DRUG USE AMONG THE HOMELESS POPULATION IN IRELAND 

Marie Lawless & Caroline Corr

Study Funded by the
National Advisory Committee on Drugs (NACD)

ACKNOWLEDGEMENTS

• Staff and Clients of Drugs and Homeless Services
• Team of Fieldworkers
• Research Advisory Group Members
• NACD
• Merchants Quay Ireland

CONTEXT TO STUDY

• Action 98 of National Drugs Strategy (Building on Experience 2001-2008;123)
  
  To carry out studies on drug misuse amongst the at-risk groups identified e.g travellers, prostitutes, homeless, early school leavers etc including desegregation of data on these groups. It is essential that the individuals and groups most affected by drug misuse and those involved in working to reduce, treat and prevent drug misuse have immediate access to relevant information.
  
  
• First Prevalence Study of Drug Use Among the Homeless Population in Ireland
  

PROJECT OBJECTIVES (1)

METHODOLOGY (1) - Quantitative

Homeless Population

• Survey Questionnaire (n=355) (70% in Dublin)
• “ Home Truths Project” / 9 Trained Fieldworkers
• Questionnaire Design/ Various Domains
• Quota Sampling
  (Dublin) -ESRI/HA Count
  (Outside Dublin) – LA Assessments of Homelessness
• Fieldwork June –October 2003
• Multi-Site Research Study (50 sites across 4 locations)
• Analysis : Statistical Package SPSS

METHODOLOGY (2) - Qualitative

Service Providers

• 14 Focus Groups
  (8 in Dublin ; 2 in each of the other 3 cities; comprising of 64 homeless and drug service providers)
• Focus Groups (Dublin) Representing Different Aspects of Service Provision
• Research Officers (MQI)/ July & August 2003
• Interview Guide- policies, procedures, examples of good practice, strengths & weaknesses in service provision, service development.
• Analysis: Tape Recorded, Transcribed, Coded into Themes & Patterns using NUD*ST 6

HOMELESS POPULATION PROFILE (n=355)

• 69% (n=244) were male, 31% (n=111) were female;
• Average age of respondents was 35 years. Over a quarter of the sample was under 25 years of age;
• Hostel (50%), B&B (19%) and rough sleeping (16%) were the most common homeless accommodation types;
• 89% were Irish;
• The majority (78%) were single (78%). Only 10% were living with children (under 18 years)- half were living alone with children in their accommodation.

EXPERIENCE OF HOMELESSNESS(n=355)

• 1- in-2 had prior experiences of homelessness (59%) (Average = 7 episodes);
• Family conflict - primary reason for becoming homeless (24%);
• Personal drug use - second most common reason for becoming homeless (19%), 13% reported alcohol use;
• Cannot access housing (private/public)- primary reason for remaining homeless (36%);
• Just over 1-in-10 reported drug use as primary reason for remaining homeless (11%);
• Other commonly cited reasons; money problems (11%), family conflict (9%), alcohol use (7%).

MEASURING PROBLEMATIC ALCOHOL USE

• AUDIT- 10 item screening instrument developed by World Health Organisation (Saunders et al, 1993)
• Administered to those reported alcohol use at interview (n=247)
• Scoring Schedule;
  - A score of less than 8: No Problem
  - A score of 8 or above: Associated with harmful or hazardous drinking and is suggestive of alcohol problems
  - A score of 16 or more:Is likely to indicate a high level of alcohol problems

PROBLEMATIC ALCOHOL USE(n=247)

• 73% were problematic drinkers (51% of the homeless population).
• 49% had a high level of alcohol problems (a score of 16 or more) (34% of the homeless population).
• Higher level of problematic alcohol use among men than women (76% v 63%).
• Over half those staying in hostels (55%) and sleeping rough (52%) were problematic drinkers.
• Almost two-fifths (39%) of B&B residents were problematic drinkers.
• Highest rate of problematic alcohol use amongst those under 20 years (87%).

MEASURING DRUG USE

• EMCDDA template of drug classification (Licit and Illicit Drugs);
• Illicit Drug Use refers to use of; amphetamines, cannabis, cocaine powder, crack, ecstasy, heroin, LSD, magic mushrooms, poppers and solvents.
• Different recall periods;
  - Lifetime (ever used)
  - Recent (used within last year)
  - Current (used within last month)
• Asked to all participants (n=355).

ILLICIT DRUG USE

• Lifetime use =74% (nearly 3-in-4 homeless persons).
• Recent use = 64% (nearly 2-in-3 homeless persons)
• Current use = 52% (nearly 1-in-2 homeless persons)

ILLICIT DRUG USEHighest Levels of Current Use (%)

Illicit Drug Prevalence by Gender & Location

DRUG ISSUES BY ACCOMODATION TYPE (1)

• Current Illicit Drug Use

• Current Prevalence Rates by Various Drug Types

PRESCRIBED DRUG USECurrent Use

• High use of prescription drugs (36%);
• Use of prescribed anti-depressants most commonly cited (15%)
• Women more likely to use prescribed medication than men (44% v 37%);
• Those on prescribed medication were more likely to be in contact with psychiatric services;
• Less than a fifth of the total study population reported current methadone use (18%). Over two thirds reported prescribed use, almost 1-in-3 not prescribed (sharing, buying etc).

POLY DRUG USECurrent Use

• 72% of current users were using more than one drug (45% of homeless population);
• Average drugs used =3 (range 1-10 drugs)
• 27% of current users (or 1-in-5) using 5 or more drugs; (13% of homeless population);
• Current use of 5 + drugs by accommodation;
  - Hostel dwellers (19%) (11% of all hostel dwellers)
  - B&B (23%) (17% of all B&B residents)
  - Rough sleepers (26%) (20% of all rough sleepers)

MEASURING DRUG USE

Problematic & Dependent

• Drug Abuse Screening Test (DAST) - 10 item screening instrument to identify problematic drug use (n=216). A score of six or more indicates a drug problem.
• Severity of Dependence Scale (SDS) – 5 item scale designed to measure degree of dependence on different drugs (n=193). Higher the score the greater degree of dependence. Maximum score obtainable is 15.

PROBLEMATIC DRUG USE (1)DAST (n=216)

• 65% scored as problematic (36% of the homeless pop);
• Higher proportion within Dublin compared to outside Dublin (43% v 19%);
• Significantly more likely to be younger than overall sample (28 yrs vs 35 yrs);
• More likely to be homeless at a younger age (mean age 20.5 years v 27.4 years);
• More likely to be in B&B than overall sample (28% vs 33%);
• More likely to be rough sleepers than overall sample (21% vs 16%);
• More likely to have experienced imprisonment.

DRUG USING HISTORY

• Majority first used drugs prior to homelessness (87%)
• Over two thirds of current users were less than 16 years when they first used drugs (68%);
• Cannabis first drug used (76%), only 5% reported commencing their drug use with heroin;
• Average age of first drug use = 15 yrs
  -(used drugs prior to homelessness) = 15 yrs
  -(used drugs after becoming homeless) = 24 yrs