Homeless And Alcohol

Homeless And Alcohol – Homelessness became an apparent pressing social issue in the United States during the 1980s and 1990s because of the frighteningly large number of homeless individuals and families appearing in public and in social work intervention programs (First, Rife, & Toomey, 1995).

It is impossible to present accurate data concerning the scope of the problem because:

there is little consensus concerning how to define and quantify this condition (narrowly or broadly; counting family units or numbers of individuals)
many communities do not choose to look for and count their homeless members
many homeless individuals and families do not choose to be found and counted

Homelessness in America during the 1950s and early 1960s almost exclusively involved single men over the age of 50. Homeless populations are now characterized by much greater diversity (Burt, 1992; First, et al., 1995).

Thirty-eight percent of homeless individuals have a mental health concern. Nearly one-half of homeless men (47%) and 16% of homeless women also experience alcohol use disorders (Johnson, 1995). Homeless individuals who abuse alcohol and other drugs are quite susceptible to liver disease, gastrointestinal ailments, tuberculosis, seizures and other neurological disorders, hypertension, cardio-pulmonary diseases/disorders, and HIV/AIDS infection (Johnson, 1995).

Furthermore, the combined chances of alcohol, drug, and mental health problems anytime in a homeless person’s life are estimated at 30% (Burt, Aron, Douglas, Valente, Lee, & Iwen, 1999). Because homeless populations are often hidden from view and therefore difficult to study, research on the homeless with alcohol disorders is not as abundant as it is with many other groups.

Learning Objectives

By the end of this module, learners should be able to:

A. Understand–
1. the factors important in the lives of homelessness individuals
2. the culture of the homeless
3. the homeless in a cultural context

B. Recognize the ways in which the problems of homelessness and alcohol use disorders interact and the prevalence of these co-occurring processes.

C. Become familiar with modifications of alcohol treatment approaches that enhance effectiveness with homeless populations.

Background

One significant barrier to the systematic study of homelessness is the lack of a coherent definition of terms. Rossi (1987) suggests that homeless means, “not having customary and regular access to a conventional dwelling” (p. 10). The United States Department of Housing and Urban Development (HUD, 1984) has defined homelessness as “living in public or private emergency shelters; or in the streets, parks, subways, bus terminals, railroad stations, airports, under bridges or aqueducts, abandoned buildings without utilities, cars, tracks, or any of public or private space that is not designated for shelters” (pp. 7-8).

These definitions, however, ignore the population of “hidden homeless” and precariously housed persons and families who develop unexpected, unconventional, and unrecognized solutions to meeting their needs, such as doubling up or camping out with friends and relatives (Johnson, 1995). In reference to homeless individuals, the term “squatting” indicates someone who is living in places not meant for human habitation. The precariously or marginally housed person is one who is at a very high risk of becoming homeless, and includes individuals who are vulnerable because they do not have legal lease arrangements.

Understanding homelessness is further complicated by its seasonal nature in many regions, and by its episodic versus chronic variations. Furthermore, the concept of “homeless” has varying meanings in different national and cultural contexts. Globally, homelessness may be conceptualized as the opposite of adequate housing.

Adequate housing protects against the elements (temperature extremes, precipitation, sun damage, etc.), has access to potable water sources, provides for sanitation (removal of human and animal waste products, sewage), protects from intruders, and provides freedom from sudden removal or having no security of tenure (Conroy, 1987).

The United Nations’ generic term for lacking shelter is “sans domicile fixe” (SDF), or “without fixed address.” Table 1 presents a variety of cultural conceptualizations of homelessness around the world.

Table 1. Conceptualizations of Homelessness

Homeless Concept

Word/Phrase

Country/Culture

Lack of shelter	roofless sin techo (without roof)	India Latin America
Cut off from a household or other people	clochard (tramp) pennebruder (prison brothers) furosha (floating people) puliukko (elderly male alcoholic) itinérants (itinerants)	France Germany Japan Finland Quebec, Canada
Homeless or street children	gamino (gamin) pixote ( from the movie Pixote) khate (rag picker)	Colombia Brazil Nepal
Squatter settlements, spontaneous settlements	bidonvilles (tin cities) pueblos jóvenes (young towns) kampung (village)	Francophone Africa Lima, Peru Indonesia

Developing nations often view their population who lives out-of-doors as a result of massive rural-to-urban migration, with the public or private housing sector not being able to accommodate the numbers of people. Squatter or spontaneous settlements are often made from found materials and emerge on land owned by someone else.

The pueblos jóvenes of Lima, Peru, are towns that emerge without an infrastructure to support the population. In the industrialized world, homelessness is viewed as: 1) a result of personal problems, such as chronic alcoholism, drug abuse or mental illness (especially following the era of deinstitutionalization), or 2) the results of gentrification, which lowers the affordable income housing stock, with a concomitant move from an industrialized to a service economy and a decrease in financial assistance-in the U.S., “Welfare Reform” (Glasser, 1994).

Generally, if being itinerant is a part of the culture, the population is not considered to be homeless (e.g., the Travellers of Ireland). However, this distinction becomes unclear in cases where individuals spend years living between shelter programs and claim this as their lifestyle.

The association between alcohol and homelessness has historical roots and stereotyping. Until very recently, the word “puliukko” has been used in Finland interchangeably to describe both homeless and alcoholic.

In Japan, the yosebas (single men, many of whom are alcoholic) are afforded inexpensive housing while they work in the construction industry but are found living out-of-doors during periods of unemployment.

In the United States, “skid row” has historically been the area of a city where single men and women with alcohol problems live transiently in inexpensive hotels or on the streets (Glasser, 1994).

Pathways To Homelessness

The ecological model allows us to view homelessness as a result of the interplay between (Toro et al., 1991; Morse, 1992):

personal problems (e.g., alcohol abuse, illicit drug use, and/or mental illness)
structural problems of the scarcity of affordable housing (e.g., through urban renewal, gentrification, or some other cause of removing affordable housing units from circulation)
economic restructuring to a low wage service economy reduction in financial assistance

The ecological model integrates issues of individual vulnerabilities within the broadest cultural and societal landscapes.

It recognizes that as housing niches for the poor have been lost, those who were most vulnerable, including those with alcohol-related problems, suffered a loss of permanent housing.

It also recognizes that vulnerability to homelessness arises with a loss of support systems (family, charity, and government) required for individuals and families to survive in a complex society (First, et al., 1995).

Institutional systems may also be a source of homelessness when individuals are released without a sufficient guarantee of residential security (e.g., deinstitutionalization, prison release).

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