Housing status, social support networks and substance misuse

Dr Iain AthertonDr Maria Stuttaford

Professor Joe Doherty

Centre for Housing ResearchUniversity of St Andrews

Overview

• Research question

• Methods

• Results

• policy implications

Housing ready vs Housing First

• Housing Ready1.Substance misusing/mental health

2.Once stabilised, then house

• Housing First (Tsemberis et al, 2004)1.Housing

2.Services available - no compulsion

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)

What’s missing?

Stable housing Substance use

Social networks

Social networks

• Positives– Friendship

– Practical support

• Negatives1. Initiation of substance misusing

2. Perpetration of substance misusing

3. Prevention of exit from substance misusing

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

Findings:

(1) Initiation of substance use

Interviewee

• Alix

• Age – early 30s

• Housing status– Currently in stable accommodation on

methadone– Previously homeless and using heroin

[I started using heroin] cause I’d let one of my friends stay with me… because they’d nowhere else to stay …and I’d never seen it before in my life…didn’t ever want…to…be 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 that’s how I ended up using.

[I started using heroin] cause I’d let one of my friends stay with me… because they’d nowhere else to stay …and I’d never seen it before in my life…didn’t ever want…to…be 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 that’s how I ended up using.

Findings:

(2) Perpetuation of substance using

Interviewee

• Matt

• Age – late 20s

• Housing status– Homeless (living with friends)

• Substance misusing – regularly using heroin

Right, well, I stay with a friend just noo… em…I get up in the morning, well I get wakened up in the morning with my friend, and he’s got a…handing me a needle wi’ kit in it, ken, for ma’…breakfast really…

Right, well, I stay with a friend just noo… em…I get up in the morning, well I get wakened up in the morning with my friend, and he’s got a…handing me a needle wi’ kit in it, ken, for ma’…breakfast really…

Interviewee

• David

• Age – mid-30s

• Housing status– Hostel

• Substance misuse– Currently not using heroin after years of use

[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 drugs…it’s in my face all the time, ken what I mean…basically. Ninety percent of people in here use. They either do drugs or drink, one of the two…don’t think there is a straight person in here.

[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 drugs…it’s in my face all the time, ken what I mean…basically. Ninety percent of people in here use. They either do drugs or drink, one of the two…don’t think there is a straight person in here.

Notes from an interview

• Elspeth

• Service Provider

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]”

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]”

(3) Prevention of exit

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.

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.

David-

[my treatment officer] gives me a weekly bus pass…to get me out of here, because I’ve told them what its like here. To get me out so I’m not in a position to get drugs, you know what I mean.

David-

[my treatment officer] gives me a weekly bus pass… to get me out of here, because I’ve told them what its like here. To get me out so I’m not in a position to get drugs, you know what I mean.

Interviewee

• Paul

• Age – mid-30s

• Housing status– Recently made homeless – now in hostel

• Substance misusing– Drug free for two months

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 hadn’t been evicted but you still got all this support?

Paul- …I reckon I would have still been the same, because I don’t think I’ve got the strength to say to my mates, beat it, your no coming back here, ken sort of like… I don’t know why because they are my mates but at the end of the day they’re, they’re no ma mates if you know what I mean, ken because basically they’re using ma house as somewhere to have a jag…I don’t think I’d be able to do it maself…but with the support that I’ve got…been able to move, get a change of life, you know.

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 hadn’t been evicted but you still got all this support?

Paul- …I reckon I would have still been the same, because I don’t think I’ve got the strength to say to my mates, beat it, your no coming back here, ken sort of like… I don’t know why because they are my mates but at the end of the day they’re, they’re no ma mates if you know what I mean, ken because basically they’re using ma house as somewhere to have a jag… I don’t think I’d be able to do it maself…but with the support that I’ve got…been able to move, get a change of life, you know.

• Prevent homelessness

• Assisting with daily geographic mobility

• Geographically sensitive housing programmes– Caution with hostel use (Wright et al. 2005)

– Location of re-housing

• Relocation?

Policy

Conclusion

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