to house the homeless. They have created a platform where they not only provide housing but also to help the individuals with their personal goals and improve their quality of life. Housing is a necessity just like food and water, without a place to live it’s hard to find jobs as most employers don’t hire the homeless. Housing First focuses and helps to resolve this issue; furthermore, Housing First gives clients the choice to select a house that they prefer therefore exercising this choice will increase the likelihood of the client’s success and improve their lives.   To dive in deeper on this solution we focused on the elements of the housing first program. Housing First will help assist the at-risk of being homeless individuals with rentals depending on the household income and needs. Clients sign a lease that will grant them access to their new homes, and they are also provided with necessary support to help them assist with any issues they might have with the housing.   The two common program they offer is Permanent Supportive Housing (PSH) and the second program is rapid re-housing to provide those who have recently lost homes. The purpose of the first program is to target families and individuals with chronic homelessness, mental health problems, disability, illness, and substance use and to help them provide a long-term rental or housing assistance with support service. The second program model’s focus it to help house or rent a place for those families or individuals who have recently lost their homes. This option provides with short-term services and rental assistance. The goal here is to provide and help the families gain quick housing, employment, remain housed and increased self-sufficiency.

Overall, addiction should be recognized as a mental illness and should be treated with proper care. The veterans on the streets have served our country with strength, we as a society should help get them off the streets and into homes and help them get proper professional help to overcome PTSD, and substance use. Once the homeless are provided with proper housing and support to overcome addiction they can get employed and have a fresh start in life. Doing so will prevent OD deaths, help with prevention of diseases, street deaths from hypothermia etc.… Housing First is one step closer to achieving that goal and fixing this issue.

 

 

 

 

 

Citations

Bennett, A., Watford, A., Elliott, L., Stokfo, B., & Guarino, H. (2019, June 17). Military veterans’ overdose risk behavior: Demographic and biopsychosocial influences. Retrieved from https://www-clinicalkey-com.ccny-proxy1.libr.ccny.cuny.edu/#!/content/journal/1-s2.0-S030646031930156X.

 

Montgomery, A. E., Dichter, M. E., Thomasson, A. M., & Roberts, C. B. (2016, March 1). Services Receipt Following Veteran Outpatients’ Positive Screen for Homelessness. Retrieved from https://www-clinicalkey-com.ccny-proxy1.libr.ccny.cuny.edu/#!/content/playContent/1-s2.0-S074937971500416X?returnurl=null&referrer=null

 

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