NACD Drug Use Among the Homeless National Advisory Population in Ireland Committee on Drugs NACD 2005 Drug Use Among the Homeless Population in Ireland 1 Authors: April 2005 Merchants Quay Ireland Merchants in Ireland Marie Lawless and Caroline Corr Marie Lawless and Caroline A Report for the Homeless Population Population Homeless Drug Use Among the Among Use Drug National Advisory Committee on Drugs National Advisory 2 Drug Use Among the Homeless Population in Ireland NACD 2005 Teach SunAlliance,SráidTheachLaighean,BaileÁthaCliath2, Sun AllianceHouse,MolesworthStreet, Dublin2, Government Publications,PostalTrade Section, © NationalAdvisoryCommitteeonDrugs2005 Foilseacháin Rialtais,anRannógPost-Tráchta, (Tel: 01-6476834/35/36/37;Fax:01-4752760). (Teil: 01-6476834/35/36/37;Fax01-4752760). 4-5 BótharFhearchair, BaileÁthaCliath2, Government PublicationsSalesOffice, Arna FhoilsiúagOifigantSoláthair. Published bytheStationeryOffice. To bepurchased directly from the Oifig DhíoltaFoilseachánRialtais, Designed by 4-5 Harcourt Road,Dublin2, Le ceannachdíreach ón or bymailorder from ISBN 0-7557-7066-8 nó trídanbpostó Baile ÁthaCliath Prn. A5/0413 Dublin € first impression 5 NACD 2005 Drug Use Among the Homeless Population in Ireland 3 40 43 25 25 39 10 11 2.7.2.1 Drug Use Among the Homeless Population2.7.2.2 Homelessness Among Drug Users 33 34 3.4.1 Content Questionnaire 3.4.2 Piloting of Questionnaire 3.4.3 of Fieldworkers Recruitment and Training 3.4.4 Sites Research 3.4.5 Access 43 42 42 43 2.3.1 Homelessness in Dublin 2.3.2 Homelessness Outside Dublin (Cork, Galway and Limerick)2.5.1 Drug Use Outside Dublin 2.7.1 Cause or Effect? 2.7.2 29 Estimates Prevalence 2.7.3 Homelessness, Drug Use and Risk Behaviour 2.8.1 Issues for the Homeless Drug User Treatment 2.8.2 Effectiveness Homeless Drug Users and Treatment 2.8.3 to the Needs of the Homeless Drug User in Service Provision Responding 28 37 31 35 37 36 33 32 3.1 Introduction 3.2 Populations Target 3.3 Involvement of Stakeholders3.4 among the Homeless Population Survey Questionnaire 42 41 40 1.5 The Report 2.1 Defining Homelessness 2.2 Counting Homelessness 2.3 Homelessness in Ireland2.4 Responses to Homelessness 2.5 Drug Use in Ireland 2.6 Responding to the Drugs Issues 2.7 Homelessness and Drug Use 2.8 Homeless Drug Users and Service Provision2.9 27 Summary 27 28 30 31 30 32 36 1.1 to the Study Background 1.2 to the Study Introduction 1.3 Aims and Objectives Research 1.4 Key Definitions 24 24 24 Table of Contents Table Chapter Three – Study Design and MethodologyChapter Three 40 Chapter Two – Review of LiteratureChapter Two 27 AcknowledgementsForeword 9 Preface Glossary of TermsExecutive SummaryChapter One – Introduction 12 24 13 4 Drug Use Among the Homeless Population in Ireland NACD 2005 hpe or–Rsac ouainPoieadCaatrsis 48 Chapter Four–Research PopulationProfile andCharacteristics hpe i atrso rgUe 72 63 ofDrugUse Chapter Six–Patterns ofAlcoholUse Chapter Five–Patterns Table ofContents . umr n ocuin 69 72 68 66 63 57 58 68 57 IllicitDruguseAmongtheHomelessPopulation 6.2 Introduction 6.1 52 64 SummaryandConclusions 5.7 Alcoholand Accommodation:theProvider Perspective 5.6 AlcoholUse: theProvider Perspective 5.5 Impactof AlcoholUseonAccommodation 5.4 48 TheAlcoholUseDisorders Identification Test Screening Instrument (AUDIT) 5.3 Frequency ofAlcoholConsumption 5.2 Introduction 5.1 SummaryandConclusions 4.8 LegalStatus 4.7 Sources ofIncome 4.6 EducationandEmployment 4.5 HistoryofHomelessness 4.4 PopulationProfile 4.3 PopulationSample 4.2 Introduction 4.1 . aaMngmn 46 45 Summary 3.9 DataAnalysis 3.8 DataManagement 3.7 EthicalIssues 3.6 FocusGroups withServiceProviders 3.5 .. urn lii rgUeb oain72 73 Current IllicitDrugUsebyAccommodation Type 6.2.2 Current IllicitDrugUsebyLocation 53 6.2.1 54 53 52 51 51 51 52 50 ReasonsforHomelessness 4.4.4 AgeFirstHomeless 4.4.3 ExperienceofHomelessness Currently Homeless 4.4.2 LengthofTime 4.4.1 LocalAuthorityHousingandAnti-SocialBehaviour 4.3.4 RegistrationonaLocalAuthorityHousingList 4.3.3 LastPermanentAddress 4.3.2 NationalityandEthnicOrigin 4.3.1 inCurrent Accommodation LengthofTime 4.2.1 .. aaPeaain 46 46 46 45 44 44 DataPreparation 3.7.3 DataProtection 3.7.2 DataQualityControl 3.7.1 Sample 3.5.2 InterviewSchedule 3.5.1 MonitoringSample 3.4.8 SamplingFrame 3.4.7 Fieldwork 3.4.6 72 63 58 51 48 46 46 45 45 44 NACD 2005 Drug Use Among the Homeless Population in Ireland 5 99 107 Table of Contents of Table 7.5.1 Complaints Physical Health 7.5.2 Medical Card 7.6.1 and Results Hepatitis B, C Testing 7.6.2 and Results HIV Testing 7.7.1 Psychiatric Health Concerns Regarding 7.7.2 Services Experience of Psychiatric 7.7.3 and Accommodation Psychiatric Health 107 109 111 113 108 111 112 7.3.1 Place of Injecting 7.3.2 Injecting Company 7.3.3 Levels of Risk Behaviour 7.3.4 Injecting Difficulties7.3.5 Risk Behaviour Overview of Injecting 7.4.1 Changes in Drug Use 7.4.2 Behaviour Changes in Injecting 103 101 99 100 102 106 104 6.3.1 Homeless Population Total 6.3.2 Dublin Homeless Population 6.3.3 Homeless Population Outside Dublin 6.5.1 by Location Medication Prescribed 6.5.2 Medication by Drug Type Prescription 6.6.1 Polydrug Use by Location6.6.2 Polydrug Use and Accommodation 6.7.1by Location Drug Use Problematic 6.7.2 Drug Users Characteristics of Problematic 6.9.1 77 First Drug Used 6.9.2 73 75 Age First Used Drug 6.9.3 First Use of Drugs and Becoming Homeless 81 81 83 84 82 83 87 86 86 7.6 Blood-borne Infections7.7 Psychiatric Health7.8 Experience Drug Use: the Provider Psychiatric Health and 7.9 Summary and Conclusions 113 109 111 114 7.1 Introduction 7.2 Over Past Month Route of Administration 7.3 Injecting Behaviour and Practices Current 7.4 Changes in Behaviour and Practices Drug Use and Homelessness: 7.5 Physical Health 104 99 99 6.4 Use Over Past Month of Frequency 6.5 Medication Among the Homeless Population Prescription 6.6 Polydrug Use Among the Homeless Population 6.7 the Homeless Population Drug Use Among Problematic 6.8 Dependent Drug Use Among the Homeless Population 81 6.9 Drug Using History 6.10 Accommodation Impact of Drug Use on 80 6.11 Perspective the Provider Drugs and Accommodation: 82 6.12 83 Perspective and Extent of Drug Use: the Provider Nature 6.13 Overview of Key Findings 6.14 Summary and Conclusions 85 89 91 87 86 94 94 6.3 by Drug Type of Use Among the Homeless Population Prevalence 73 Chapter Seven – Risk Behaviour and Health Chapter Seven – Risk Behaviour and 99 6 Drug Use Among the Homeless Population in Ireland NACD 2005 hpe ie–CnlsosadPlc mlctos 153 List ofTables Appendices References Chapter Nine–ConclusionsandPolicyImplications 119 Chapter Eight–ServiceProvision Table ofContents . Du s mn h oa td ouain74 72 58 66 75 65 73 65 64 57 54 63 Current Prevalence RatesofDrugs byMainAccommodationType 48 66 6.4 64 DrugUse Among theTotal StudyPopulation 6.3 55 IllicitDrug UseOverPastMonthbyMain AccommodationType 56 6.2 IllicitDrugPrevalence RatesbyLocationandGender 6.1 50 49 5.8 ResultsofAUDITScreening InstrumentbyAge 5.7 ResultsofAUDITScreening InstrumentbyMainAccommodation Type 5.6 ResultsofAUDITScreening InstrumentbyLocation 5.5 157 ResultsofAUDITScreening Instrument 5.4 Frequency ofAlcoholConsumptionbyAccommodationType 5.3 Frequency ofAlcoholConsumptionbyGender 5.2 Frequency ofAlcoholConsumptionbyLocation 5.1 Current LegalStatus 4.9 MainReasonforRemainingHomeless 4.8 SecondaryReasonsforFirstBecomingHomeless 4.7 MainReasonforFirstBecomingHomeless 4.6 AgeFirstBecameHomeless 4.5 Current AccommodationType byLocation 4.4 Current AccommodationType byGender 173 4.3 203 AgebyLocation 4.2 GenderbyLocation 4.1 Appendix 2–QualitativeInterviewGuideServiceProviders (Drug/Homeless) Appendix 1–QuantitativeSurveyQuestionnaire –HomelessPopulation 119 PolicyImplications 9.2 Conclusions 9.1 122 DrugServices 8.4 HomelessServicesProvision: theProvider Perspective 8.3 HomelessServices 8.2 Introduction 8.1 . umr n ocuin 149 148 148 137 SummaryandConclusions 8.8 AssessmentofServiceNeeds 8.7 ContactwithGenericServices 8.6 DrugServiceProvision: theProvider Perspective 8.5 eotdDfiute nAcsigEegnyAcmoaina euto loo s 67 Reported Difficulties inAccessingEmergency AccommodationasaResultofAlcoholUse 119 120 119 121 Improvements toHomelessServices–ServiceUserPerspective 8.2.4 Difficulties AccessingHomelessServices 8.2.3 FactorsInfluencingUseofHomelessServices 8.2.2 ContactwithHomelessServices 8.2.1 .. otc ihDu evcs134 134 136 Improvements toDrugServices–ServiceUserPerspective 8.4.3 Difficulties AccessingDrugServices 8.4.2 ContactwithDrugServices 8.4.1 161 153 134 119 49 NACD 2005 Drug Use Among the Homeless Population in Ireland 7 101 Table of Contents of Table 4.1 Study Population Homeless of Total Age First Became 6.1 Use Age of First Drug Company 7.1 Injecting 7.2 Ever Experienced Injecting Difficulties 7.3 in Patterns of Drug Use as a Result of Being “Out of Home” Negative Changes 7.4 in Patterns of Drug Use as a Result of Being Homeless Positive Changes 7.5 Practices as a Result of Being Homeless Changes in Injecting 8.1 104 to Homeless Services (Drugs/Alcohol Issues) Refusal of Access 8.2 to Homeless Services (Drugs/Alcohol) Improvements 8.3 Accessing Drug Services Difficulties 8.4 105 Services Accessing Methadone Treatment Difficulties 53 8.5 to Drug Services (Service User Perspective) Improvements 106 120 102 121 136 135 87 100 135 6.5 the Homeless Population – Dublin Drug Use Among 6.6 – Dublin by Main Accommodation Type Rates of Drugs Prevalence Current 6.7 – Cork Drug Use Among the Homeless Population 6.8 – Galway Drug Use Among the Homeless Population 6.9 the Homeless Population – Limerick Drug Use Among 6.10 of Use Over Past Month Frequency 77 6.11 Past Month Medication Over Prescribed 6.12 Medication by Drug Type Prescription 6.13 Polydrug Use by Location 6.14 Type Polydrug Use by Main Accommodation 6.15 Drug Use by Location Problematic 6.16 Populations Drug-Using and Problematic by Homeless Key Variables 76 6.17 Dependent Drug Use by Location 6.18 Type Dependent Drug Use by Main Accommodation 77 78 6.19 in Accessing Accommodation as a Result of Drug Use Reported Difficulties 78 6.20 and Extent of Drug Use Among the Homeless Population Nature 7.1 Place of Injecting by Gender 7.2 84 Inject Self by Gender Sites 7.3 Injecting 88 81 80 82 83 94 86 84 82 85 100 101 7.4 Sharing Behaviour by Gender Current 7.5 Months the Past Three within Injecting Difficulties 7.6 Overview of Injecting Risk Behaviour 7.7 Physical Health Complaints 7.8 Medical Card Current 7.9 for Hepatitis B, C Test 7.10 B by Gender for Hepatitis Vaccination 7.11 Results Hepatitis (B and C)7.12 by Main Accommodation Type HIV Test 7.13 Experience of Psychiatric Services 7.14 Experience of Psychiatric Services by Main Accommodation Type 8.1 Service Needs by City Location Self-reported 103 102 113 103 109 108 111 109 149 109 112 110 List of Figures 8 Drug Use Among the Homeless Population in Ireland NACD 2005 NACD 2005 Drug Use Among the Homeless Population in Ireland 9 We wish to thank the staff and clients of the different drugs and homeless services in Dublin, Cork, drugs and homeless services and clients of the different to thank the staff wish We study. the research and enthusiastically with who facilitated so agreeably Galway and Limerick of the survey involved in the administration of fieldworkers who were Many thanks to the team Andrew Tim Morrissey, Bingham, Seamus Gemert, Helen Connolly, Van Caroline questionnaire; thank you to Also Walshe. Elaine O’Neill and Catherine Emmet Bergin, Boilson, Shauna Kearney, the questionnaires. Liza Costello for coding for their Advisory Group to the NACD and to the members of the Research Grateful appreciation support: Aileen O’GormanAlice O’Flynn HickeyClaire National Advisory Committee on Drugs (Chair) Derval HowleyFrank Mills Health Authority (ERHA) Eastern Regional Lyons Maureen Focus Ireland Mary Higgins (ERHA) & National Drugs Strategy Eastern Regional Health Authority Paul Conlon Homeless Agency Stephane Donati Eastern Regional Health Authority (ERHA) Willie Conway Homeless Agency McKeeverVourneen Health Board Northern Area Dublin Simon Acknowledgement to James Williams (ESRI) for his Institute of the Economic and Social Research Homeless Persons Unit Cedar House for the Dublin Area. the sampling methodology employed assistance regarding on-going support and comments on for their Quay Ireland Thanks to our colleagues at Merchants Education and Development), Research, Director, especially Dermot Kavanagh (Assistant the project, who transcribed all and Mary Browne the report Seamus Kileen and Barbara Connolly who proof-read the focus groups. Acknowledgements 10 Drug Use Among the Homeless Population in Ireland NACD 2005 Foreword Minister ofStatewithresponsibility fortheNationalDrugsStrategy TD Noel Ahern Mr DeclanCrean. Director –MsMairéadLyons, Research Officer –MsAileenO’Gorman,MrAlanGaffney and National AdvisoryCommitteeonDrugs,inparticular, itsChairperson–DrDesCorriganandstaff, Finally, Iwouldliketorecord myappreciation oftheon-goingworkall ofthemembers part oftheHomelessStrategyReview. it hasalready fedintotheMid-Term ReviewoftheNationalDrugsStrategyandwillbeconsidered as best practiceinservicedeliveryandthisreport isnoexception.Inthisregard, thereport istimelyas The research andanalysispreviously provided bytheNACDinformsbothpolicydevelopmentand to anumberofGovernmentDepartmentsandAgencies. over thelifetimeofresearch, itisclearthattheneeds of homelessdrugusersposeachallenge unquestioned andwhileIamhappytonotethatthere havebeenimprovements inservicedelivery In addition,overathird had beendiagnosedwithapsychiatriccondition.Thisgroup’s vulnerabilityis As thereport pointsout,homelesspeoplesuffer from highlevelsofproblematic alcoholanddruguse. project andwascarriedoutbyMerchants QuayIreland withkeystakeholdersinvolvedinallstages. extent andcontextofdruguseamongpeoplewhoare homelessinIreland. Itwasacollaborative In thisregard, theNACDcommissionedthisreport, whichhadasitsoverallaimtoassessthenature, number ofvulnerablegroups includingthehomeless. It isforthisreason thatAction98oftheNationalDrugsStrategycallsforresearch tobecarriedona issue isaccessingreliable informationconcerningthenature andextentofdrugmisusebythisgroup. homelessness are particularlyvulnerable.Aspolicymakers,partofthechallengeindealingwiththis misuse andhomelessnesscancause.Peoplewhocarrytheburden ofbothdrugdependenceand State forboththeNationalDrugsStrategyandHousing,Iamconsciousofharmthatdrug I warmlywelcomethisreport from theNationalAdvisoryCommitteeonDrugs(NACD).AsMinisterof NACD 2005 Drug Use Among the Homeless Population in Ireland 11 Dr Des Corrigan Chairperson, NACD I am pleased to present the findings from the first comprehensive study of drug use and homeless in study the first comprehensive the findings from I am pleased to present was commissioned by This research Homeless Population in Ireland.” “Drug Use Among the Ireland (MQI) in response Quay Ireland Unit in Merchants undertaken by the Research the NACD in 2002 and Action 98 of the National to relation and in part fulfilment of our duties in to a Ministerial Request Drugs Strategy 2001-2008. services of improved to the development and planning will contribute research The NACD believe this indeed a very that homeless drug users are the research to homeless drug users. It is clear from drug users and whilst drug problematic of the study population were Over a third vulnerable group. for remaining for people becoming homeless, it is the key reason use was not the primary reason exposed to higher levels of risk as they use are noted also that homeless drug users homeless. We It is worrying that so many drug taking paraphernalia. drugs in unhygienic public places and share homeless drug users injected drugs in the last month many of whom injected alone, problematic a Drug use is combined with alcohol use and which is high-risk behaviour for a fatal overdose. of the sample experienced mental health issues. considerable proportion of a multi-disciplinary Research was implemented under the guidance and support The research Health Service Executive (HSE) Focus Ireland, from (RAG), comprising representatives Advisory Group Dublin Simon, the Homeless Persons Unit, HSE Team, Eastern Region, the National Drugs Strategy the Homeless Agency and NACD. of Special Needs and drug counselling), (Office Northern Area project. and monitoring this research indebted to them for their commitment to mentoring are We to recommendations. the findings and advised the NACD in relation The RAG also considered to Mr Noel Ahern TD, Minister of State who has not only the NACD have written Consequently, to 12 him in relation for the National Drugs Strategy but also for Housing, advising responsibility harm reduction; policy and planning; drug treatment; covering four key areas: recommendations a challenge to accommodation and housing. It is clear that the needs of homeless drug users pose this Report and a number of Government Departments and Agencies. The NACD is of the view that it should inform and influence the development of arising from crucially our recommendations priorities for this at-risk group. services and Departmental improved Marie Lawless and Dermot Kavanagh of MQI for their Corr, the NACD is grateful to Caroline Finally, also acknowledge our We and sensitivity. which was conducted with efficiency work, valuable research Aileen O’Gorman for Officer and to our Research Mairéad Lyons Director, indebtedness to the NACD’s their painstaking work in bringing this Report to completion. Preface 12 Drug Use Among the Homeless Population in Ireland NACD 2005 emergency accommodationwhichisprovided byprivateownersoncontracttolocalauthorities. Bed andBreakfast Accommodation(B&B) hazardous andharmfulconsumption. Identification Test (AUDIT)isdesignedtoscreen forarangeofdrinkingproblems andinparticularfor as problematic inaccordance withabriefinstrumentforclinicalscreening. TheAlcoholUseDisorders Problematic AlcoholUse anxiety aboutuseandissuesregarding cessationofuse. Scale (SDS)provides ameasure ofdependencewhichfocusesondifficulties incontrol ofdruguse, dependent inaccordance withabriefinstrumentforclinicalscreening. TheSeverityofDependence Dependent DrugUse problems arisingfrom druguseinthepreceding 12months. Test (DAST)coverstheuseofdrugs,physical,medicalcomplications,emotionalandpersonal problematic inaccordance withabriefinstrumentforclinicalscreening. TheDrugAbuse Screening Problematic DrugUse within thelasttwelvemonths)andcurrent (usedadrugwithinthelastmonth). time period.Thethree mostusedrecall periodsare; lifetime(everusedadrug),recent (usedadrug Prevalence strategies whichcanreduce theharmfulconsequencesofdruguse,whileusecontinues. users cannotbeexpectedtoceasetheirdruguseatthepresent timeandaims,therefore, toprovide Reduction Harm comparable informationconcerningdruguseandaddiction. Centre forDrugsandDrugAddictionprovides European Communitymemberswithreliable and European MonitoringCentre forDrugsandDrugAddiction(EMCDDA) Gaeltacht Affairs. Since June2002,theNACDfallsunderauspicesofDepartmentCommunity, Rural& research onissuesrelating todrugsandadviseGovernmentonpolicydevelopmentinthearea. auspices oftheDepartmentTourism, SportandRecreation toconduct,commissionandanalyse National AdvisoryCommitteeonDrugs(NACD) primary objectiveistoimplement“TheNationalDrugsStrategy2001-2008:BuildingonExperience”. representatives from relevant governmentdepartments,voluntaryandcommunitysectors.Their National DrugsStrategyTeam (NDST) Treatment, andResearch. Furtherinformation canbeobtainedatwww.drugsinfo.ie/nds.htm and Agenciesinvolvedindrugspolicyunderthefourpillarsof;SupplyReduction,Prevention, prevention, treatment andresearch”. TheStrategyassignsresponsibility tothedifferent Departments to individualsandsocietybythemisuseofdrugsthrough aconcertedfocusonsupplyreduction, Glossary ofTerms National DrugsStrategy This termrefers totheproportion ofapopulationwhohaveuseddrugoverparticular The principalfeature ofharm reduction istheacceptanceoffactthatsomedrug This termisusedinthereport tocharacterisealevelofdrugusedefinedas This termisusedinthereport tocharacterisealevelofdrugusedefinedas The overallaimofthestrategyis“tosignificantlyreduce theharmcaused This termisusedinthereport tocharacterisealevelofalcoholusedefined The NationalDrugsStrategyTeam (NDST)comprisesof B&B accommodationisthetermusedtodescribe The NACDwasestablishedinJuly2000underthe The European Monitoring NACD 2005 Drug Use Among the Homeless Population in Ireland 13 n was nd relatives . More specifically, the study focused on obtaining; specifically, . More 1 (National Drugs Strategy 2001-2008: 123. Dept. Tourism, Sport & Recreation) Dept. Tourism, (National Drugs Strategy 2001-2008: 123. The adequacy of services provided for homeless drug users and suggestions for improvement; for homeless drug The adequacy of services provided for homeless drug users, and examples of service provision and successes regarding Problems good practice. The perceived capacity of the organisation to work with homeless drug users; capacity of the organisation The perceived drug users; in working with homeless The experiences of staff for homeless drug users; service provision The issues surrounding to drug use and have in relation providers of knowledge and training homeless service The degree to homelessness; have in relation drug service providers The extent and context of drug-related risk behaviour among the homeless population; risk behaviour The extent and context of drug-related and The needs of homeless drug users and the barriers they encounter in accessing homeless services. drug treatment Policies concerning homeless drug users; The relationship between homelessness and drug use with emphasis on the extent to which drug between homelessness and drug use with emphasis on the extent to which The relationship extent to which homelessness contributes to, and use contributes to homelessness and the exacerbates, drug use; population in Dublin, Cork, Limerick and and extent of drug use among the homeless The nature used by age, gender and accommodation type; types of drug in particular, Galway, or sleeping rough. For the purpose of target locations outside of Dublin (i.e., Cork, Galway and Limerick), a broader definitio Limerick), a broader locations outside of Dublin (i.e., Cork, Galway and For the purpose of target or sleeping rough. employed to include transitional housing or long-term supported housing. To carry out studies on drug misuse amongst the at-risk groups identified e.g. travellers, drug misuse amongst the at-risk groups carry out studies on To of data on these groups. homeless, early school leavers etc. including desegregation prostitutes, by drug misuse and those involved in most affected It is essential that the individuals and groups statistical have immediate access to relevant drug misuse and prevent treat working to reduce, information (Action 98). 1 buildings etc.), staying with friends a B&B, squat (e.g., derelict to those living in either a hostel/shelter, Homeless refers ■ ■ ■ ■ ■ ■ ■ ■ on: homeless and drug service providers Qualitative data from ■ ■ ■ Research Objectives Research of drug use among people extent and context the nature, The overall aim of this study was to assess homeless in Ireland who are population on: Quantitative data among the homeless The National Advisory Committee on Drugs (NACD) advises the Government in relation to the Government in relation Committee on Drugs (NACD) advises the The National Advisory drug use in Ireland, of problem and consequences treatment/rehabilitation prevention, prevalence, asked the and information. The National Drugs Strategy findings of research based on its analysis programme: the following action within its research NACD to accommodate the Research in November 2002 the NACD commissioned open tender, following Consequently, extent and context study on the nature, to carry out a research Quay Ireland Department of Merchants homelessness in Ireland. of drug use among people experiencing Introduction to the Study Introduction Executive Summary Executive 14 Drug Use Among the Homeless Population in Ireland NACD 2005 2. 1. above objectives,datawere collectedbyemployingthefollowingdatacollectionmeasures. The research studyemployedbothquantitativeandqualitative methodologies.Inorder toachievethe Research Methodology Executive Summary co-ordinated andfacilitatedby theResearch Officers atMerchants QuayIreland. settlement services,drugfree services,servicesforunder-18s etc.).Thefocusgroups were (e.g. lowthreshold services/openaccessservices,accommodationprescribing services, (Cork, GalwayandLimerick).Eachfocusgroup represented adifferent aspectofserviceprovision were undertakenwithinDublinandtwofocusgroups were undertakenineachoftheothercities conducted withapurposivesampleof64homelessanddrugserviceproviders. Eightfocusgroups Focus Groups withServiceProviders: DuringJulyandAugust 2003,fourteenfocusgroups were provision ofhomelessservices,inorder toensure confidentialityofinformationreceived. and understandingoftheissuesinvolved.Nonefieldworkerswere directly involvedinthe and trainedforthepurposeofquantitativedatacollection.Allfieldworkershadpriorknowledge to 355homelesspersonsduringtheperiodJuneOctober2003.Ninefieldworkerswere recruited Survey Questionnaire Administered toHomelessPersons:Asurveyquestionnaire wasadministered ■ ■ ■ ■ Drug AbuseScreening Test (DAST)–aten-pointscale,whichisusedtoidentifyproblematic - use scales: and current useofvariousdrugclassifications.Thiswascomplementedbythefollowing The drugcomponentofthequestionnaire followedtheEMCDDAtemplateoflifetime,recent harmful consumption(Saunders designed toscreen forarangeofdrinkingproblems andin particularforhazardous and Disorders IdentificationTest Screening Instrument)whichisaten-itemscreening instrument Problematic alcoholusewas measured bytheemploymentofAUDIT(TheAlcoholUse self-assessment ofcurrent needsandservicedelivery. drug andalcoholuse,riskbehaviours,contactwithservices(homeless,generic) accommodation types,experiencesofhomelessness,health(physicalandpsychiatric),income, The surveyquestionnaire elicitedinformationonbasicidentifiers/personalcharacteristics, provision forhomelessdrugusers. procedures, examplesofgoodpracticeandfinallystrengths andweaknessesinservice information onorganisations, serviceusers’characteristicsandcircumstances, policies, The interviewscheduleforthefocusgroups consistedoffourmainsections:background SeverityofDependenceScale(SDS)–afive-itemscaledesignedtomeasure thedegree of - drug use; methadone. dependence onavarietyofdrugs,includingheroin, cocaine,amphetamines,and et al., 1993). NACD 2005 Drug Use Among the Homeless Population in Ireland 15 Executive Summary Executive Over half of the total study population reported previous experience of imprisonment. Analysis previous Over half of the total study population reported having been in prison than likely to report more significantly were that male respondents revealed their female counterparts. The largest proportion of individuals in the Dublin sample reported their last permanent address as their last permanent address of individuals in the Dublin sample reported proportion The largest D.7; 14%), and being in the South Dublin suburbs (D.22 & D.24; 17%), the North Inner City (D.1 & last their reported (n=16) of respondents the South Inner City (D.2 & D.8; 14%). Seven percent UK. as being in the known address Only 6% of the Respondents demonstrated low educational attainment and poor economic status. higher education and a further minority of the having reached overall study population reported dependent were or occasional). The majority of respondents in employment (regular sample were on government benefits. The majority of the total study population (89%) were Irish with the remaining 11% largely Irish with the remaining (89%) were The majority of the total study population Scotland. England, and Northern Ireland, comprising of individuals from themselves as single (78%). Only 10% of the study identified The majority of respondents living alone with children half were (under 18 years), of whom living with children population were in their accommodation. The mean age of respondents was 35 years. Over a quarter of the sample was less than 25 years of was 35 years. Over a quarter of the sample The mean age of respondents employed). age (*dictated by sampling methodologies the most common homeless sleeping (16%) were Hostel (50%), B&B (19%) and rough methodologies employed). accommodation types (*dictated by sampling Of those interviewed (n=355), 69% (n=244) were male and the remaining 31% (n=111) were female 31% (n=111) were male and the remaining were Of those interviewed (n=355), 69% (n=244) (*dictated by sampling methodologies employed). Nature, Extent and Context of Drug Use among the Nature, Homeless Population extent and context of drug use among nature, an overview of the The following summary provides to to some of the main findings relating in addition those experiencing homelessness in Ireland, to refers to drug use. The information presented health, policy and service responses risk behaviour, of the homeless population (n=355) and homeless and drug service members data collected from (n=64). providers ■ ■ ■ ■ ■ ■ ■ ■ Homeless Population – Profile of Research Participants of Research – Profile Homeless Population in the survey questionnaire to participate experiencing homelessness agreed A total of 355 individuals the Dublin from the majority were with the tender specifications, In accordance element of the study. Cork, from participants (n=108; 30%) recruited (n=247; 70%), with the remaining homeless population sampling methods employed, In view of the differing Galway and Limerick, 36 individuals respectively. not comparable are age, accommodation type) population (gender, demographics of the research as follows; of the study can be presented the overall participant profile However, locations. across Summary of Research Findings Research Summary of 16 Drug Use Among the Homeless Population in Ireland NACD 2005 Executive Summary ■ ■ ■ ■ ■ ■ ■ Prevalence ■ ■ Homelessness andDrugUse ■ ■ ■ consistent withintheDublinsample. sleeping rough thanamongeitherhosteldwellersorB&Boccupants. Thisfindingwasalso Higher ratesofcurrent heroin (34%),cocaine(25%)andcrackuse(7%)were foundamongthose two thirds (n=44;69%)ofB&Bresidents were current illicitdrugusers. Nearly one-in-twohosteldwellersinDublinreported current useofanillicitdrug(48%),whileover higher amongB&Boccupantsthanwasobservedhostel dwellersorrough sleepers. (n=67; 19%)andtranquillisers(n=58;16%).Useof andanti-depressants were also A quarterreported current useofsedatives(n=90;25%), almostafifthreported anti-depressants very limitedcurrent useinGalwayandLimericknoamongtheCorksample. current heroin prevalence rateamongtheDublinhomelesssample.Thisisincomparison toonly Dublin hadthehighestpercentage ofcurrent illicitdrug users(59%).Findingsrevealed a30% the useoffivedrugsormore (26%). represents 17%oftheDublinhomelesssample.Overaquarterrough sleepersreported The majorityofcurrent drugusersreported useofmore thanonedrug(72%).Overall, this a quarterare currently usingheroin (22%). Cannabis istheprimaryillicitdrugofcurrent useamongthehomelesspopulation(43%).Almost was themostreported lifetimedrug(69%). Nearly three-in-four homeless individualsreported lifetimeuseofanillicitdrug(74%).Cannabis rough-sleeping samplewere problematic alcoholusers(52%). frequency ofalcoholconsumption intermsofuseexcess4timesaweek.Overhalfthe In termsofaccommodationtype,thosestayinginsquatsandsleepingrough reported ahigher becoming partofmore complexdrugusingrepertoires. in eachcitylocation.However, serviceproviders havenoticedarecent change,withalcoholuse Service providers similarlyperceived alcoholtobethemaindrugofuseamonghomelesspeople those whoreported alcohol use inexcessoffourtimesaweekwere older. consumption inexcessoffourtimesaweekcomparisontofemalerespondents. Furthermore, alcohol consumptionvariedbygenderandage.Agreater proportion ofmalesreported alcohol Alcohol remains theprimarydrugofchoiceamonghomelesspopulation(70%).Frequency of (15 v24years). (87%). Thosethatuseddrugsbefore becominghomelessreported ayoungerageoffirstdruguse The majorityofthoseexperiencinghomelessnessfirstuseddrugsbefore becominghomeless comparison to11%inbothDublinandCork. for becominghomelesswashigherinLimerickandGalway(22%17%respectively) in homeless. Thirteenpercent reported personalalcoholuse(n=44).Alcoholasaprimaryreason Personal druguse(n=67;19%)wascitedasthesecondmostcommonreason forbecoming NACD 2005 Drug Use Among the Homeless Population in Ireland 17 Executive Summary Executive Almost half of respondents reported that they usually inject alone (46%). Males were significantly that they usually inject alone (46%). Males were reported Almost half of respondents likely to inject alone than their female counterparts. more within the difficulty not experiencing an injecting related injectors reported Only 26% of current site was the most commonly reported months. Scarring and bruising of the injecting last three abscesses or infections of the site (32%), while one reported (71%). Almost one-in-three difficulty months prior to interview (20%). in the three accidental overdose injectors reported in five current not having experienced any difficulties. likely to report significantly more Male injectors were Over a third of the total study population reported having ever injected (35%) increasing to almost to having ever injected (35%) increasing population reported of the total study Over a third of the total study population reported half within the Dublin sample (46%). Nineteen percent the Dublin sample (27%). The majority from in the last month, all of whom were injecting heroin daily users (52%). users were heroin of current likely to report more Males were injectors. street injectors were of current Fifty-four percent injecting in public than their female counterparts. Changes in drug using patterns as a result of becoming homeless were reported by over three- reported of becoming homeless were Changes in drug using patterns as a result in primary drug and users (77%). Initiation into drug use (for a minority), changes in-four current and associated lifestyle behaviour changes frequency/quantity, of administration, increased routes cited. were Thirty percent of the Dublin sample indicated a high degree of psychological dependence on the of the Dublin sample indicated a high degree Thirty percent the highest level of dependence (36%) within the total used. B&B occupants scored drugs currently sleepers (30%). study population, followed closely by rough Over a third of respondents (36%) were problematic drug users. There was a much higher There drug users. problematic (36%) were of respondents Over a third v 19%). to outside Dublin (43% drug users found within Dublin compared of problematic proportion their first homeless likely to be younger and report significantly more drug users were Problematic and the overall drug-using counterparts episode at a younger age than their non-problematic study population. Over half those staying in hostels (55%) and sleeping rough (52%) were found to be problematic (52%) were sleeping rough Over half those staying in hostels (55%) and drinkers. problematic were residents drinkers, while almost two-fifths (39%) of B&B 20 or above on the sleeping population (32%) scored the hostel dwelling sample and rough of A third warrants further diagnostic evaluation for alcohol dependence. instrument which alcohol screening Among those who consumed alcohol, 73% were problematic drinkers, which represents 51% of the drinkers, which represents problematic alcohol, 73% were Among those who consumed their alcohol use than a higher level of problematic reported total population. Male respondents female counterparts (76% v 63%). Less than a fifth of the total study population reported current methadone use (18%) and over current total study population reported Less than a fifth of the methadone use was found among it. No current not prescribed were a quarter of them (28%) outside of Dublin. homeless individuals ■ ■ ■ ■ Risk Behaviour ■ ■ ■ ■ ■ ■ Problematic and Dependent Use Problematic ■ ■ 18 Drug Use Among the Homeless Population in Ireland NACD 2005 Executive Summary Psychiatric HealthandWell-Being ■ ■ ■ ■ ■ ■ ■ Physical Health ■ ■ ■ ■ ■ ■ Results foundthatmore hosteldwellersreported havingeverundergone apsychiatricassessment were proportionally more likelytoreport prescribed medicationthantheirmalecounterparts. Prescribed medicationwasthemostcommonpsychiatrictreatment cited.Femalerespondents counterparts (50%vs.40%). more likelytoreport psychiatrichealthconcernsthantheirnon-problematic drugusing non-problematic counterparts.Whilenotsignificant,problematic druguserswere proportionally Problematic drinkerswere significantlymore likelytoreport havingpsychiatricconcernsthantheir psychiatric illness(n=30%). less thanathird havebeenadmitted toapsychiatrichospital(n=30%),ordiagnosedwith Less thanhalfoftherespondents reported havingundergone apsychiatricassessment (42%),while Nearly one-in-twoofthestudypopulationreported havingconcernsabouttheirpsychiatric health. report acurrent medicalcard (51%v64%). Problematic druguserswere proportionally lesslikelythanmembersofthestudypopulation to physical healthcomplaintsthanproblematic rough sleepersorhosteldwellers. Problematic drugusersstayinginB&Baccommodationreported ahighermeannumberof 5 ormore complaintsincomparisontooveraquarterofthetotalstudypopulation(37%v28%). observed (mean;5v3complaints).Overathird ofproblematic drugusersreported suffering from was foundamongthetotalstudypopulation.Ahighermeannumberofcomplaintsalso Problematic drugusersreported higherratesforthemajorityofphysicalhealthcomplaintsthan study population(62%v43%). Problematic drugusersreported higherlevelsofdentalcomplaintsthanmembersthetotal complaints. Headaches, bonesandjointproblems anddentalissueswere themostcommonlycitedphysical hepatitis Cpositive. study population.Individualswhohadeverinjectedwere alsosignificantlymore likelytobe Over halfofproblematic druguserswere hepatitisCpositive (51%)compared to23%ofthetotal received thehepatitisBvaccinationthantheirmalecounterparts(48%v36%). homeless population(69%v40%).Femalerespondents were proportionally more likelytohave Higher ratesofhepatitisBvaccinationwere foundamongproblematic drugusersthanthetotal a result ofhomelessness. Over twothirds ofcurrent injectors(69%)reported thattheirinjectingpracticeshadchangedas injecting equipmentratherthanborrowing others’equipment. borrowing were lowerat17%.Injectorswere significantlymore likelytoreport lendingused weeks (53%).Almostone-in-fourreported lendinginjectingequipment(23%)whileratesfor Over one-in-twocurrent injectorsreported sharinginjectingparaphernaliaintheprevious four NACD 2005 Drug Use Among the Homeless Population in Ireland 19 Executive Summary Executive The general perception among service providers was that homeless services do not adequately among service providers The general perception lack of meet the needs of homeless drugs users. Barriers faced by homeless services included experience and the negative attitude of some drug issues, lack of knowledge and training around Many of the challenges faced by homeless service providers working with homeless drug users Many of the challenges faced by homeless service providers able to deal with a number of issues drug use, being included detecting and recognising of homeless drug users, fear of dealing with their own preconceptions addressing simultaneously, their and client safety and motivating drug users to address staff protecting death by overdose, drug use. Few of the homeless services interviewed had official policies on illicit drug use, possession and Few of the homeless services interviewed had official but dealing. All agencies interviewed did not allow drug use or drug dealing on the premises flexible. more incidents were drug-related policies around There were high levels of contact with emergency accommodation, drop-in centres and food centres accommodation, drop-in high levels of contact with emergency were There a homeless service was cited by very few users from services. The absence of drug or alcohol attended a as a factor influencing whether respondents (3% and 1% respectively) respondents particular service or not. drug would indicate that problematic to contact with homeless services, the results In relation accessing likely to have problems more drinkers, were problematic users, and to a lesser degree the total to access to homeless services compared to be refused likely homeless services and more homeless population. Staff awareness of respondents’ drug using status was lower than awareness relating to their relating was lower than awareness drug using status of respondents’ awareness Staff of current a third alcohol status in all city locations, with the exception of Cork. Almost current accessing such services due difficulties accommodation reported drug users staying in emergency with being a drug user was the most commonly to their drug use (30%). The stigma associated cited difficulty. Providers of emergency accommodation (with the exception of wet hostels/shelters) reported the of wet hostels/shelters) reported accommodation (with the exception of emergency Providers flexible to accommodate for individual policies were operation of a ‘no drink policy’ however most use on premises. alcohol to be less flexible around perceived were cases. B&B service providers likely be excluded for violent or disorderly that individuals would more reported Service providers behaviour rather than use per se. The majority of drinkers staying in emergency accommodation reported that staff were aware aware were that staff accommodation reported The majority of drinkers staying in emergency in accessing emergency difficulties reporting of their alcohol use (70%), with only one fifth as a result often the behaviour, cited suggest that it is more accommodation (20%). Difficulties in accessing practice itself, which can cause problems of consumption, rather than the drinking accommodation. emergency or have being admitted to a psychiatric hospital. This was consistent for the total study and to a psychiatric hospital. This was consistent or have being admitted hostel dwellers and rough B&B occupants exceeded However, drug using population. problematic diagnosed with a psychiatric illness. sleepers in terms of ever ■ ■ ■ ■ ■ ■ ■ ■ Service Provision for Homeless Drug Users for Homeless Service Provision Homeless Services 20 Drug Use Among the Homeless Population in Ireland NACD 2005 Executive Summary ■ ■ ■ Drug Services ■ ■ ■ homeless drug users were oftensetuptofail. programmes often didnotsuithomelessdrug users.Furthermore, thelack ofaftercare meantthat drug treatment puthomelesspeopleatriskandtheroutine andstructure oftreatment there were notenoughdetox andresidential places, the delaybetweeninitialassessmentand having toattendmethadoneclinics daily. Inrelation totreatment, drugservice providers feltthat waiting lists,keepingappointments, harshsanctioningforfailingurinalysisandtheproblems in users hadinaccessingmethadonemaintenancetreatment includedlackofpermanentaddress, serious gapsinserviceprovision. According todrugserviceproviders, difficulties homelessdrug absence ofneedleexchangesintheeveningandatweekends inDublinwere highlighted asother under-resourced andshort-staffed. ThelackofneedleexchangesinGalwayandLimerick the According toserviceproviders thequalityofservicesoffered tohomelessdruguserswasoften found itfrustrating. those workingwithintheconfinesofanabstinence-orientedmodel (mainlyinCorkandGalway) trying tomeettheirmultipleneeds,engagingwiththosewho didnotwanttogiveupdrugs,while The mainchallengesdrugserviceproviders reported inworkingwithhomelessdruguserswas with homelessclients. During thefocusgroups, no drugservicesinterviewedreported havingapolicyonhowtodeal months, representing 17%ofthetotalhomelesspopulation. percent ofcurrent injectorswere incontactwithaneedleexchangewithinthepreceding three relatively highlyreported byone-in-twoofthosewhoreported drugservicecontact.Eighty-five previous three months(36%).Contactwithdrop-in centres andmethadonetreatment serviceswere Just overathird ofthehomeless populationreported contactwithadrugservicewithinthe way houses. housing, long-termstableaccommodation(through localauthoritiesandprivaterented) andhalf move-on accommodationfordrugusersinemergency accommodation,additionaltransitional the feasibilityofasafeinjectingroom; provision ofarangeaccommodationoptionsincluding development ofacontinuumcare andsettlementplanforhomelessdrugusers;explorationof that servicescouldbedevelopedinthefollowingways:increases inresources andfunding; remaining flexibleandpromoting multi-disciplinarywork.Serviceproviders alsorecommended which couldbebuilton,includedfocusingonindividuals’behaviourratherthandruguse, According tohomelessserviceproviders, successfulways ofengagingwithhomelessdrugusers, appropriate harmreduction services. to accommodation.Moreover, theyemphasisedthatanyspecialistserviceneededtoprovide that specialistserviceswere themostappropriate forhomelessdrugusers,particularlyinrelation ex-user wishingtosustainadrugfree lifestyle.Themajorityofserviceproviders interviewedfelt Reference wasoftenmadetovarioushomelessserviceenvironments notbeingconducivetoan emergency accommodation. quality oftheseservicesforhomelessdrugusersandhighlightedthelackmove-onoptionsfrom targeted athomelessdrugusers.Inrelation toaccommodation, serviceproviders questionedthe an abstinence-orientedratherthanharmreduction approach andnodayservicespecifically staff towards drugusers,lackofresources andfundingrestrictions, alienatingclientsbyadopting NACD 2005 Drug Use Among the Homeless Population in Ireland 21 Executive Summary Executive Stable accommodation was reported as the primary service need among respondents (86%). One- respondents as the primary service need among Stable accommodation was reported to 28% as a service need (24%), increasing drug or alcohol treatment reported in-four respondents drug/alcohol requiring sleepers (29%) reported of rough within the Dublin sample. Higher numbers than hostel dwellers or B&B occupants (23% respectively). treatment Despite high levels of contact with GPs, hospital clinics, and A&E departments, almost one-in- Despite high levels of contact with GPs, hospital of those who as a service need. Over a third health care individuals reported homeless three drug users (n = 75, 37%). problematic contact with GPs were reported Drug service providers recommended the need for sufficient funding and appropriately trained funding and appropriately need for sufficient the recommended Drug service providers in Dublin drug users. Some service providers to meet the needs of homeless in order staff Limerick felt needle while those in Galway and for a safe injecting room highlighted the need advocated Service providers locations in these areas. piloted in different exchanges should be structured, should be flexible, less programmes and treatment that methadone maintenance to access accommodation. Some service and assist homeless drug users take a holistic approach for homeless drug users as well care a need for respite in Cork and Dublin expressed providers employment and social support. retraining, housing, addressing as aftercare Conclusions extent and context of drug use examines the nature, This is the first Irish study undertaken which complex highlights that the causes of homelessness are among the homeless population. This study drug use was initiated societal/structural factors. For many, and include both individual/personal and of their homeless as a feature drug use emerged minority, prior to becoming homeless, while for the the complexity of the relationship that drug use causes homelessness, reduces argue To predicament. with no intervening variables. High levels of licit process and effect a cause and simplifies it to merely among the homeless population with regional reported (including alcohol) and illicit drug use were drug of choice among the current use patterns and experiences. Alcohol remains in drug differences the of use. Moreover, the highest frequency the homeless population, with older males reporting use among the homeless population is supports the hypothesis that the extent of illicit drug research commonly used substantially higher than it is among the general Irish population. Cannabis is the most to the Dublin Area. illicit drug. The use of opiates among the homeless population was mainly confined housing among drug the importance of lifestyle factors, i.e. appropriate has highlighted This research in The circumstances users and the impact of their housing arrangements in patterns of risk behaviour. over and above those of which drug use and drug injecting among the homeless took place were and other public places was increasingly personal choice or motivation. Injecting drugs in the streets interviewed. common among homeless injectors and was often the only viable option for those to a worsening drugs situation. The issue is not that people start to Homelessness was clearly related ‘risky’. In terms of risk use when they become homeless but their practices and behaviour become more complicating and exacerbating one clearly interrelated, drug use and homelessness are behaviour, likely to involve more The social context of injecting practices among the homeless was also another. injecting with others, either with their contact with other injectors. Over half of injectors reported injecting themselves, and as such, were less likely to report Female injectors were partner or in a group. communal injecting practices. Homeless injectors exhibited likely than male injectors to report more ■ Service Needs ■ ■ 22 Drug Use Among the Homeless Population in Ireland NACD 2005 Executive Summary 1. Policy Implications development inorder thatservicesdeveloptomeettheneedsofhomelessdrugusers. met byexistingservices.Thefollowingpointsoutlineanumberofimplicationsforpolicyandservice substantiate thathomelessdrugusershavenumerous complexneedsthatare notbeingsufficiently use. Surveydatafrom thoseexperiencinghomelessnessandinformationfrom serviceproviders where accessinghepatitisCtreatment canbeonerous forindividualsintermsofstabilisingtheirdrug users whowere currently receiving treatment forhepatitisC(11%)mustbeseenwithintheacontext problematic drugusersreporting apositivehepatitisCstatus.Thelownumbersofproblematic drug have demonstratedtheimplicationsforindividualriskbehaviourandhealthconcernswithoverhalfof sharing” ofinjectingequipmentandparaphernaliawasobviousfrom individualquotes.Such activities borrowing ofusedinjectingequipmentandthesharingparaphernalia.The“situational extremely highlevelsofinjectingriskbehaviour(i.e.withinlastthree months),mostnotablythe 4. 3. 2. care andplanninginorder tomeettheneedsofhomeless drugusers. forces. Furthermore, homelessanddrugservicesshouldworktogethertoimplementintegrated plans, whilehomelessservicesshouldbeencouragedtoparticipateinlocal/regional drugtask in Dublin).Supportshouldbegiventolocaldrugservicesinputtingintohomelessaction Strategy Team hasbeenappointedtotheexpandedConsultativeForumofHomelessAgency sharing havebegunbutrequire furtherconsolidation(e.g. arepresentative oftheNationalDrug working withdrugusinghomelessindividuals.Activitiesrelating toco-operationandinformation strategic andpartnershipapproach withclearlinesofresponsibility andaccountabilityforthose regarding where theresponsibility forthisclientgroup lies.Itisimportanttoensure amore Results conveythatafeature ofexistingserviceresponses hasbeenthelackofawareness homeless servicesandjointworkingrelationships betweenstatutoryandnon-statutoryagencies. The findingsofthestudyhighlightthatthere are issuesregarding co-ordination ofdrugand effective inretaining individualsandlinking themintoappropriate aftercare networks.Itis It isimportantthathomelessdrug userscannotonlyaccesstreatment, butthatthetreatment is peer educationandcommunity changeprogrammes forhomeless drugusers. coverage ofdrugserviceswithin homelessservices(includingdrugoutreach projects) and tailored assessment andentrytotreatment, accessibleprogrammes withfewerdemands,increased support, flexibleprescribing options,eliminationofwaitinglistsandtimeintervalsbetween more targeted treatment practicesforthisclientgroup, suchas;care plannedcounsellingand of drugtreatment forhomelesspersonsinIreland. Thiscouldbeachievedbythedevelopmentof management ofdrugservices.Itisimportanttoincrease theavailability, capacity andeffectiveness The issueofhomelessnessamongdrugusershasimplications forcurrent deliveryand and toensure thatallhomeless serviceproviders receive drugawareness training. and alcoholfree environments), lowthreshold drugservices,strategiestodealwithdualdiagnosis of care, arangeofaccommodationoptions(rangingfrom harmreduction servicesthrough todrug responses facilitatehomeless individualswhousedrugsbyproviding thefollowing;acontinuum Homeless drugusersdo,andwill,accesshomelessservices.Itisimportantthatservice them from someoftheirservices.Druguseisnotsolelyanissuefordrugserviceproviders. It isimportantthathomelessservicestakeaninclusiveapproach todrugusersratherthanexclude NACD 2005 Drug Use Among the Homeless Population in Ireland 23 Executive Summary Executive important to approach the treatment of homeless people in a multi-disciplinary, holistic, flexible, homeless people in a multi-disciplinary, of the treatment important to approach of with the process services for homeless people would help Pre-treatment non-judgmental way. support of the individual, offering determining the readiness by engaging in drug treatment drug use and sustaining motivation. stabilising/reducing entry criteria, meeting treatment around motivational be enhanced through could in treatment of the client group retention Increased to encourage practical measures intensive ongoing support, as well as interventions and active importance on is a need to place greater there Furthermore, attendance and engagement. and housing needs assessment should be an integral part practices and follow-up care, discharge process. of the treatment of drug risky style and more to a different predisposed people are homelessness prevails, Where to reduce the general drug using population. Measures use than would be commonplace among needle exchange coverage for following; increased harmful consequences could include the workers, mobile services etc.), strategically placed homeless injectors (e.g. pharmacies, outreach polydrug use, services), educational strategy regarding sharps bins (in public places and homeless injecting facility. of a supervised houses and provision respite should be understood to include all substances both licit and illicit. Given the Harm reduction strategy for alcohol harm reduction of homeless drug users, it is important that a targeted profile may be As with drug use, abstinence members of the homeless population is promoted. and in such cases, it is necessary to implement strategies unacceptable as a goal for the individual harm. alcohol-related which focus on moderation in use and reducing 5. 6. 24 Drug Use Among the Homeless Population in Ireland NACD 2005 nature ofthisassociationisuncertainandunder-researched. homelessness. Internationalresearch indicatesthathomelessness anddruguseare connected,yetthe confirmed through research findingsandvariouspolicystatementsintheareas ofbothdrugsand accommodation andare vulnerable tobecominghomeless.Thisassociationhasbeenfurther providers havebeenaware thatmanyoftheirclientsare currently homelessorare livingininsecure realised thatincreasing numbersofpeopleusingtheirservicesare drugusers.Similarly drugservice recognition ofsomedegree ofoverlapbetweenthetwoproblems: homelessserviceproviders have viewed aseitheracriminalmatterorpublichealthissue.Recently, there hasbeenincreased Homelessness hastraditionallybeenseenprimarilyasahousingproblem whiledrugusehasbeen To date,homelessnessanddrugusehaveoftenbeentreated astwoseparatesocialissues. health issues(Gill 2003; FountainandHowes,2001;CostelloHowley, 1999;CoxandLawless,1999)mental groups oftenpresent withcomplexneedsaswellhigh levelsofdrug/alcoholuse(Wincup Introduction Chapter One NACD toaccommodatethefollowingactionwithinitsresearch programme: based onitsanalysisofresearch findingsandinformation. TheNationalDrugsStrategyaskedthe prevalence, prevention, treatment/rehabilitation andconsequencesofproblem druguseinIreland, The NationalAdvisoryCommitteeonDrugs(NACD)advisestheGovernmentinrelation tothe 1.2 Introduction totheStudy (Jones, 1999)andayounger, more heterogeneous, group ofindividuals(Warnes international research refers toapopulationincreasingly madeupofagreater proportion ofwomen The homelesspopulationcannotbeclassifiedasahomogeneousgroup (Neale,1997a).Nationaland 1.1 Background totheStudy As definedinthe tender andproject objectives documents. 2 ■ Quantitative dataamongthe homelesspopulationon: homeless populationinIreland. More specifically, thestudyfocusedonobtaining: The overallaimofthisstudywastoassessthenature, extentandcontextofdruguseamongthe 1.3 Research AimsandObjectives of druguseamongthehomelesspopulationinIreland. Department ofMerchants Quay Ireland tocarryoutaresearch studyonthenature, extentandcontext Consequently, followingopentender, in November2002theNACDcommissionedResearch information (Action98). working toreduce, treat andprevent drugmisusehaveimmediateaccesstorelevant statistical It isessentialthattheindividualsandgroups mostaffected bydrugmisuseandthoseinvolvedin prostitutes, homeless,early school leaversetc.,includingdesegregation ofdataonthesegroups. To carryoutstudiesondrugmisuseamongsttheat-riskgroups identifiede.g.travellers, exacerbates, drug use; use contributes tohomelessnessandtheextent towhichhomelessnesscontributes to,and The relationship betweenhomelessnessanddrugusewith emphasis ontheextenttowhichdrug (National DrugStrategy2001-2008:123.DepartmentofTourism, SportandRecreation) et al., 1996; ClearyandPrizeman,1998;Crowley, 2003). 2 et al., 2003). These et al., NACD 2005 Drug Use Among the Homeless Population in Ireland 25 Introduction Chapter 1 Chapter . For the purpose of target 3 locations outside of Dublin (i.e., Cork, Galway and Limerick), a broader definition was employed to locations outside of Dublin (i.e., Cork, Galway and Limerick), a broader include transitional housing or long-term supported housing. “drug use” – refers to the use of any licit (including alcohol) or illicit substance, which is consumed to the use of any licit (including “drug use” – refers medication unless otherwise specifically stated. or non-prescribed as prescribed B&B, squat (e.g., derelict “homelessness” – this term includes those living in either a hostel/shelter, or sleeping rough buildings etc.), staying with friends and relatives Problems and successes regarding service provision for homeless drug users, and examples of for homeless drug users, and service provision and successes regarding Problems good practice. The issues surrounding service provision for homeless drug users; service provision The issues surrounding to drug use and have in relation of knowledge and training homeless service providers The degree to homelessness; have in relation drug service providers for homeless drug users and suggestions for improvement; The adequacy of services provided Policies concerning homeless drug users; drug users; to work with homeless capacity of the organisation The perceived in working with homeless drug users; The experiences of staff The extent and context of drug-related risk behaviour among the homeless population; risk behaviour among the homeless of drug-related The extent and context in accessing homeless and drug users and the barriers they encounter The needs of homeless services. drug treatment The nature and extent of drug use among the homeless population in Dublin, Cork, Limerick and use among the homeless population in Dublin, and extent of drug The nature accommodation type; types of drugs used by age, gender and Galway; in particular 3 1999, 2002. The definition of “homelessness” employed for Dublin was based on the HA/ESRI assessments of homelessness The following Report outlines the nature, extent and context of drug use among the homeless The following Report outlines the nature, population in Ireland. of homelessness and in the area examines both national and international literature Chapter Two of the population group, on the profile literature of drug use. This chapter will also include a review will of homeless drug users. The review problems and the multiple and inter-related figures prevalence with defining and measuring exists, the difficulties body of research highlight that while a theoretical in the area. in a lack of empirical studies homelessness has resulted 1.5 The Report For the purpose of this study, the terms “drug use” and “homelessness” will be defined as; For the purpose of this study, ■ ■ ■ 1.4 Key Definitions ■ ■ ■ Qualitative data from homeless and drug service providers on: homeless and drug service providers Qualitative data from ■ ■ ■ ■ ■ ■ 26 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter 1 various evidence-basedconclusionsandpolicyimplications. The ReportconcludeswithChapterNinewhichprovides asummaryofthemainfindingsandpresents homeless drugusersisillustratedinChapterEight. health statusisexaminedwithinChapterSeven.Finally, datarelating totheserviceprovision for drug-using patternsandpracticesare discussedinChapterSix.Informationonriskbehaviour and participated intheresearch project. ChapterFivefocusesonalcoholpracticesofrespondents while data are presented throughout thesechapters.ChapterFouroutlinestheprofile ofthosewho Chapters FourtoEightillustratethefindingsofresearch study. Bothqualitativeandquantitative different samplingmethods,datamanagementandanalysistechniquesemployed. negotiation andaccessare alsocovered withinthischapter inadditiontodetailsrelating tothe design andimplementationofresearch instrumentsused inthestudyare discussed.Siteselection, Chapter Three outlinestheresearch methodsemployedinachievingtheobjectivesofstudy. The Introduction NACD 2005 Drug Use Among the Homeless Population in Ireland 27 dation . Collins and McKeown 5 4 people who have housing but are likely to become homeless because of economic difficulties or likely to become homeless because of economic difficulties people who have housing but are (1997) argue, however, that there are a number of problems with the a number of problems are that there however, (1997) argue, 2002:51-52). It is particularly difficult to obtain an accurate picture of the picture to obtain an accurate 2002:51-52). It is particularly difficult et al. people who are staying with relatives or friends because of the lack of alternative accommodation or or friends because of the lack of alternative accommodation staying with relatives people who are et al., (Section 2: Irish Housing Act, 1988). . Pleace 6 of the kind referred to in paragraph (a), and he is, in the opinion of the authority, unable to provide accommodation from his accommodation from unable to provide (a), and he is, in the opinion of the authority, to in paragraph of the kind referred own resources” resides with him or who might be reasonably expected to reside with him, can reasonably occupy or remain in occupation of, or occupy or remain with him, can reasonably expected to reside with him or who might be reasonably resides the threat of violence. the threat Hidden Homelessness – accommodation. because of the lack of affordable in institutional care remaining People at Risk of Homelessness – (a) he, together with any other person who normally is no accommodation available which, in the opinion of the authority, there (b) in a hospital, county home, night shelter or other such institution, and is so living because he has no accommo he is living concept of hidden homelessness. Of primary concern is the fact that it can result in all housing needs in all housing concern is the fact that it can result concept of hidden homelessness. Of primary many may live in specialist accommodation Furthermore, to as a form of homelessness. being referred homeless persons. In 2001, Houghton and Hickey pointed that is not labelled as accommodation for by the State as many people experience not be ignored out that those at risk of homelessness should been acknowledged under the Government have recently Those needs homelessness periodically. the risk of have been put in place to reduce Strategy (2002) and a number of measures Preventative to These include allowing people in prison on short sentences homelessness among these groups. prisoners on housing lists, and special accommodation maintain local authority tenancies, including for young people leaving care. provision (1992) argue that this legal definition of homelessness is not well formulated as it can be open to that this legal definition of homelessness is not well formulated as it can be open (1992) argue in of the definition as it excludes the “hidden homeless” (i.e. those living varying interpretations advocates that O’Sullivan (1996) and those at risk of homelessness. Similarly, accommodation) insecure of homelessness (visible, hidden and at risk) should be used when conceptualising categories three homelessness number of people experiencing homelessness as they are highly transient, to a large extent relatively highly transient, to a large number of people experiencing homelessness as they are 2003). to identify (Dublin Simon Community, perspective, difficult a research “hidden”, and from makes The tendency for members of the homeless population to drift in and out of homelessness also issues are of homelessness. There to obtain an accurate estimation of the extent it difficult based. are the accuracy of data upon which estimates of those experiencing homelessness regarding while accounting for the bulk of the made by local authorities, For example, the statutory returns accepted those who have been bureaucratically information on homeless population, only provides the accuracy of these and defined as being homeless (Cox and Lawless, 1999). Furthermore, some local assessments has been disputed in the past by O’Sullivan (1996) who pointed out that despite the existence of homeless services there. no homelessness in their areas authorities reported It has been noted by researchers that the “absence of reliable data on the homeless population that the “absence of reliable It has been noted by researchers of poverty one of the most significant data gaps in our knowledge and understanding represents (Corrigan in Ireland” 2.2 Counting Homelessness 2.2 Counting Homelessness There is no universally agreed definition of homelessness (O’Sullivan, 1996). The definition of of homelessness (O’Sullivan, 1996). The definition is no universally agreed There individuals accommodated Section 2 of the Irish Housing Act 1988 includes homelessness under sleeping rough accommodation and those bed and breakfast hostels, shelters, within emergency family or friends or living in insecure, sharing accommodation with but excludes those involuntarily accommodation (for example, overcrowding) standard inadequate or below Review of Literature Review of Homelessness 2.1 Defining Chapter Two Two Chapter 6 shelters or bed and breakfasts. emergency or living in designated Visible Homelessness – people sleeping rough 45 to Neale (1997a; 1997b). examination of the term “homelessness” refer For a theoretical if – by a housing authority as being homeless for the purposes of the Act “A person shall be regarded 28 Drug Use Among the Homeless Population in Ireland NACD 2005 According tothe2002LocalAuthority AssessmentofSocialHousingNeed,thewaitinglistforsocialhousing stoodat48,413 7 The1999AssessmentofHomelessness undertakenbytheHomeless AgencyandtheESRIalsoincludedcounties Kildare and 8 individuals whiletheremainder reported stayinginemergency orinsecure accommodation. were estimatedtobehomelessin2002,4,060were inDublin. Roughsleepersaccountedfor312 Chapter 2 homeless population The “CountedIn”assessmentsofhomelessness(1999;2002)containsomevitalinformationonthe 2.3.1 HomelessnessinDublin week inMarch 2002 The DepartmentofEnvironment estimatedthat5,581individualswere homelessinIreland duringone 2.3 HomelessnessinIreland it isnonethelessvaluableinproviding someinsightintothenature andextentofhomelessness. and thiscanlargely accountforthevariabilityofresults inthisarea. Whilesuchdatahasitslimitations, (one nightcounts,street surveys,service-baseddesigns,computerisedclient-trackingsystems etc.) Overall, manydifferent methodshavebeenemployedto studyandcountthehomelesspopulation sophistication ofthedataavailablefrom localauthorities”(HousingAccessforAll,2003:20). plan foraddressing homelessness,howeverthere remains “significantdeficienciesintheaccuracyand required, inconjunctionwiththeHealthBoards andvoluntarybodies,todrawupacityorcountylevel Under theGovernment’s IntegratedStrategyonHomelessness(2001)eachlocalauthorityisnow a 36%increase onthestreet countofJune1998(149personssleepingrough). Street countswere also representing a60%increase onthestreet countofDecember1997(125personssleepingrough) and number ofrough sleepersin Dublin citycentre duringoneweekinOctober2000was202, jointly carriedoutbytheSimonCommunity, Focus Ireland andDublinCorporation foundthatthetotal reporting andstreet countswhichare basedonaheadcountofpeoplesleeping out. Astreet count rough sleepers.Themostfrequently usedmethodologies are street surveyswhichare basedonself- Different methodologies,whichare notalwayscomparable,are employedtomeasure thenumberof However, someconcernshavebeenraisedwithit(Corr, 2003c). by homelessservicestorecord serviceuserdetailsandtraceparticipationonanongoingbasis. the HomelessAgencyhasdevelopedaninternet-basedtracking system(‘LINKS’system)whichisused recognisably homelessduringonespecificweek(HoughtonandHickey, 2001:8).To address thisissue assessments havebeendescribedasarathercrudeandsterilemeasure astheyonlyincludethose who were notincontactwith eitherhomelessservicesorthelocalauthority. Therefore, these assessments (HA/ESRI,2002:5).Corr(2003c)highlightedthattheyalsoignore thehiddenhomeless 1999 to312in2002.Howeverthere were variousinconsistencies notedbetweenthe1999and2002 in B&Baccommodation.There wasa13%increase inthenumberofthosesleepingrough from 275in 2002 byalmost15%to1,140(HA/ESRI,2002).Almost90%offamilieswhowere homelesswere staying same in2002,at2,920.Thenumberofchildren infamilieswhowere homelessincreased from 1999to assessment identified2,900adultswhowere homeless,withthefigure remaining approximately the authority duringaone-weekperiodandthoseincontactwithhomelessservice.The1999 ( individuals. Whenhouseholdslivinginunsuitable orunfitaccommodationare includedthisfigure risesto56,000 Wicklow. Cornerstone Review ofLiterature 2003). 7 . Thiscompares to2,501homelessduringthesameperiodin1996.Ofthosewho 8 . Theseassessmentsincludedpersonsregistered ashomeless withalocal NACD 2005 Drug Use Among the Homeless Population in Ireland 29 gh of Review of Literature of Review 2000) while the Local Chapter 2 Chapter et al., 2001). . Fifty-five percent of the . Fifty-five percent 10 et al., April 20th, 2002. . In view of the recent activities in relation to the activities in relation . In view of the recent 13 October 8, 2003. October 2nd, 1999. The Limerick Leader, The Limerick Leader, The Irish Times, . 9 The Limerick Leader, 2003). A recent survey co-ordinated by Dublin Simon, and carried out by survey co-ordinated 2003). A recent et al., . Furthermore, in terms of the issue of youth homelessness, 60 young people presented in terms of the issue of youth homelessness, . Furthermore, 12 . In 2001, Focus Ireland reported a record high of 90 single people on its accommodation a record reported . In 2001, Focus Ireland 11 at High Levels”. 90 People Currently on its Waiting List for Single Accommodation”. on its Waiting 90 People Currently Authority Assessment of Homelessness (2002) recorded 382 homeless persons (Department of recorded Authority Assessment of Homelessness (2002) with hostel headcounts (Williams problems and O’Connor, are 2002c). Even though there Environment, of homelessness. During 1999, 1,094 individuals were 1999) they can also give an indication of levels which was a 40% increase Shelter Cork Simon Emergency admitted on a short-term or crisis basis to that 2000). In 1998, Cork Simon Community recorded year (Cork Simon Community, on the previous 6% of from had increased shelter aged 25 and under the number of persons staying at the emergency period (Frost the total hostel population to 22% in a twelve-month MacNeela (1999) found an estimated 963 people were classified as homeless in Galway in 1998, with classified as homeless people were MacNeela (1999) found an estimated 963 five and twenty This included between 76 people homeless in Galway on any given day. approximately during the increasing on a given night during the winter months with figures people sleeping rough was not (information men, 22% women and 28% children 41% were summer months. Approximately The Local Authority Assessment of Homelessness 9%). available on the characteristics of the remaining to the 2002 2002c). According 155 homeless persons (Department of Environment, (2002) recorded was a total of 1,497 people seeking help in 2002 which was an 18% Annual Report by COPE, there persons seeking assistance in 2001 in the number of homeless increase people were single men, 23% were women and 22% were children (COPE Annual Report, 2003). children women and 22% were were single men, 23% people were has been undertaken on homelessness in Limerick. In 1999, it was estimated that Limited research for the in hostels homeless” in Limerick City with a further 139 residing 16 “street around were there homeless 9 Rough in Dublin City Remain 2004 “Numbers of People Sleeping and Dublin Simon on 22nd March Joint Release by Focus Ireland 10 “Rise in Homeless Seeking Help in Galway” in themselves as homeless to the health board in 2001 themselves as homeless to the health board 13 Homelessness” in of Rise in Youth “Study Warns 11 is No Room at the Inn” in “When There 12 Hi Reports a Record as Focus Ireland July 13th, 2001: “Limerick Housing Crisis on the Increase Release by Focus Ireland Press Outside the Greater Dublin area few prevalence studies have been undertaken. One survey conducted few prevalence Dublin area Outside the Greater of about 300 in the city (Kearns in Cork estimated a homeless population 2.3.2 Homelessness Outside Dublin (Cork, Galway and Limerick) 2.3.2 Homelessness Outside Dublin organised by the Homeless Agency and carried out on one night each in 2002 and 2003. The first on one night each in 2002 and 2003. The by the Homeless Agency and carried out organised sleepers. These 86 rough while the second count found sleeping rough, count found 140 people the actual number single night and cannot hope to represent a ‘snapshot’ on a counts only represent meaningful than more Flow or period estimates are (Cox and Lawless, 1999). of people sleeping rough one-night counts (Warnes in that 237 people slept rough with Dublin City Council in 2004, cited along by homeless organisations period. This than 50% of the time) over a six-week on 4 out of 7 nights (i.e. more Dublin City Centre that “figures argued sleeping in the suburbs and the count organisers does not include people rough policy of moving people who are recent Council’s to have gone down, given Dublin City’s unlikely are locations” homeless out of city-centre waiting list prevention and reduction of youth homelessness, it is probable that this does not reflect the current that this does not reflect of youth homelessness, it is probable and reduction prevention City Council situation. The Local Authority Assessment of Homelessness 2002 carried out by Limerick 2002c). (Department of Environment, March 88 homeless persons on 28th recorded 30 Drug Use Among the Homeless Population in Ireland NACD 2005 treatment intheRepublicofIreland hasincreased consistently. TheNationalDrugTreatment Treatment figures are anotherreliable indicatorofdruguse.Thenumber ofcasespresenting for (Comiskey, 1998). This indicatesadecrease from the13,460opiateusersestimatedinGreater DublinArea in1996 et al. active drugusersinDublinwhichopened2001. the needsofhomelesspeoplewithdrugandalcoholproblems suchas“wet”hostelsandahostelfor people, outreach anddrop-in servicesandalsospecificinnovativenewinitiativesaimedatmeeting investment intransitionalhousing,settlementservices,dedicatedhealthcare servicesforhomeless beds) andqualityofemergency bedsavailabletohomelesspeople,there hasalsobeensignificant available forhomelesspeopleinIreland. Aswellasincreasing thenumber(providing 900additional These developmentshaveledtoverysignificantimprovements inthequalityandquantityofservices area andsignificantadditionalresources were setasidebyGovernmenttofundtheseplans. service providers inlocallybased partnerships.Three-year “ActionPlans”were developed foreach were establishedinotherlocal authoritiesacross thecountrybringingtogetherstatutoryandvoluntary delivery ofservicestopeoplewhoare homelessintheGreater Dublinarea andHomeless Forums persons. InDublintheHomelessAgencyemerged from theHomelessInitiativetomanage and voluntaryagenciestoprovide amore coherent andintegrateddeliveryofservicesto homeless partnership structures ineverylocalauthorityarea tobring togetherthevariousstatutorydepartments Chapter 2 Recapture Methodologyisusedtoestimatetheprevalence ofopiateuse “Indirect” methodsare more appropriate inestimating problematic druguse.InIreland, theCapture- (NACD andDAIRU,2003). vast majorityofthosereporting useofanyillegaldruginthelastmonthhadusedcannabis(2.6%) reported druguseintheprevious yearwhileone-in-33 (3%) reported useintheprevious month.The reported evertakinganillegaldrug,withcannabisasthemostcommonlyused(18%).One-in-18 (5.6%) the 15-64-yearagegroup. Results showedthatalmostone-in-five(19%)ofrespondents inIreland The firstdrugpopulationsurveyinIreland andNorthernIreland wascarriedoutin2002/2003among 2.5 DrugUseinIreland policy withthepublicationof provision forhomelesspeople.Thisinnovativepartnershipapproach wascementedinGovernment service providers, withtheaimofimproving theco-ordination, planninganddeliveryofservice direction oftheEasternHealthBoard andDublinCityCouncil, andinpartnershipwithvoluntarysector emerged in1996withtheestablishmentofDublinHomelessInitiative.Itoperatedunderjoint recognising themulti-dimensionalnature oftheproblems whichhomelesspeoplepresent with, Childcare Actgivingthemresponsibility forhomelesschildren. Amore holisticpolicyresponse, imposing adutyonhealthboards toprovide shelterandassistancetohomelesspersonsthe1991 homeless people.HealthBoards share responsibility forhomelessnesswiththe1953HealthAct The 1988HousingActidentifiedlocalauthoritiesasthestatutoryagencieswithresponsibility for 2.4 ResponsestoHomelessness 4The Capture-Recapture Methodologyused datafrom three different sources; theCentralDrugTreatment List,the Hospital 14 Inpatients EnquiryDatabase andtheNationalGarda StudyonDrugs,Crimeand RelatedCriminalActivity. (2003) estimatedthatthere were 14,452opiateusersinIreland ofwhich12,444were inDublin. Review ofLiterature Homelessness –AnIntegratedStrategy in May, 2000whichestablished 14 . UsingthismethodKelly NACD 2005 Drug Use Among the Homeless Population in Ireland 31 . This 15 2003) 2002b). Review of Literature of Review 2002a). , Jackson (1997) 17 et al., et al., et al., Chapter 2 Chapter 2002c). Nearly three-quarters of all of 2002c). Nearly three-quarters illustrate that the number of drug users 19 et al., indicate that despite the fact that the number 18 2002a). In 2000, nearly two thirds of all those receiving 2002a). In 2000, nearly two thirds 2002c). et al., 2003). 16 et al., et al., 2002c). Among new clients, the number of heroin users more than doubled over the users more 2002c). Among new clients, the number of heroin et al., It is co-ordinated by the Drug Misuse Research Division at the Health Research Board. Board. Research Division at the Health by the Drug Misuse Research It is co-ordinated (Cork, Galway and Limerick). Ecstasy was the main drug of use, accounting for over half of all treatment contacts in 2000, followed contacts in 2000, for over half of all treatment Ecstasy was the main drug of use, accounting the use of psychoactive drugs, especially cannabis, ecstasy by cannabis. Earlier studies have noted that 1996). (Nic Gabhainn & Comer, particularly among young people in the region and LSD is widespread, a limited analysis of the provide the WHB area drug use within numbers reporting the low However, drug-using population. outside the treated overall drug patterns and trends Area Health Board for the Mid Western figures Treatment 2.6 Responding to the Drugs Issue on Force the establishment of a Ministerial Task history of Irish Drugs Policy began with The recent of these in 1997. As a result in 1996 and second report its first report Drugs in 1995 which produced on was adopted. The Cabinet Committee strategy to tackle the drug problem Reports, a three-tiered to national Social Inclusion operates at the highest political level to give overall political leadership from with representatives is the National Drugs Strategy Team, At the second tier there drug policy. 2.5.1 Drug Use Outside Dublin 2.5.1 Drug Use Outside Region Health Board alcohol and drug use in the Southern In a survey on smoking, Reporting System showed an increase from 4,865 in 1996 to 6,994 in 2000 (O’Brien 4,865 in 1996 to 6,994 in 2000 (O’Brien from an increase Reporting System showed of total treatment contacts fell from 22 to 14 in the period 1999 to 2000, the number of new treatment contacts fell from of total treatment (O’Brien static and accounted for the majority of those treated contacts remained found that alcohol remained the dominant drug of use in terms of prevalence and problem use. problem and dominant drug of use in terms of prevalence the found that alcohol remained drinking. The vast problematic/dependent of men aged 20-24 years reported Thirteen percent followed by cannabis use (17%). Opiate lifetime use of alcohol, reported majority (87%) of respondents that within the reveal figures use of almost nil. Treatment use showed lifetime use of 1% and current relatively remained for treatment the number of drug users presenting Area Southern Health Board of total treatment of 66% in the number an increase was there stable in the years 1996-1999. However, receiving of those treated 258 contacts in 1999 to 429 in 2000) with over half contacts in 2000 (from for the first time (262) (O’Brien treatment treatment (65%) reported cannabis use as the primary drug type with ecstasy use accounting for 15% (65%) reported treatment in opiate use. The trend indications of an upward however, are, of contacts and opiate use 10%. There 14 in 1996 to 41 in 2000 (O’Brien from number of all opiate contacts increased Area Health Board for the Western figures Treatment treatment contacts in 2000 were polydrug users. Over half those presenting for treatment reported for treatment polydrug users. Over half those presenting contacts in 2000 were treatment opiates as their main drug of choice. This that cannabis was their main drug (53%) while 27% reported cannabis use is closely followed by ecstasy use where dissimilar to other regions pattern is largely (O’Brien period in question (O’Brien four-year presenting for treatment increased from 83 in 1996 to 327 in 2000 with over half of all those presenting from increased for treatment presenting for the first time (O’Brien treatment each year receiving increase can be attributed to either an increase in drug use, service provision or the numbers of in drug use, service provision be attributed to either an increase can increase (O’Brien returns services providing 15 drug use in the Republic of Ireland. an epidemiological database on treated Reporting System is The National Drug Treatment 16 urban locations target based on the project to drug use outside Dublin is largely relating Review of information 17 Kerry. Counties Cork and 18 Mayo and Roscommon. Counties Galway, 19 Limerick and Tipperary Counties Clare, North Riding. 32 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter 2 homelessness isoftenpresented asademographicvariableindrugresearch. Kennedy Irish studyonhomelessnesshasuseddruguseasthemainfocusofresearch. Similarly, experience ofinstitutionalcare, includingprisonandpsychiatriccare (O’Gorman,2002).Howeverno behaviour, poorhealth,mentalillness,alcoholanddruguse,relationship breakdown, andprevious consequential tohomelessness.Theseincludeunemployment,poverty, housingshortages,anti-social There existsarangeofstructural andindividualfactorswhichcanbecausal,contributory 2.7 HomelessnessandDrugUse facilities intheareas worstaffected. education-based drugsprevention initiativesalliedtosignificantinvestmentinsportsandrecreational of drugusersintolocalcommunitieshavebeendevelopedaswelltheimplementationvarious to 7,190inAugust2004.Inaddition,awiderangeoflocallybasedinitiativesaimedatthere-integration drug usersinmethadone-basedtreatment, from 2,859inDecember1997to5,8652001, Since theintroduction oftheNationalDrugsStrategythere hasbeenahugeincrease inthenumberof role ofvariousgovernmentdepartmentsinachievingthesetargets outlinedaccordingly. supply reduction, prevention andtreatment. Actionsare categorisedunderthesefourpillarswiththe Strategy 2001-2008.Itaimsatafour-pronged response totheissueofdruguse,namely;research, Strategy wasdevelopedin2001withthepublicationof“BuildingonExperience”-theNationalDrugs promote acommunity-basedinteragencyresponse toproblem druguseinIreland. TheDrugs comprises oflocaldrugstaskforces whichoperateinfourteenpriorityareas andwhichseekto objective istoimplementthegovernment’s drugstrategyandtooverseethethird layerwhich relevant governmentdepartments,aswellthevoluntaryandcommunitysectors.Theirprimary difficulties (Fitzpatrick associated withhomelessnessalsotendtotriggerdrugtaking, whichalsoexacerbateotherpersonal There are anumberofcommonriskfactorswhichleadtohomelessnessanddruguse.The 2.7.1 CauseorEffect? the multipleandinterrelated problems ofhomelessdrug users(Kennedy number ofsimilarthemeswhichemerge, includingprevalence figures, similaritiesofriskfactorsand at riskofhomelessness(Kennedy be includedintheresearch, withlittledataondruguseamongthe“hidden”homelessnessorthose “recreational” use.Finally, thosewhoare “roofless” orcomeincontactwithservicesare more likelyto with “problematic” or“chaotic” useamongthehomelesspopulationratherthan“occasional”or members ofthehomelesspopulationorfamilies.Secondly, research tendstobeassociated available literature largely relates totheyoungandsingle,thusignoringdruguseamong older argue thatresearch ondrugsandhomelessnessremains limitedduetothree main factors.Firstly, situation (Johnson consequence ofhomelessness, ameansofadaptingtolifeonthestreets andcopingwiththedifficult 1993). There isalsothesocialadaptationtheorywhichargues thatsubstanceuseisoften a often theconsequenceofanindividual’s resources becominggraduallyexhausted(Baum andBurnes, problematic drugusersare athighriskofhomelessness(SpinnerandLeaf,1992)asis between druguseandhomelessnessiscomplex.Thesocialselection approach argues that Review ofLiterature et al., et al., 1997; Neale,2001). 2000; Kennedy et al., 2001: 17).Nevertheless,withinexistingliterature there are a et al., 2001). Regardless ofsimilarities, therelationship et al., 2001). et al. (2001) NACD 2005 Drug Use Among the Homeless Population in Ireland 33 . 20 Review of Literature of Review Chapter 2 Chapter 1999). et al., (2003), in a study of drug use among 160 young homeless people aged 25 years and et al. 20 days in the past week. crack or cocaine on five or more use was defined as using heroin, Problem 2.7.2.1 Drug Use Among the Homeless Population 2.7.2.1 Drug Use Among the Homeless of drug use among the homeless population has consistently Information on the prevalence drug use as well as indications that drug use is with ‘problem’ numbers presenting highlighted large likely 7.5 times more that homeless people are Australia illustrate from For instance, figures increasing. dependent than the general population (Horn, 1999). to be heroin Hammersley reported. people have been repeatedly High levels of drug use among young homeless housing issues and (1997) study illustrates that among homeless young people in Glasgow, and Pearl’s had used that over three-quarters The findings revealed ‘intimately related’. were drug problems addicted to these drugs. cannabis, hallucinogens or amphetamines and just under half felt they were people Carlen (1996) also found high levels of drug use, in that 76% of the 150 young homeless had used illegal drugs. and rural Shropshire Birmingham, Stroke-on-Trent interviewed in Manchester, Wincup and 38% crack cocaine. taking heroin currently that 43% were revealed under in England and Wales, drug users identified as “problem” were of the young people interviewed Seventeen percent 2.7.2 Prevalence Estimates 2.7.2 Prevalence among the homeless rate of alcohol and drug use Attempts to estimate an overall prevalence homeless accommodation vary across as rates can in an underestimation population is likely to result exists (Horn, 2001). Within and drug use there of homelessness types and client profiles the areas using members of the homeless population who engage in drug on two distinct groups; research lies in the manner in which the issue is homeless. The difference behaviour and drug users who are at a drug For example, if a person presents a service perspective. from and approached perceived ancillary to their homeless status becomes whereby user, service, he/she is primarily viewed as a drug the reverse. at a homeless service suggests presentation However, their drug-using profile. These theories however fail to fully demonstrate the nature of the relationship. Other commentators Other of the relationship. fail to fully demonstrate the nature These theories however have described the relationship and interdependent that drug use and homelessness are have argued 1994), a web of causation, the other (Hutson and Liddiard, each reinforcing as a cyclical pattern with of whether homelessness Regardless meeting point (McCormack, 1997). (Lloyd, 1998) or an interactive of found that the proportion studies have consistently research numerous or drug use comes first, the general population (Forst, 1994; use drugs is significantly higher than in homeless people who Cox, 2000). 1998; Horn, 1999; Cox and Lawless, 1999; Flemen, 1997b; Seddon, Flemen’s (1997b) study of drug use among young homeless people in London revealed that 88% of (1997b) study of drug use among young homeless people in London revealed Flemen’s illicit drugs. using the sample (n=700) reported the homeless population have focused on specific of drug use among Other studies on the prevalence sleepers. Fountain and Howes (2001) reported for example, rough of the homeless population, groups had used a drug (excluding alcohol) the month prior sleepers in London that 83% of a sample of rough found sleepers in Edinburgh A study of rough (47%). to interview with almost half having used heroin of using illicit drugs with the proportion regularly than half of the people interviewed were that more Henry, aged below 26 years of age (Owen and among respondents to two-thirds those increasing that 34% of 2001). An interim evaluation of the Rough Sleepers Initiative (RSI) in Scotland estimated with drugs (Yanetta RSI clients had difficulties 34 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter 2 quarter ofthesample(24%)reported injectingdrugs.Smith reported everhavingtakenillicitdrugs,ofwhom70%haddonesointheprevious year. Nearlya (2001), inastudyofthehealthanddentalneedshomelesspeopleDublin,revealed that38% third ofthesamplehadeverusedheroin, and6%were currently dependentonheroin. Condon used drugs,withmore than one-third oftheoverallsamplecurrently usingillicitdrugs.Almostone- (2000), inastudyofthehealthhostel-dwellingmenDublin,foundthat55%reported everhaving illustrated alifetimeprevalence ofillicitdruguseforoveraquarter(27%)thesample.Feeney Holohan (1997),inastudyonhealthstatusandserviceutilisationofhomelessadultsDublin, and 32%offemalecontacts,presented withdrugproblems. prevalence ofdruguseamongrough sleepers.Findingsillustrated thatin1999,25%ofthemale, An analysisofDublinSimonOutreach contactsundertakenbyHowley(2000)highlightedahigh Ireland hasservicesthatcaterfortheneedsofdrugusers. between 15and19years(41%).Thesehighfigures are notsurprisinggiventhatMerchants Quay some pointduringtheirdrug-usingcareers, asubstantialnumberofwhomhadcommencedinjecting reporting arangeofsecondarydrugs.Inaddition,86%clientsreported havinginjecteddrugsat with 44%ofclientscurrently injecting.Furthermore, 63%ofthetotalsamplewere polydrugusers drugs, thevastmajority(85%)alsoreported thecurrent useofdrugs(i.e.withinthelastfourweeks) vast majorityofserviceusersreported currently usingdrugs.Ofthosewhoreported lifetimeuseof Fáiltiú (aresource centre forhomelesspersonswithinMerchants QuayIreland), highlightedthatthe undertaken byCorr(2003a)amonghomelessindividualsusingtheinformationandadviceserviceof ranging from 29%to64%forlifetimeuseand26%41%current use(O’Gorman,2002).Astudy Prevalence ofdrugtakingamongsthomelessindividualsinDublinishighwithsurveysshowingfigures drug usersasthey are onlyconcernedwithdrug usersincontactwithtreatment services.Moreover, in 2000(O’Brien who reported theywere homeless more thandoubledover afour-year period,from 114in1996 to305 Cox, 2003).According totheIrishNationalDrugTreatment ReportingSystem, thenumberofclients substantially tohomelessnessamong problem drugusers(Memery andKerrins,2000;Lawless in particulartheindirect useoftheHousing(MiscellaneousProvisions) Act1997,hascontributed of homelessnessamongthedrug-usingpopulation.Studiessuggest thatIrishhousinglegislation, Both national(CoxandLawless,1999)internationalresearch (Neale,2001)havefoundhighlevels 2.7.2.2 HomelessnessAmongDrugUsers Cork, 41%reported theuseofillegaldrugs(Frost In aresearch studyofdrugandalcoholexperiencesamong34younghomelessmenwomenin opiate dependentandallbutonewere involvedinatreatment programme. homeless womenfoundthatalmost45%oftherespondents were classifiedasdependent–allwere the needforintensiveassessment. indicting lowlevelofproblems, 24%scored 3-5ormoderateleveland35%scored over 6indicating reported that42%ofthosewhohaduseddrugsscored 1-2ontheDrugAbuseScreening Test needs of65homelesspeopleintheWestern HealthBoard Region,HouriganandEvans(2003) and ecstasy(CorkSimonCommunity, 2000).Inastudy ofthehealthstatusandpromotion Emergency Shelterin1999observedanincrease inthenumbers usingillegaldrugssuchascannabis reported drugsofchoicewithonlyonerespondent reporting theuseofheroin. TheCorkSimon Review ofLiterature et al., 2003). Thesefigures mayunderestimate theextentofhomelessnessamong et al., 2001). Cannabisandecstasywere themost et al. ’s (2001)studyofonehundred et al. et al. NACD 2005 Drug Use Among the Homeless Population in Ireland 35 Review of Literature of Review Chapter 2 Chapter ’s (1992) study of injecting drug users in the UK found that those who reported (1992) study of injecting ’s et al. recently sharing injecting equipment were significantly more likely to report living in unstable likely to report significantly more sharing injecting equipment were recently It was also found that living with other accommodation, such as squats and hostels, than non-sharers. ethnographer noted in one study that associated with sharing. An American injectors was strongly 2.7.3 Homelessness, Drug Use and Risk Behaviour 2.7.3 Homelessness, Drug Use and upon patterns of drug housing options have on the impact that different is a dearth of literature There indicates that homelessness can have an the available research Nevertheless, use and risk behaviour. drug use. Homeless drug on drug users’ injecting risk behaviour and can exacerbate adverse effect and in less safe ways than their housed counterparts frequently and alcohol users tend to use more that in reported The British Home Office 2003b). 1999; Corr, (Klee and Morris, 1995; Cox and Lawless, and one-fifth of the homeless population have injected heroin, the United Kingdom, over one-third syringe or passed used someone else’s likely to have over 10% are have injected crack. Furthermore, and Sondhi, 2001). Homeless drug users also have a on their own syringe in the last month (Goulden (1995) study of polydrug injectors 2002). Klee and Morris’s (Wright, polydrug use tendency towards injectors. inject in public places and non-street between those who significant differences revealed likely to be significantly more places were that those who injected in public Their analysis revealed also more they were homeless and consequently lacked the facilities to inject in private. Furthermore, likely to inject in the company more likely to have close contact with other injectors, in that they were quantities of drugs, injecting at particular risk of using large injectors were street of friends. Moreover, and using others’ injecting equipment. The lack of passing on used injecting equipment frequently, lifestyle, together with and depressing safe and private places to inject, a chaotic predictable likelihood to engage in injecting risk in a greater dependence on peers, can result increased environment behaviour (Klee and Morris, 1995:841). Horn (2001) similarly includes the lack of a private to maximise their as the individuals may be under pressure to inject as a possible high risk factor, that argues “hit”. Referring to the drug using patterns of young homeless persons, Henkel (1999:3) their drug use is public, hurried, unsanitary and dangerous. to occur among homeless drug users due to the fact that they are likely Needle sharing may be more place (Rogers, 1992). unable to keep quantities of sterile injecting equipment in a safe and secure Donoghoe it is possible that homeless drug users may provide the postal code or address of family and friends of the postal code or address drug users may provide it is possible that homeless or for catchment contact source, reliable either as a more in drug treatment, upon seeking to engage reasons. In an Ireland. Quay carried out at Merchants found in studies were Higher levels of homelessness homeless at some 75% of the 262 drug users met had been programme, evaluation of their outreach among attendees at in a study of homelessness Furthermore, 2003b). year (Corr, point during the last being homeless at the time 63% of clients (n=120) reported Contact Centre, Quay Ireland’s Merchants that they had never experienced homelessness. Nearly with only 7% of clients reporting of interview, homeless status. for their current of clients (64%) cited drug use as their primary reason two-thirds drug-using behaviour was a main barrier that their current Fifty-seven per cent of clients also reported accommodation (Cox and Lawless, 1999). A survey of all new presenters accessing appropriate towards found lower levels of homelessness with 19% Quay Ireland Unit at Merchants at the Health Promotion the fact that this study was on homeless (Cox and Lawless, 2000). However, that they were reporting the extent of homelessness. first time attendees to the service may underestimate 36 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter 2 Accessing drugandalcoholservicesforhomelessclientscanbedifficult (Pleace 2.8.1 Treatment IssuesfortheHomelessDrugUser 2.8 HomelessDrugUsersandServiceProvision undetected. Family andCommunityServices,1998).Moreover, thisgroup are alsoatriskofanoverdose going most highlycorrelated withthenumberofpeoplewhowere homeless(AustralianDepartmentof Australia, revealed that“heroin overdoses treated before hospitalisation”wasoneofthesixvariables of drugoverdose. A1998study, whichestimatedthenumberofpeoplewhowere homelessin Other research indicatesastrong associationbetweenanindividual’s homelessstatusandexperience al., also atincreased riskofcontractingandtransmittingblood-borneviruses(Seddon,1998;Magura practices becomenormalised(Bourgeois, 1999:2332-2333).Therefore, homelessstreet injectorsare syringes andparaphernaliaare shared inhomelessstreet scenesonsucharoutine basisthatriskyHIV problems and argues thatonlythencana drug problem evenbeginto beaddressed. Inastudyby Seddon (1998)presents secure housingastheimmediatepriorityforhomelesspeople with drug (1999: 46)argue that; crisis accommodationinwhichthere maybehighlevelsofdruguse(Horn,2001).Similarly, Orwin for individualswhohavebecomedrugfree orhavecompletedwithdrawalprogrammes istoreturn to programmes unfeasible(Horn,2001).Itisoftenthecasethatonlyavailableaccommodation option drug users,asthelackofahomeandpersonalsupportnetworks makeshome-basedwithdrawal Residential withdrawalprogrammes are oftentheonlyviableoptionformajorityofhomeless 2002), asNeale(2001)refers to the“doublejeopardy” ofbeingbothhomelessandadruguser. complicates thealready insecure positionofanindividualinneedaccommodation(Bessant population (Orwin retention problems withhomelessclientsare equallyormore pervasivethaninthegeneraladdicted commitment andmotivationare oftendifficult tomaintain(RandallandDrugscope,2002) Sustaining engagementwithtreatment isalsoakeyproblem facedbyhomelessdrugusersas methadone andcontinuingtheirtreatment programme (Howley andCostello,2001;Horn,2001). the geographicalarea inwhich theywere previously basedandthiscanleadtoproblems inobtaining group, makesreceiving treatment difficult (Henkel,1999).Homelessindividualsoftenlosecontactwith addresses whileonwaitinglists, orprogrammes, inadditiontothemobilenature of thepopulation confined tothehomelesspopulation.However, thepracticalitiesofnotbeingabletoprovide contact et al., in drugsliterature (Seddon,1998; Neale,2001;Bessant The importanceofsecuringstableaccommodationforthoseseekingtreatment iswellestablished assignment tothegroup andtheprogramme commencement. increased risk”forthehomelessdruguserseekingtreatment particularlyatassessmentor 2000). homelessness. episode, buttendalsotoreturn tothehighlyprecarious circumstances thatprecipitated their When homelessclientsleavetreatment prematurely, theydonotmerely fail inatreatment 2001; RandallandBrown, 2002;RandallandDrugscope2002),althoughtheseproblems are not Review ofLiterature et al., 1999: 62).Orwin et al. (1999:63) argue thatthere are “recognisable periodsof et al., 2002). Adrugdependencyfurther et al., 2000; Kennedy et al., et al. et NACD 2005 Drug Use Among the Homeless Population in Ireland 37 becomes Review of Literature of Review (1995) identified et al. Chapter 2 Chapter (1995), in a follow-up study et al. 1996). In a US study by Argeriou and McCarty (1993) 1996). In a US study by Argeriou (Drugscope, 2001 cited in Randall and Brown 2002; 39) (Drugscope, 2001 cited in Randall and Brown et al., (1999) also compared residential with non-residential drug treatment with non-residential residential (1999) also compared et al. (2003), homeless service staff reported that the most chaotic drug users were least likely the most chaotic drug users were that reported staff (2003), homeless service (1995) argue that even treatment outcomes that were positive seemed to lessen over outcomes that were that even treatment (1995) argue (1995) compared a residential programme using a therapeutic approach with non- using a therapeutic approach programme a residential (1995) compared et al. et al. et al. many of the clients had left detoxification or residential rehabilitation indicating that they may not rehabilitation or residential many of the clients had left detoxification clients to to encourage The pressure for such abstinence-based programmes. have been ready associated with increased practice and it’s in dangerous can result become drug and alcohol free and overdose. relapse 2.8.3 Responding to the Needs of the Homeless Drug User in Service Provision 2.8.3 Responding to the Needs of the Homeless Drug User in Service to the availability and accessibility of drug services been undertaken with regard has Limited research 2.8.2 Homeless Drug Users and Treatment Effectiveness 2.8.2 Homeless Drug Users and Treatment for alcohol and effectiveness conducted on treatment has been considerable research While there members of the for effective are little is known about what types of treatment drug use, relatively can be impeded by entering treatment of homeless individuals homeless population. The progress to low- of income, limited access lack of stable sources barriers such as poor social support systems, 1995). Stahler and Yamaguchi, cost housing and psychological issues (Sosin Wincup also drug users are to have their tenancies discontinued. Homeless and most likely to get rehoused 1998). Henkel needs (Rutter, accommodation to match their high support unlikely to find suitable is 100 times more the drug use of homeless individuals or reduce that to control (1999:3) argues issue ‘ McCormick (1997:9) states that the drug safely housed. when they are than difficult itself a central preoccupation in the face of which everything else is put on the long finger.’ in the face of which everything else is put itself a central preoccupation several characteristics that were associated with successful outcomes for members of the homeless several characteristics that were lifetime drug use, fewer prior drug and lower recent population six months following treatment; of imprisonment and less social isolation. stable housing, fewer experiences episodes, more treatment Stahler Erickson However, time indicating the need for extended aftercare. Smith residential services among a population of homeless women with children. Clients within the services among a population of homeless women with children. residential similar to those in the non- out but the outcomes were less likely to drop were programme residential services. Orwin residential on homeless, predominantly male, alcohol users, found that greater motivation and readiness for motivation and readiness male, alcohol users, found that greater on homeless, predominantly An interim in drug use. reduction and greater retention to longer programme related were treatment drug and alcohol sleepers of the rough undertaken by Drugscope (2001) on the evaluation report in the UK found that; specific grants projects rates. higher retention option consistently demonstrated and found that the residential and accessible to the homeless population by available The importance of making drug treatment has also documented such as a homeless shelter, familiar environment, locating it within an already outcomes (Miescher favourable treatment in which part of a homeless shelter was transformed into a post detoxification stabilisation favourably to traditional drug was found to be 63.5% which compared the rate of success programme, a valuable and and McCarty (1993), shelters can represent to Argeriou According use programmes. of the homeless population in drug treatment. way with which to engage members cost effective 38 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter 2 homeless services has become a matter of concern since the Wintercomfort CaseintheUK1999 homeless serviceshasbecomeamatterofconcernsincetheWintercomfort use ordrugdealingwhichare ofconcerntothehomelessserviceprovider (Flemen,2001).Drugusein needed assistancefrom servicesifexclusioncriteriaare enforced. Itisoftenthelegalaspectsofdrug that individualsare oftenmore likelytoconcealtheirdrug-usingbehaviourordenythemselvesmuch homeless projects interviewedreported thatdruguserswere notaccepted.Flemen(1997a)argues Drugscope, 2002).InaDublinstudy, HowleyandCostello(2001)citedthatfiveofthesevenindividual services canbehindered by theemploymentofexclusionpoliciestowards drugusers(Randalland However, thepotentialforhomelessservicestoact asa“gateway”intomore specialistdrugtreatment drug treatment services(Drugscope,2001). position toprovide low-threshold druginterventionsandtoactasareferral pointtomore specialist drug userswhoare notincontactwithotherservices(Drugscope,2001).Homeless are ina non-specialists. Nevertheless,homelessservicescanplayakeyrole inreaching those“hard-to-reach” streets andinhostelsare betterabletonegotiateaccessservicesandtreatment programmes than al., have traineddrugsworkerswhileothersgenericwithlittlespecialisttraining(Warnes their clientsisoftendebatedbydrugservices(RandallandDrugscope,2002).Somehomeless complexity oftheirneeds.Theabilityhomelessservicestoprovide effective druginterventionsto users. Thecapacityofhomelessservicestodealwithdrugusersisbeingchallengedbythe within internationalliterature thatagrowing demandis being placedonhomelessservicesbydrug to meettheneedsofhomelessdruguserswithinIrishcontext.However, there isaconsensus 1In1999, theDirector Drop-In andManager oftheWintercomfort Centre inCambridge were jailedforallowing heroin tobetrad 21 are oftenreinforced. Thiscouldultimatelycontribute tochangesinlifestyle(Flemen,2001). the clientgroup wouldbedivertedawayfrom street-based needleexchangeswhere theirstreet identities service wouldbepossible.Thisincreased servicewouldhelp reduce sharingorreuse ofequipmentand injecting drugusers.Ifdrugsworkers ofhostelsoperatedneedleexchanges,amore intensiveandholistic example withinhostels.Inthisway, adedicated,privateanddiscrete servicecouldbeprovided to includes locatingneedleexchangeprovision withinservicesusedbythehomelesspopulation, for appropriate accesstoneedleexchangefacilities.Onerecommendation putforward byFlemen(2001) for homelessdrugusers.Flemen(2001)argues thathomelessinjectorsshouldhaveadequateand Literature alsohighlightsthe needforappropriate accommodation whichpromotes harmreduction to prevent becomingabsorbed intoadrug-basedculture (KleeandReid,1998a:276). drug usersasitisargued that itisnecessarythatthisgroup are accommodatedappropriately inorder take intoaccounttheageorlevelofexperiencedruguser. Thisisparticularlyrelevant foryoung Drugs PolicyForum,1999).KleeandReid(1998a)alsonotethat anyinterventionsemployedneedto vulnerability ofdrugusersandshouldputstrategiesinplacetoprevent tenancybreakdown (London problems (RandallandDrugscope,2002;Neale,2001).Housingproviders shouldalsobeaware ofthe the needforarangeofaccommodationoptionspeoplewithpastorpresent drugand/oralcohol continue tousedrugsandforthosewhowishbecomedrugfree. Othercommentatorsadvocate argue thatseparatehosteland supportedaccommodationshouldbeprovided forthosewhowantto former drugusersrequest thatcurrent drugusersare excluded.TheLondonDrugPolicy Forum(1999) 1998). Neale(2001)feelsthathomelessservicesproviders haveaparticularlydifficult taskinthatsome restricted accesstootheressentialservicessuchaspsychiatric,health,andwelfare services(Seddon, vicious cycleasthehomelessdruguserismaintainedinastreet homelesssituationthereby beingalso The evictionorexclusionofindividualsfrom hostelsandotherhousingservicescanperpetuatea needs byexclusion (Hebden,2002). the Home Office in2002,there remains insufficient protection forservice staff whomay notwanttoaddress drugusershousing apparently condoningtheactivityon premises. Despitethe factthatguidanceconcerningthelegal implicationswasissued on theirpremises. Theyargued thattheconfidentialitypolicyprevented thestaff from givinginformationtothepolicethereb 2003). RandallandBrown (2002)argue thatspecialistsubstancemisuseworkersworkingonthe Review ofLiterature y et 21 . ed by NACD 2005 Drug Use Among the Homeless Population in Ireland 39 2001). et al., Review of Literature of Review Chapter 2 Chapter 1999). Many service providers are challenged by the multiple are 1999). Many service providers et al., (1999:63) recommend eliminating unnecessary waiting time and engaging clients (1999:63) recommend et al. needs with which this client group presents and it is often the case that such individuals fall outside presents needs with which this client group homeless or – either you are “either/or” approach of service delivery which operate an the structures for has indicated that drug treatment you have a drug dependency (Hamilton, 2001). Overall, research access can be homeless individuals can have favourable outcomes. It is particularly successful where that the person’s alongside wider support to ensure and is developed quickly, flexible and provided focused a more requires Responding effectively also addressed. issues are housing, health and welfare in which a multiple service system operates all service providers from approach and targeted (Hamilton, 2001; Randall and Drugscope, 2002). This chapter has presented a review of the literature in the area of drug use and homelessness. in the area of the literature a review This chapter has presented that they are an acknowledgement and recognition demonstrates National and international literature of this association, and for the nature literature within the closely associated. Explanations provided complex and are understandings of the pathways into and out of both homelessness and drug use of drug use among the homeless population estimates of the level multi-dimensional. Prevalence higher than the general convey that levels of drug use among people experiencing homelessness are population (Horn, 1999; Orwin 2.9 Summary Literature has also questioned the ability of drug services to meet the needs of homeless drug users. the ability of drug services to meet the needs has also questioned Literature meet the needs of the not designed to are that existing models of drug treatment It is argued for drug (2002:6) feel that targets (Hamilton, 2001). Randall and Drugscope homeless population and the likelihood of group the high level of needs of this people should reflect services for homeless (Randall as a distinct group treated be therefore Homeless drug users should treatment. from relapses to This could be achieved, according Neale 2001; Neale 2002; Hamilton, 2001). and Drugscope, 2002; a special strategy for homeless drug (2002) by designing and implementing Randall and Drugscope while also services for drug users services to provide users. This would involve encouraging homeless a study to those experiencing homelessness. Findings from facilitating drug service provision related that good practice in working with homeless drug users undertaken by Neale (2002) revealed service delivery and support provided, agency environment, staffing, These were: areas. to five broad agency aims and objectives. of social and economic factors that range “lifestyle issues” and dealing with a broad Addressing practice (Kennedy good as current is proposed drug treatment influence an individual’s Orwin immediately by ensuring frequent contact, undertaking active searches for clients who do not make contact, undertaking active searches immediately by ensuring frequent (2003), tangible items such as food coupons or bus tokens. Sosin and Grossman contact and providing participation among the homeless population, present in an analysis of empirical work on drug service in that they lacking, homeless services are that general they argued Firstly, arguments. two different needs”. This in turn means that homeless adequately for homeless adults “pressing fail to provide less likely likely to be wary of any other service system (e.g. drug services) and are more individuals are if it appears drug treatment posits the notion that they may avoid to participate. The second argument may require for example entering drug treatment their immediate material circumstances, to threaten be the case that tangible benefits, such as their hostel accommodation. It may also surrendering (Sosin and important to the individual than seeking drug treatment more finding a bed or food are 2003: 524). Grossman, 40 Drug Use Among the Homeless Population in Ireland NACD 2005 .To gaininformationthrough focusgroups from arangeofserviceproviders whoare increasingly 2. urban locations;Cork,LimerickandGalway. local authorityhomelesslistsandwere notincontactwithhomelessserviceseachofthe other contact withhomelessservices.Similarly, itwasdecided toomitthosewhowere solelyregistered on inaccurate ortheirstatusquestionable.Asaresult, itwasdecidedtoconcentratesolelyon thosein was considered importantbutaccessingthisgroup wasdifficult iflocalauthoritylistswere outdated, for theirparticularserviceona daily basis. Limerick were targeted andwere chosenbasedonhavingsomedegree ofoperationalresponsibility Representatives from arangeofdrugservicesandhomelessinDublin,Cork,Galway Study DesignandMethodology Chapter Three .To gaininformation(through surveyquestionnaire) amongthehomelesspopulationonnature, 1. Dublin, Cork,GalwayandLimerick.Thetwomainobjectivesofthestudywere; As outlinedinChapterOne,thiswasanationalstudyconductedfourcitiesthroughout Ireland; 3.2 Target Populations methods, datamanagementandanalysistechniques. negotiation andaccessare presented, inadditiontodetails relating tothedifferent sampling study implementationandcompletion.More specifically, stakeholderinvolvement,siteselection, Ireland. Thischapterexaminestheresearch process from theinitialpreparatory activitiesthrough to of themedfocusgroups whichwere facilitatedbytheResearch DepartmentofMerchants Quay Service providers (drugandhomeless)ineachcitylocationwere alsoinvitedtoparticipateinarange range ofhomelessservicesineachthefourcitylocations,Dublin,Cork,LimerickandGalway. undertaken reflected thisapproach. Studyparticipantswere recruited byninefieldworkersfrom a study. Asastudyofdruguseamongthehomelesspopulation,itwasimportantthatmethodology This chapteroutlinestheresearch methodologywhichwas adoptedtoachievetheobjectivesof 3.1 Introduction 2The functionalarea oftheAuthorityincludesDublin,Kildare andWicklow. 22 based onERHAboundaries local authoritieswere includedinthemostrecent assessment unlikethe1999assessmentwhichwas homelessness. Asthe2002assessmentwasundertakeninDublin,onlyhomelessservicesandfour Authority HomelessLists.Thesetwogroups were identified inthe1999and2002assessmentsof It wasoriginallyintendedtorecruit individualsincontactwithhomelessservicesandthoseonLocal authorities assessments,astheyexhibitedhighratesofhomelessness. Cork. Thesenon-Dublinlocationswere selectedonthebasisoffindings1999local be targeted withintheDublin area, withtheremaining 30%toberecruited inGalway, Limerickand In accordance withthetender agreement, themajority(70%)ofhomelesspeopleinterviewedwere to coming intocontactwithhomelessdrugusingindividuals. extent andexperienceofthosewhoare homelessandusedrugs. 22 . Havingasampleofthehomelesspopulationnotintouchwithservices NACD 2005 Drug Use Among the Homeless Population in Ireland 41 or Study Design and Methodology and Design Study in Cork, Galway and Limerick in 24 Chapter 3 Chapter (2000) a Homeless Forum was established in every county comprising of experts and gatekeepers in 23 Homelessness – An Integrated Strategy homeless services. In particular they assisted in finalising the design and testing of the homeless services. In particular they assisted and training of population, advising on the recruitment accessing the research questionnaire, between held regularly Meetings were drafts of reports. fieldworkers, and commenting on various Ireland. Quay of Merchants Department and the Research Advisory Group the Research strategies; April/May 2003. Furthermore, all homeless services were contacted individually and sent details of contacted all homeless services were April/May 2003. Furthermore, project. the research A letter outlining the research study and seeking access was sent to all the homeless services A letter outlining the research the participation of sites. This letter requested to be included as potential research which were participants the homeless service in question to allow one of the fieldworkers to access and recruit was project ensuring that the research Consideration was also given to for inclusion in the study. homeless drug understood as a study of drug use among the homeless population rather than on services in each of the four city to all targeted made Follow-up phone calls were users specifically. details, and to arrange a service to clarify any project agreed, access was locations to ensure to various service managers was also delivered presentation A project contact person for the study. within homeless services. Presentations outlining the project were made at Homeless Fora were outlining the project Presentations within the sent to homeless services were project Information and posters outlining the research of topics included in the survey as well as four urban locations. These detailed the range project The research of all information provided. emphasising the anonymity and confidentiality other research to distinguish it from in order Project” Research was entitled the “Home Truths those who were as well as targeting and to highlight the objectivity of the research projects stage the members of the homeless population and not using drugs/alcohol. At the consent was being undertaken. Those “who” and “why” the research informed of participants were also asked or did not wish to do so were in this research unable to participate services who were information to their clients. by disseminating the enclosed to support the project homeless service providers from the four different urban locations were invited to attend and were urban locations were the four different from homeless service providers implementation methodology and proposed rationale, research briefed on the background, process. comprising representatives of the health boards, the local authorities and the voluntary organisations involved with services f organisations the local authorities and the voluntary of the health boards, comprising representatives homeless persons. 3. was undertaken by the following communicative The support of homeless service providers 23 outlined within the acknowledgment section of the Report. are Advisory Group Members of the Research 24 of the government’s As a result ■ ■ ■ It was important that any concerns among service providers (e.g. data protection issues, confidentiality (e.g. data protection any concerns among service providers It was important that was accomplished This to commencement of the study. prior overcome of information etc.) were the following strategies: through 1.the NACD. All Dublin on February 14th 2003, hosted by An “open forum” session was held in 2. Advisory Group, a Research The NACD appointed 3.3 Involvement of Stakeholders of Stakeholders 3.3 Involvement 42 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter 3 who completeall thesectionsofquestionnaire was38minutes(range: 15-105mins). was shorterthanhadbeenthe case forthepilotexercise. Overall, theaveragelengthoftimeforthose missing dataorpartiallycompleted questionnaires. Generally, thetimesurveytooktoadminister The changestothequestionnaire followingthepilotfacilitated highresponse rateswith verylittle of somequestionsandformatting (creation ofopenresponse asopposedtoyes/nooption). (clarity regarding interviewerinstructionsforeachsection,increase inrecording spaceetc.),rewording recommendations ofthe Research AdvisoryGroup. Generalquestionnaire changesincludedstructure amendments were madetothequestionnaire asaresult ofthepilotingprocess andfollowingonthe those respondents whodidnotneedtoanswerthealcoholanddrugsections.Anumberof questionnaire averagedbetween 50-60minutesandevenlesstime(approximately 30minutes)with As aresult, abroad rangeofsiteswasselectedforthepilotphase.Thetimetakentocomplete from open-access,low-threshold day-care servicestomore structured accommodation-based projects. that theadministrationofsurveyquestionnaire wasfeasibleacross arangeofhomelessservices exercise wastoensure thatthequestionswere clear, unbiasedandunderstoodbytheparticipants Ten pilotsurveyswere administered bytheresearchers duringMarch 2003.Theaimofthepilot 3.4.2 PilotingofQuestionnaire ■ ■ recent useofvariousdrug classifications.Thiswascomplementedbythefollowingdrugusescales: The drugcomponentofthequestionnaire followedtheEMCDDAtemplateoflifetime,current and et al., for arangeofdrinkingproblems andinparticularforhazardous andharmfulconsumption(Saunders Identification Test Screening Instrument)whichisa10-itemscreening instrumentdesignedtoscreen Problematic alcoholusewas measured bytheemploymentofAUDIT(TheAlcoholUseDisorders included withinspecificsections,suchasriskbehaviour, assessmentofneedsandservicedelivery. assessment ofcurrent needs.Thequestionswere largely close-endedwithopen-endedquestions drug andalcoholuse,riskbehaviours,contactwithservices(homeless,generic)self- accommodation types,experiencesofhomelessness,health(physicalandmentalhealth),income, The surveyquestionnaire elicitedinformationregarding basicidentifiersandpersonalcharacteristics, 3.4.1. Questionnaire Content population aswellobtainingaprevalence figure ofdrug useamongthehomelesspopulation. A surveyquestionnaire wasconsidered themostappropriate wayofcollectingdataonthehomeless Homeless Population 3.4 SurveyQuestionnaire amongthe In thisregard, theshorter10-pointscalewasusedwhich more relevant forthistarget group. instrument were notappropriate forthehomelesspopulation(i.e.questionsaboutemploymentetc.). It transpired duringsomeof the pilotinterviewsthatsomeofitemsin20-itemscreening (Gossop dependence onavarietyofdrugs,includingheroin, cocaine,amphetamines,andmethadone The SeverityofDependenceScale(SDS)isa5-itemscaledesignedtomeasure thedegree of The DrugAbuseScreening Test (DAST)isusedtoidentifyproblematic druguse(Gavin 1993). Study DesignandMethodology et al., 1995). et al., 1989). NACD 2005 Drug Use Among the Homeless Population in Ireland 43 vices dy. Study Design and Methodology and Design Study . When access to a service was 25 Chapter 3 Chapter . 26 These included; 2 hostels catering for single homeless men, 1 female hostel, a day centre for homeless men, women and children, These included; 2 hostels catering for single homeless men, 1 female hostel, a day centre a specialist homeless service. It is also important to note that clients accessing these ser was from refusal and the remaining in other services. targeted were sampling frame. 25 stu all located in Dublin, declined to participate in the research for the research, targeted Five homeless services who were 3.4.5 Access and their key contacts to ensure Advisory Group worked closely with the Research team The research was a high level of support population was obtained. Overall, there that optimal access to the research the research homeless services and very few declined to facilitate from 26 the total number of sites accessed. Not all sites accessed had homeless individuals to match the This does not represent 3.4.4 Research Sites 3.4.4 Research the to the setting where of drug use can vary according has indicated that the prevalence Research accommodation, etc. emergency day programmes, centres, information is collected for example, food spectrum of open access consisting of a broad project the inclusion of a multi-site research Therefore, for this study. a prerequisite specialised services was therefore and more the of members from for the recruitment targeted were No drug services in any of these locations of drug services as typical sites of recruitment homeless population. It was felt that the employment centres Treatment group. and extent of drug use among this population would have biased the nature levels. Needle exchange programmes problematic use has reached access to those whose drug offer to be identified as injecting drug users. by those prepared frequented also services who are are an obvious bias into the study by have introduced drug services would therefore Recruiting from problematic fashion or those who are neglecting those who may use in an experimental/recreational agencies. drug treatment and do not access mainstream In view of the sensitive nature of the research project, and to ensure confidentiality, nine fieldworkers confidentiality, to ensure and project, of the research nature In view of the sensitive it of homeless services. Nevertheless involved in the provision directly not who were recruited were to homelessness of issues relating had a good knowledge and understanding was necessary that they the their ability to administer Furthermore, group. with working with the target and had experience taken into consideration. and non-judgmental manner was also interviews in a sensitive familiar with, and were that they were to ensure programme The fieldworkers participated in a training by Merchants The training was delivered process. well equipped, to undertake the data collection the key experts in with inputs from Department over one day in May 2003 Research Quay Ireland’s concepts and background outlined the aims and objectives of the study, The training programme area. training specific to the study and research in Ireland information on drug use and homelessness plays, handling interview skills, role survey questionnaire, (access and negotiation, administration of situations and possible questions by interviewees, boundaries and limitations of problematic issues). fieldworker involvement, ethical and confidentiality 3.4.3 Recruitment and Training of Fieldworkers and Training 3.4.3 Recruitment granted, a member of staff was nominated as the key contact person or ‘gatekeeper’ and this person was granted, a member of staff carry out the surveys. The majority of interviews to facilitated the fieldworker and arranged a room undertaken elsewhere, sites. Of those which were undertaken by the fieldworkers on such (90%) were 16% and the remaining within a park setting, 23% in a café, 19% on the street administered 42% were 50 sites from recruited were In total, individuals in hostels of which the individual was not a resident. locations the four different across 44 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter 3 hostel, B&Bs,relatives andfriendsother 25 –34years;3544and45+years.Mainaccommodationcategorieswere rough sleeping, by 4nightsormore overtheweekprevious tointerview). Age categoriesincludedlessthan24years; homeless servicesandcompriseof3variables:gender, ageandprimaryaccommodationtype(defined sample were developedfrom theESRI/HomelessAgencycountandrefer onlytothose incontactwith characteristics thefinalsamplewillberepresentative’ (De Vaus, 1996:78).ThequotasfortheDublin samples withoutrandomselectionofcases[…]Thequotasare organised sothatintermsofthequota sampling wasused,whichisa‘commonnon-probability techniqueaimedatproducing representative group andthere isnodefinitivewayofknowingthetotalnumberpopulation.Therefore quota Gaining aprobability sample ofthehomelesspopulationisproblematic, asitisamobile,transient SamplingFrame 3.4.7 was theleastfavoured optionemployed. the chaoticlifestyleofpopulationgroup. Arranginginterviewsbyappointmentproved difficult and representative thesampleisfrom eachsite.Mostsurveyswere administered uponrecruitment given the different siteswere notreflective ofthesitesize.Therefore, noclaimismaderegarding how recruited from sitesinaccordance withtheoverallsamplingstrategy. Thenumbersrecruited from felt theirsitewassaturated(i.e.ifnopotentialindividualsremained forrecruitment). Individualswere at different stagesduringtheresearch andthefieldworkerinformedResearch Team whenthey homeless servicesandlastlyinformationadviceservices.Siteswere ascribedtoeachfieldworker recruited from hostels,thenfoodcentres, thendrop-in/street-outreach services,thenday/specialised The datacollectionprocess wasstaggered across different servicesi.e.participantswere initially 3.4.6 Fieldwork 9Corr(2003c) highlightedthatthecountmay beanunderestimation asitisapoint-in-timecount, it ignores thehiddenhomel 29 WhiletheESRI/HAassessmentofhomelessness(2002)didcount thosewithintransitionalhousingitdidnotincludethisgroup 28 “Other”includesaccommodation suchas;shed,van,squatetc. 27 were interviewed,247inDublinand108outsideDublin. commenced onJune9th2003andfinishedOctober31st2003. Duringthisperiod355individuals once aweekandalsodisseminatedtothefieldworkersoutside Dublin.Thedatacollection surveyed more thanonce.A client IDspreadsheet wasalsoprovided toallDublinfieldworkers atleast Each personinterviewedwasgivenauniqueidentifier(initials, gender, dateofbirth)toavoidbeing 3.4.8 MonitoringSample data from localauthorityassessmentsofhomelessness. feasible. Howeverquotaswere developedbroadly basedononevariable(accommodationtype)using services intheselocations.Therefore abreakdown ofservicecontactbygenderand agewasnot unlike Dublin,assessmentshavenotbeenformallycarriedoutonthoseincontactwithhomeless In theotherurbanlocations(Cork,GalwayandLimerick)quotasamplingwasalsoemployed.However, homeless populationandcannotbeargued thatitistotallyrepresentative. in obtainingtheoriginalsamplingframe, inappropriate toincludetransitionalhousing inthesamplingframe. within theiranalysis. As thesamplingframeforDublinArea isbasedonthe ESRI/HAAssessment,itwastherefore deemed service providers andtheorganisations whodid not respond tothe survey are notdocumented. the informationmay notalwaysbereliable asitdependsonaccuratereturns from localauthorities,healthboards andvoluntar Study DesignandMethodology 29 it canonlybeusedasaguideforthecompositionof 27, 28 . Giventheproblems thatexist withthemethodology ess, y NACD 2005 Drug Use Among the Homeless Population in Ireland 45 all Study Design and Methodology and Design Study Chapter 3 Chapter participants in the focus groups so the names and details, or any other issue that might identify participants in the focus groups omitted. were organisations 3.6 Ethical Issues and conformed with the was carried out both ethically and appropriately that the research In order implemented. When were several safeguards by the funding body, ethics recommended research was given to the language of questions to avoid accusatory particular care finalising the questionnaire encouraged to carry out the interviews in a sensitive were the fieldworkers questions. Furthermore, all targeted not identified or exposed as drug users as the project participants were Research manner. project the acceptability of the research members of the homeless population. This method promoted issue of drug use among the homeless population the among the homeless population. Researching on their can be highly sensitive for some interviewees as they could fear potential repercussions needs. Anonymity and confidentiality of all information provided accommodation or future present Participants form prior to participation in the study. and all interviewees signed a consent was ensured to show that the researchers in order of the questionnaire in cash on completion 15 euro offered were to confidentiality was assured Similarly, valued the time they contributed to the research. 3.5.2 Sample carried out with a purposive sample of 64 were During July and August 2003, 14 focus groups undertaken within Dublin and two were Eight focus groups homeless and drug service providers. all sectors of drug undertaken in each of the other cities. Interviewees covered were focus groups services, needle exchanges, methadone outreach and homeless services. Drug services included therapeutic communities and rehabilitation programmes, residential maintenance programmes, food services, centres, Homeless services included accommodation services, day programmes. more are (1994: 77) advises that focus groups services. Krueger resettlement services and aftercare among participants to allow for variation homogeneous ‘but with sufficient successful when they are a represented and each focus group homogeneity was sought contrasting opinions’. In this research (e.g. open-access services, accommodation services, settlement aspect of service provision different services etc.). services, drug free prescribing services, low-threshold services, services for under-18s, Quay at Merchants Officers and facilitated by the Research co-ordinated were The focus groups an-hour-and- and lasted approximately attended, on average, by five organisations Each were Ireland. a-half to two hours. 3.5.1 Interview Schedule information consisted of four main sections: background The interview schedule for the focus groups and examples policies, procedures service users’ characteristics and circumstances, on organisations, for homeless drug users. and weaknesses in service provision strengths of good practice and finally, The second part of the data collection process involved obtaining qualitative information from a range information from involved obtaining qualitative data collection process The second part of the drug use and/or of area Cork, Galway and Limerick working in the in Dublin, of service providers to collect data as they add way the most appropriate deemed were groups homelessness. Focus ‘ideal for exploring people’s 1994) as well as being surveys (Krueger, large-scale useful information to 1999: 5). wishes and concerns’ (Kitzinger and Barbour, experiences, opinions, 3.5 Focus Groups with Service Providers Groups 3.5 Focus 46 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter 3 findings become more fully‘explored, explained andevidenced’(Dixon, 2004:19). and explained. This isdeemedthemostsystematic andreliable wayoftreating qualitativedataasthe represent typicalorcommon responses. However anyvariationsornegativecasesare alsodescribed qualitative research procedures’ (Krueger, 1994:154–155).Quotesused in theanalysiswere chosento impression thatresults can beprojected toapopulation andthisisnotwithinthecapabilitiesof percentages were notused inthereporting ofthefocus group dataasthiscan‘sometimes conveythe these initialquestionswere developedandrefined inlightofnewandemerging ideas.Numbersand favourable examples’.Thequestionsintheinterviewguideacted astheanalyticalframeworkalthough be more confidentthatthepatterns reported actuallyexistedthroughout thedatarather thanin Silverman (2000:186–187)‘computer-assisted recording andanalysis ofdatameansthatonecould used intheanalysisandcodedintorelevant themesandpatternsusingNud*st6,asaccording to of qualitativedatawhichwere analysedinasystematicandthorough manner. Thewholedatasetwas All focusgroups were tape-recorded andfullytranscribed. Thefocusgroups generated agreat deal of thesample,aswellamongtotalsample. data wasundertakenbyapplyingtheappropriate statisticaltestswithinandacross different cohorts The quantitativedatafrom Analysisofquantitative the surveywasentered intoSPSSforWindows. 3.8 DataAnalysis missing data.Open-endedquestionswere entered intoa word documentandcodedsubsequently. instructions. Missingresponses were codedaccordingly andtheresults presented are adjustedfor questionnaire. Aresponse sheetwascompletedforeachquestionnaire inaccordance withthecoding book wasdevelopedproviding codinginstructionsforeachofthequestionsincludedonsurvey the datacollectionprocess. Non-valid questionnaires were removed from thedatacollection.Acode Prior todataentry, questionnaires were checkedtodeterminewhethertheywere validforinclusionin 3.7.3 DataPreparation protected computer, whichhindered unauthorisedpersonsaccesstotheresearch databases. Questionnaires andconsentformswere stored securely. Informationwasentered ontoapassword 3.7.2 DataProtection proportion ofthequestionnaires wasdouble-checkedbytheleadresearcher atregular intervals. collection errors orinconsistencies byamemberoftheresearch team.Following thisperiod,a data collectionperiod,allquestionnaires returned bythe fieldworkerswere checkedforanydata 10 surveyquestionnaires were giventoafieldworkerat any onetime.Furthermore, duringtheinitial In order toexercise control regarding thenumberofsurveyquestionnaires beingadministered, only 3.7.1 DataQualityControl 3.7 DataManagement fieldworker hadintheirpossession. provided withmobilephones.Moreover, there wasadailylimitontheamountofpaymentseach were briefedtoundertakeinterviewsinservice-basedareas orotherpublicareas andtheywere all The issueofsafetythefieldworkerswasalsoaddressed. Aspartofthetraining,fieldworkers Study DesignandMethodology NACD 2005 Drug Use Among the Homeless Population in Ireland 47 Study Design and Methodology and Design Study Chapter 3 Chapter This chapter has presented an overview of the research process employed to achieve the study aims process an overview of the research This chapter has presented as data collection undertaken were qualitative and quantitative methodologies and objectives. Both and homeless persons in Dublin, Cork, Galway was used to survey 355 methods. A questionnaire numbers with the large and worked very well was most appropriate Limerick. This methodology questions with various standardised the survey combined closed and open-ended Moreover, recruited. of drug use. The quantitative data collection activities were measurements scales to allow different had prior June to August 2003. Fieldworkers from undertaken by 9 fieldworkers in the period of involved in the provision not currently although were group experience of working with the target the ease with which the data collection was undertaken. homeless services. This positively improved those in contact with homeless services in the four city Due to varying data collection methods of used among the Dublin homeless sample and those quota sampling types were locations, different outside of Dublin. during undertaken with 64 drugs and homeless service providers were Fourteen themed focus groups and coded into and fully transcribed tape-recorded were July and August 2003. All focus groups adhered that ethical issues were also taken to ensure were themes and patterns. Measures relevant confidentiality and anonymity. to during the data collection period, in particular 3.9 Summary 3.9 Summary 48 Drug Use Among the Homeless Population in Ireland NACD 2005 Research PopulationProfile andCharacteristics Chapter Four Table 4.1Gender byLocation Limerick andGalway Table 4.1demonstratesthegenderofrespondents ineachofthefourcitylocations;Dublin,Cork, (i.e. gender, ageandaccommodationtype)are notstrictlycomparable. purposive quotasamplingtechniques.Inthisregard, demographics oftheresearch population in 2002.Theremaining participants(n=108)were recruited inCork,GalwayandLimerickusing homeless personswhoaccessedservicesaccording togender, ageandmaintypeofaccommodation with theESRI/HomelessAgencysamplingframeprovided. Thiswasbasedonthedistributionof Of the355studyparticipants,atotalof247homelesspersonsinDublinwere sampledinaccordance 4.2 PopulationSample in drug-usingbehaviour. collected from allmembersofthegeneralhomelesspopulationirrespective ofwhethertheyengage homeless population.Therefore thedatapresented throughout thisChapterrefers toinformation is aresearch studyofdruguseamongthehomelesspopulationratherthanmerely ofthedrugusing homelessness, education,employmentandlegalstatus.AsstatedinChapterThree ofthe Report,this (n=355). Informationconveyedincludesdemographicdetails,current accommodation,experiencesof This chapterpresents anoverviewoftheprofile andcharacteristics ofthehomelessstudypopulation 4.1 Introduction 0As illustratedinChapterThree, genderdifferences across locationscanbelargely explainedbydiffering samplingstrategie 30 eae3 11 9[2 2[5 8[0 9[14] 39 [22] 61 [10] 28 [26] 72 [15] 42 [21] [72] 58 [175] 29 71 [111] Female 31 [244] Male 69 Gender employed. 30 . Population City Total Study Locations n%n% %n n % %n n % %n n35 n27 n3)(=6 (n=36) (n=36) (n=36) (n=247) (n=355) ulnCr ieikGalway Limerick Cork Dublin s NACD 2005 Drug Use Among the Homeless Population in Ireland 49 rm ons es ), 33 Research Population Profile and Characteristics and Profile Population Research . 31 Chapter Four Chapter Dublin Cork Limerick Galway Population Respondents Respondents Total Study Total Male Female %n%n%n (n=355) (n=247) (n=36) (n=36) (n=36) %n % n %n % n %n Population City Locations Study Total City Population employed. employed. For the Dublin homeless population this is living in either a hostel/shelter, B&B, squat (e.g derelict buildings etc. B&B, squat (e.g derelict employed. For the Dublin homeless population this is living in either a hostel/shelter, locati For the purpose of target temporary accommodation) or sleeping rough. (i.e. insecure, staying with friends and relatives definition was employed to include transitional housing or long te outside of Dublin (i.e Cork, Galway and Limerick), a broader Methodology – Chapter Three). supported housing (See Research Missing Observations [2] [2] [-] B&BSleeping RoughOtherFriends/RelativesSquat 16 19 (56) 3 10 (69) 20 (12) (34) 12 2 (48) 4 10 (28) (6) 7 (10) (24) 37 2 (8) 2 9 (41) (5) (2) (10) 1 (1) AccommodationHostel (n = 353) (n = 242) 50 (176) (n = 111) 52 (127) 44 (49) 35-44 yrs45+ yrsMean Age 19 [68] 26 35.26 yrs 19 [93] 34.30 yrs [46] 23 22.5 [58] yrs 34.28 [8] 22.5 37.25 yrs [8] 19 40.83 yrs [7] 33 [12] 19 42 [7] [15] < 20 yrs20-24 yrs25-29 yrs30-34 yrs 7 22 [23] 13 [78] 13 6 [47] 24 [46] [16] 13 [59] 15 11 [32] 25 [36] [4] 8 [9] 11 [3] 6 17 [4] 14 [6] [2] 11 [5] 11 3 [4] [4] 19 [1] 6 [7] [2] Age 31 sampling strategies explained by differing locations can be largely across age differences Three, As illustrated in Chapter 32 strategi sampling explained by differing locations can be largely accommodation types across As illustrated in Chapter Three, 33 sampling strategies employed. explained by differing locations can be largely across Gender differences Table 4.3 Current Accommodation Type by Gender Accommodation Type 4.3 Current Table Table 4.2 Age by Location Table Table 4.2 demonstrates the age profile of respondents 4.2 demonstrates the age profile Table As illustrated in Table 4.3, although not significant, male respondents were more likely than female more were 4.3, although not significant, male respondents As illustrated in Table of the total female study staying in a hostel (52% v 44%). Over a third to report respondents sleeping than rough likely to report more staying in a B&B (37%). Males were population reported this 20%) of the male study population reporting their female counterparts, with a fifth (n=48; 7% (n=8) of the female group. accommodation type in comparison to only 50 Drug Use Among the Homeless Population in Ireland NACD 2005 5Thisdoes notrelate toactual numberofchildren perrespondent. Respondents were not askediftheyhadanychildren asitw 35 Agedifferences across locationscanbelargely explainedbydiffering samplingstrategiesemployed. 34 6Allpercentages citedthroughout the report are based on validpercentages, adjustedformissing data. 36 Chapter Four Table 4.4Current AccommodationType byLocation locations Table 4.4demonstratesthecurrent accommodationtypeoftherespondents ineachofthefourcity accommodation for“afewdays”,whileovera quarter(n=95;27%)reported lengthoftimeas“afew than sixmonths.More specifically, 15%(n=52)of thetotalstudypopulationwere intheircurrent thirds oftherespondents (n=224;64%)were intheircurrent accommodationfor periodsofless This doesnotnecessarilyrelate tothelengthoftimeclients havebeenhomeless.Nearlytwo- All respondents were asked howlongtheyhavebeenintheircurrent homelessaccommodation. Length ofTimeinCurrent Accommodation 4.2.1 sharing withfriends(n=3;1%) another 5%reporting livingwith apartnerandchildren (n=16)andtheremaining individuals reported 11% shared withapartner(n=36),5%reported livinginaccommodationalonewithchildren (n=18), dependent children. Overthree-quarters ofthesamplereported beingontheirown(n=261; 78%), primarily intendedtoascertainwhethertheyhadanyresponsibility fortheaccommodationneedsof Respondents were alsoaskedwithwhomtheyshared their current accommodation. Thisquestionwas had 4and5dependentchildren 2 dependentchildren, 11%(n=3) had3dependentchildren andtheremaining respondents (7%;n=2) those whoreported sharingtheir accommodationwithchildren had1dependentchild,14%(n=4) children, were askedtoreport thenumberofchildren under18years.Sixty-eightpercent (n=19)of (mean age=30.8years)orstayingwithfriendsrelatives (meanage=27.4years) reported stayinginaB&B(meanage=30.1years),sleepingrough (meanage=33.3years),squatting who reported thattheywere stayinginahostelwere older(meanage=37.1years)thanthosewho Analysis revealed thatthere were agedifferences across variousaccommodationtypes.Individuals bevtos[][][][][-] - [-] - - - - [4] [-] - 11 [2] - - [16] 6 [1] [14] 44 - [2] [6] 3 39 - [5] [1] 2 [30] [1] - 14 3 [2] [6] 83 3 [4] [7] [10] 2 [23] [64] 11 19 4 64 26 [47] [9] [109] Observations [12] [69] Missing 19 45 4 3 19 Squat [176] [56] [34] Friends/Relatives 50 16 Other 10 Sleeping Rough B&B Hostel Accommodation considered particularlysensitive ifthere wasnochild-care responsibility involved. population outsideofDublinasthisaccommodationtypewasnotcollectedwithinthesample. accommodation underTable 4.3aboverefer tocurrent accommodationofmembersthestudy shed (5),long-termresettlement (4),boat(1),recovery house(1).Thenumbersfortransitional “Other” current accommodationrefers totransitionalhousing (17),car(2),detoxcentre (2),tent 32 . Research PopulationProfile andCharacteristics Population City Total Study Locations n%n% %n n % %n n % %n n33 n25 n3)(=6 (n=36) (n=36) (n=36) (n=245) (n=353) 36 . Thosewhoeitherlivedalonewithchildren, orwithpartnerand 35 . ulnCr ieikGalway Limerick Cork Dublin 34 . as NACD 2005 Drug Use Among the Homeless Population in Ireland 51 Research Population Profile and Characteristics and Profile Population Research Chapter Four Chapter 4.3.3 Registration on a Local Authority Housing List on a registered being currently population (n=240; 68%) reported of the total study Over two-thirds (n=113; 32%). not registered were of the respondents Local Authority Housing List. Almost one-third illustrated as data using the survey questionnaire self-reported This information was obtained through with the local authorities in question. However, and as such, was not verified chapter, in the previous on a not registered of these individuals, who are what is not possible to ascertain is what proportion the potential Any prior evictions can reduce eligible for social housing. local authority housing list, are authority. by the local likelihood for an individual to be rehoused sleepers (n=31; 66%) in the Dublin sample (n=75; 69%) and rough of hostel dwellers Over two-thirds (n=59; 92%) of those staying in The vast majority with the local authority. registered said they were within the Of those registered with the local authority. registered B&B accommodation in Dublin were with Dublin City Council, being registered Dublin sample, the vast majority (n=161; 89%) reported 4.3.2 Last Permanent Address 4.3.2 Last Permanent Address Within their last known permanent address. the Dublin also asked to report Respondents were as being their last permanent address of individuals reported proportion homeless sample, the largest 17%), the North Inner City (D.1 & D.7; 14%), and the South in the South Dublin suburbs (D.22 & D.24; their last known address reported (n=16) of the respondents Inner City (D.2 & D.8; 14%). Seven percent as being in the UK. their last Galway-60%) reported (Cork-69%; Limerick-74%; Outside of Dublin, the majority of respondents was there undertaken. However, interviews were as being the city within which the permanent address locations. For example, within the Galway different also indications of various mobility patterns across as being outside of Galway. their last permanent address reported sample, 40% of the respondents 4.3.1 Nationality and Ethnic Origin 4.3.1 Nationality and Ethnic Origin 11% (n=40) largely (n=315; 89%) was Irish with the remaining The majority of the total study population Scotland. However in Cork, only three England, and Northern Ireland, comprising of individuals from 95% (n=337) of the In terms of ethnicity, Ireland. from were quarters (75%) of the homeless population members of the the majority white population, 4% (n=15) were from total study population were and the remaining of a black or mixed ethnic group two individuals were traveller community, was coded as missing. response 4.3 Population Profile 4.3 Population Profile weeks”, and over a fifth (n=77; 22%) for “a few months”. This illustrates the high mobility patterns of (n=77; 22%) for “a few months”. This weeks”, and over a fifth 23% (n=81) However, homeless accommodation types. within and across the homeless population (n=63) of percent Twenty-six in excess of one year. accommodation being in their current reported to only 16% (n=18) of female respondents. such, in comparison reported male respondents half by homeless accommodation type, nearly accommodation time in current In terms of length of doing so in at the time of interview had been sleeping rough who reported (n=26; 47%) of those (n=56; 32%) and just over of hostel dwellers less than a third excess of the last six months in contrast to a fifth of B&B occupants (n=15; 22%). 52 Drug Use Among the Homeless Population in Ireland NACD 2005 the homelesspopulationoutsideofDublin(median=8weeks;range=1-156weeks). reason fortheireviction,whichrepresents 3%ofthestudypopulation. their eviction.Overall,atotaloftwo-fifths(n=11)citedeitherdruguseordealingastheprimary anti-social behaviour(n=27;19%).Overone-in-fourofthoseevictedciteddruguseasthereason for lived inlocalauthorityaccommodation,nearlyone-in-fivereported havingbeenaskedtoleavedue Chapter Four SD= 229.03;range1-1976weeks) weeks; SD=129.79;range1-780wks)thanfortheDublinhomeless population(mean=153.82weeks; Mean lengthoftimecurrently homelesswassubstantiallyshorterforthoseoutsideDublin (mean=73.5 rough (146.7weeksv112.5and113.40respectively). mean lengthoftimehomelessthaneitherthosestayinginB&B accommodationorthosesleeping (mean=133 weeks).Intermsofhomelessaccommodation,those stayinginhostelsreported ahigher of beingcurrently homeless(mean=118weeks)thanwasthecasefortheirmalecounterparts less thansixmonths.Althoughnotsignificant,womenonaverage reported aslightlyshorter duration 38 years.Athird ofthetotalstudypopulation(n=112;33%)reported beinghomelessforaperiodof 18%) withonerespondent statingthattheircurrent episodeofhomelessnesshadlastedformore than respondents reported theircurrent episodeofhomelessnessasbeinginexcessfiveyears(n=61; All respondents were askedhowlongtheyhavebeencurrently homeless.Almostone-in-fiveof 4.4.1 LengthofTimeCurrently Homeless 4.4 HistoryofHomelessness respondents (n=142;41%)reported havingeverlivedinlocalauthorityaccommodation ever askedtoleavedueanti-socialbehaviour. Resultsillustratethatlessthanhalfofthe Individuals were alsoaskedif theyhadeverlivedinlocalauthorityaccommodation,andifwere 4.3.4 LocalAuthorityHousingandAnti-SocialBehaviour Dublin sample(median=17months;range=1-168months) The averagenumberofmonthssinceentryontothehousinglistwas28(2.3years)for of therespondents whoreported beingonalocalauthority housinglistwere registered inDublin. be indicativeofthelarge homelesspopulationgroup located inthecitycentre. OutsideDublin,none Traveller HousingWaiting List.Thehighpercentage ofthoseregistered withDublinCityCouncilmay individual reporting bothDublinCityCouncilandSouthCountyoneonthe remaining three andGalwayCountyCouncil,withan percent (n=5)comprisedofFingal,Wicklow followed bySouthDublinCountyCouncil(n=10;6%)andDunLaoghaire/Rathdown (n=4;2%).The 0Thiscan largely beexplained bythedifferent accommodation types includedwithinthesampling strategies employedacross 40 Thequestionaskeddidnotspecifywhether thiswasasamemberofhousehold livinginlocalauthorityhousingorunder the 39 Outlierswere removed from theDublinsampleforappropriate calculationofthe mean lengthoftimesincelastcontact withL 38 Outlierswere removed from theDublin sampleforappropriate calculationofthemeanlengthtime onhousinglist.Original 37 Dublin samplewas13weeks(median=4weeks;range=1-156weeks) number ofweekssincelastcontactwiththeLocalAuthorityHousingDepartment,meanfor for thehomelesspopulationoutsideofDublin(median=12months;range=1-180months).Interms homeless forlessthantwelvemonths, incomparisonto40%(n=94)withintheDublinsample. Cork (n=25;71%)andLimerick (n=26; 72%)andoverahalfinGalway(n=19;53%)were currently locations. own tenancy. Authority housingdepartment. Originalrangewas1-364weeks. range was1-300months. Research PopulationProfile andCharacteristics 40 . More specifically, almostthree-quarters ofthestudypopulationin 37 in comparisonto34.2months(2.9years) 38 in comparisonto25weeksfor 39 . Ofthosethat ocal ir NACD 2005 Drug Use Among the Homeless Population in Ireland 53 ss ge 42 45 yrs + . Sixty-four per cent (n=70) of the 43 Research Population Profile and Characteristics and Profile Population Research 40-44 yrs 35-39 yrs Chapter Four Chapter 30-34 yrs 44 25-29 yrs 20-24 yrs . 41 15-19 yrs < 15 yrs distribution of respondents in these locations are older. older. in these locations are distribution of respondents with their families. 5% 0% 41 of the sampling strategy employed as the a homelessness in Cork and Galway could be as a result The higher levels of previous Figure 4.1 Age First Became Homeless of Total Study Population 4.1 Age First Became Homeless of Total Figure 42 adjusted for missing data. based on valid percentages, are the report cited throughout All percentages 43 homele both to those unaccompanied and also those who were age first homeless as 15 years or less refers reporting The figure 44 adjusted for missing data. based on valid percentages, are the report cited throughout All percentages 4.4.3 Age First Homeless of respondents homeless of the total study population. Over a third 4.1 illustrates the age first Figure 40) the age of first becoming homeless as 19 years or less (n=132; 38%) with 11% (n = reported the age of first becoming homeless as less than 15 years reporting The mean length of time homeless for those who had prior experience was 130.48 months or 10.9 The mean length of time homeless for those clients that although not significant, female revealed years (SD 147.331; range 1-780 months). Analysis of homelessness than their male counterparts. Women on average had experienced longer periods homelessness, while their male counterparts an average of 117.3 months (9.8 years) of reported 137.6 months (11.5 years) of homelessness. reported 7 times an average of of homelessness reported Those for whom this was not their first experience “many homeless on that they were also reported respondents homeless (range: 1-60 times). Twelve was coded as “countless”. and as such their response occasions”, or “too many to remember” All respondents were asked whether their current experience of being homeless was their first. Over experience of being current asked whether their were All respondents This remained prior experiences of homelessness. 59%) reported (n=211; half of the sample group prior experience having had of respondents same for the Dublin sample with 56% (n=138) the largely level of prior homelessness (75% and and Galway samples displayed the highest of homelessness. Cork 72% respectively) 4.4.2 Experience of Homelessness 4.4.2 Experience female respondents reported first becoming homeless as less than 25 years in comparison to 47% reported female respondents (n=112) of the male respondents. Analysis revealed that although not significant, there was a gender difference in previous experience of previous in difference was a gender that although not significant, there Analysis revealed likely than their male counterparts to report more proportionately homelessness. Female clients were (n=69) of female respondents Sixty-two percent having had prior experiences of homelessness. with 58% (n=142) of male respondents. this compared reported also asked how many were that they had prior experience of homelessness Respondents who reported of period of time they had spent homeless. A third times they had been homeless and the longest A further one year. that their longest period homeless was less than (n=65; 33%) reported respondents (n=9) 1-2 years. Five percent that their longest period out of home was between 18% (n=35) reported of ten years. that their longest time out of home was in excess of the sample reported 30% 25% 20% 15% 10% 54 Drug Use Among the Homeless Population in Ireland NACD 2005 for theDublinhomelesspopulation Outside Dublin,themeanageoffirstbecominghomelesswas29.7yearsincomparisonto26.4 24.5 yearsfortherough sleepingsample;and22.7yearsforthoseresiding withfriendsandrelatives. any othergroup. Thisisincomparisonto23.3yearsforB&Boccupantsandthosestayingsquat; that themeanageoffirstbecominghomelesswashigherforthosestayinginhostels(29.4years)than were onaverage29years-of-age.Furtheranalysisbycurrent homelessaccommodationtyperevealed Female respondents were onaverage24years-of-agewhen firsthomeless,whilethemalerespondents were firsthomelessatasignificantlyyoungeragethanmalerespondents (t-test=3.15;df=344;p<0.05). younger ageoffirstbecominghomelessthantheirmalecounterparts.Analysisrevealed thatwomen Dublin withameanageof26.4years. homeless bycitylocation.Asconveyed,Corkexhibitsthelowestmeanageof25.9yearsfollowed Chapter Four while malerespondents were proportionally more likelytoreport personalalcohol use(17%v4%). to report personaldruguseas aprimaryfactor, incomparisontotheirmalecounterparts (24%v17%) while 13%reported personal alcoholuse(n=44).Femalerespondents were proportionally more likely reason forbecominghomeless. Nineteenpercent (n=67) oftherespondents cited personaldruguse the primaryreason forfirstbecominghomeless.Drugusewascitedasthesecondmostcommon homelessness. Nearlyaquarter(n=84;24%)ofthetotalstudy population reported familyconflictas Primary Reason: report boththeirprimaryandanysecondarycontributoryreasons forbecominghomeless. As thefactorscausinghomelessnessare oftencomplexandintertwined,respondents were askedto 4.4.4 ReasonsforHomelessness Table 4.5Age FirstBecameHomeless The meanagerespondents firstbecamehomelesswas27.4years 6Differences inmeanagefirsthomeless across locations canbelargely explained bydiffering samplingstrategies employed. 46 First homelessincludedages2,7,8and9aspart ofafamily. Thesewere removed forthepurposeofcalculating meansinor 45 awy3 112 3 32 13-64 11-58 12-60 11-79 13.24 13.22 12.9 11-79 13 13* 12.72 21* 12* 17 27 17 31 21 24 31.1 22 31.8 25.9 27.4 35 26.4 36 33 346 AgeFirstBecameHomeless *Multiple modesexist.Thesmallestvalueisshown. 242 Total Population Galway Limerick Cork Dublin Location to prevent skewingofdata. Research PopulationProfile andCharacteristics Table 4.6illustratesthemainreason triggeringrespondents’ firstepisodeof enMda oeS Age SD Mode Median Mean N 46 . Table 4.5belowillustratestheagebreakdown offirstbecoming g g g Range Age Age Age 45 . Femalerespondents reported a der NACD 2005 Drug Use Among the Homeless Population in Ireland 55 y a n=5), oice Research Population Profile and Characteristics and Profile Population Research Chapter Four Chapter Dublin Cork Limerick Galway (n=350) (n=243) (n=35) (n=36) (n=36) %n % n %n % n %n 23 [80] 24 [58] 14 [5] 11 [4] 36 [13] Population City Locations Study Total City Population The questionnaire was designed to allow respondents provide more than one more provide to allow respondents was designed The questionnaire 47 physical/sexual abuse (n=5), evicted from private rented accommodation (n=4), unfit accommodation (n=4), leaving institution/ accommodation (n=4), unfit accommodation private rented physical/sexual abuse (n=5), evicted from (n=2), personal ch (n=2), lost job (n=2), early school leaving prison (n=3), alcohol use-family (n=2), physical health problems UK (n=1), lost LA accommodation – from accommodation sold (n=2), returned (n=2), gambling (n=2), intimidation (n=2), previous living alone (n=1), pregnanc school teachers (n=1), house burnt down (n=1), lonely for mother (n=1), violence from went to care at and had to move (n=1), alcohol use of other tenant (n=1), ADHD problems (n=1), sold house/lost money (n=1), threatened setting and was asked to leave (n=1), expelled from in residential home (n=1), government system (n=1), caused problems local community from pressure (n=1), with police (n=1), lost passport in London on way to Amsterdam priesthood (n=1), trouble of drug use of to quit (n=1), became homeless as a result (n=1), evicted due to anti-social behaviour (n=1), court order/notice family member (n=1). Main Reason Observations [5] [4] [1] [-] [-] Money ProblemsDomestic Violence 5 5Mental Illness- [19]Personal 3 [16]Other [10] 5 2 1 [12] [6] [3] - 11 6 - [4] [2] 17 14 8 [6] [5] [3] 6 - [2] 6 - [2] Family Conflict Drug Use-Personal 24 19Alcohol Use- Personal [84] [67]Relationship 27 23 8Breakdown [65] [55] [30] 13 27 20 [44] 7 [9] [7] 11 [18] 19 [26] 6 11 [7] 11 [4] [2] [4] 8 3 8 22 [3] [1] [3] [8] 19 17 [7] [6] Missing 47 (n=6), asked to leave by family ( local authority (n=9), told to go by landlord died (n=9), evicted from Family member/spouse Table 4.6 Main Reason for First Becoming Homeless 4.6 Main Reason Table Across city locations, over one-fifth of the respondents in Dublin and Cork reported personal drug use and Cork reported in Dublin locations, over one-fifth of the respondents city Across in Limerick substantially lower were 4.6, figures Table as illustrated in However, as the primary reason. was higher for becoming homeless use as a primary reason Alternatively personal alcohol and Galway. to 11% in both Dublin and Cork. in Limerick (22%) and Galway (17%) in comparison Secondary Reasons: secondary reason for becoming homeless. Similar to main reason for homelessness, family conflict was to main reason for becoming homeless. Similar secondary reason for first becoming homeless (12%; n=44). Unlike the main as the highest secondary reason reported alcohol use than personal for first becoming homeless, a higher number of individuals reported reason (n=36; 10%) reported One-in-ten of the respondents personal drug use as a secondary reason. drug use (n=33). Although not significant, male respondents personal alcohol use and 9% reported likely to cite personal drug use as a secondary factor than their female counterparts more were (10% v 7%). 56 Drug Use Among the Homeless Population in Ireland NACD 2005 9Due tothecodingscheduleemployed itisnotpossibletoascertainthereasons forlackofaccess tolocalauthorityhousing 49 most frequent factorinrespondents remaining homeless(n=86;25%) homeless. AsillustratedinTable 4.7,lackofaccesstolocalauthority accommodationwascitedasthe Remaining Homeless: respondents (n=25;7%). primary reason forremaining homeless.Continuingalcoholusewaslessfrequently reported by study populationreported continuingdruguse(n=39;11%)ormoneyproblems (n=39;11%)astheir Chapter Four Table 4.7SecondaryReasonsforFirstBecomingHomeless 8Physicalhealthproblems (n=7),domesticviolence (n=7),mentalillness-personaldruguse-family(n=5),unfit 48 *Multiple responses were allowed yFml 4[5 1]------[2] - - [6] 6 17 - - [3] [2] [6] [2] - [1] 8 [5] 17 6 3 6 [15] 14 - [6] [3] 6 [14] [3] [2] [3] 17 8 6 - 8 [15] 6 8 [8] [13] 4 [15] [12] Other [5] [3] [4] 22 5 Abuse 4 14 5 8 Physical/Sexual 11 [16] [20] [21] by Family [22] [21] [6] 7 Asked toLeave 6 9 6 17 9 Alcohol Use-Family [36] [29] Money Problems [32] [33] 10 Breakdown 8 13 9 Relationship [44] Drug Use-Personal Personal 12 Alcohol Use- Family Conflict Main Reason death ofafriend(n=1), evictedduetoanti-socialbehaviour(n=1), courtorder/notice toquit(n=1),mentalillness-family(n was forced toleavehome(n=1),disowned byfamilybecauseofsexuality(n=1),criminal conviction(n=1),lostLAhouse lack ofeducation/literacy (n=1),chosetoleavecommunitydue totheavailabilityofdrugsthere (n=1),wentwithboyfriend wh barring order (n=1),sibling died/emotionalbreakdown (n=1),notconsidered eligibleforLAhousing(n=1),criminalactivities disability (n=2),mixingwithwrong people/crowd (n=2),alcoholuseamonghousemates (n=2),evictedfrom localauthority(n=2), job (n=3),evictedfrom privaterented (n=3),gambling(n=2),personalchoicehomelostinfire (n=2),lostjobdueto accommodation (n=5),leavinginstitution-prison (n=4),parent(s) died(n=4),jobfinishedtoldtogobylandlord (n=3), 48 Research PopulationProfile andCharacteristics All individualswere alsoaskedtostatetheprimaryreason forremaining Population City Total Study Locations 2[0 0[9 2[]4 1]2 [8] 22 [15] 41 [8] 22 [49] 20 [80] 22 n%n% %n n % %n n % %n ulnCr ieikGalway Limerick Cork Dublin 49 . Justoverone-in-tenofthe =1). lost . (n=1), o NACD 2005 Drug Use Among the Homeless Population in Ireland 57 1), on a n=1). (n=1), ack of Research Population Profile and Characteristics and Profile Population Research Chapter Four Chapter Dublin Cork Limerick Galway (n=343) (n=238) (n=33) (n=36) (n=36) %n % n %n % n %n 21 [70] 18 [42] 27.5 [9] 33 [12] 19 [7] Population City Locations Study Total City Population 51 50 upbringing (n=1), just moved to Ireland (n=1), can’t get a referral (n=1), left hospital directly referred to homeless services referred (n=1), left hospital directly get a referral (n=1), can’t upbringing (n=1), just moved to Ireland use (n= domestic violence continues (n=1), gambling (n=1), length of time homeless-institutionalised (n=1), others drug/alcohol (n=1), waiting short term homeless (n=1), ADHD (n=1), no other choice (n=1), lack of ID (n=1), discrimination (n=1), not ready ( (n=1), had a fight with the landlord landlord stole from (n=1), friend but not in same area house (n=1), wants to be rehoused Other Missing Observations [12] [9] [3] [-] [-] RentedFamily Conflict Continuing Alcohol Use 9 11Personal Choice [31] [37] 5 7 11 7 [16] [25] [26] [17] 3 6 5 27.5 [2] [13] [8] [9] 18 3 8 14 [6] [1] [5] [3] 3 6 17 - [1] [6] [2] - 14 14 [5] [5] Housing- L. Authority 25Continuing Drug Use 11 [86]Money Problems [39] 31Cannot Access 11Housing-Private 15 [74] [39] [35] 12 10 6 [4] [23] [2] 8 - 3 [3] - [1] 14 25 [5] 3 [9] [1] 19 [7] Main Reason Cannot Access 51 adjusted for missing data. based on valid percentages, are the report cited throughout All percentages 50 (n=2), emigration (n=2), lack of training (n=1), l in care disability (n=2), needs caravan as children No job (n=2), physical 4.6 Sources of Income 4.6 Sources allowed. were of income. Multiple responses the various sources asked to report All individuals were (n=336; 95%), while criminal activities by the majority of respondents cited Government benefits were by 15% (n=54) of the total study population. Less than one-in-ten of the respondents reported were (n=4; 1%) or occasional employment whether regular employment as an income source, reported of government benefits. Nearly three-quarters the most income from (n=30; 8%). Respondents received of income (n=263; 78%). the total study population cited government benefits as their primary source Two-thirds of the total study population (n=233; 66%) were unemployed at the time of interview with of the total study population (n=233; 66%) were Two-thirds courses, training 10% (n=35) reported unable to work. The remaining being 24% (n=83) also reporting in employment at the time of This also included 3 individuals who were and retirement. childrearing interview. In terms of education, a quarter of the total study population (n=88; 25%) reported that primary study population (n=88; 25%) reported In terms of education, a quarter of the total lower (n=176; 50%) having reached and half reported education or less was their highest level reached upper second-level education. Only 6% (n=20) (n=54) reported second-level education. Fifteen percent 4% (n=13) higher education. The remaining having completed of the overall study population reported the Little variations exist across ‘other’ education such as, FÁS courses and apprenticeships. reported city locations. 4.5 Education and Employment Table 4.8 Main Reason for Remaining Homeless 4.8 Main Reason Table 58 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Four Table 4.9Current LegalStatus (n=5), onremand (n=1),charge inabsence(n=1),temporary release (n=1),dueincourt(n=1). reported havingoutstandingwarrants(n=48).“Other”legalstatusspecifiedrefer to;charges waiting (n=48) ofthehomelesssamplereported beingonbailawaitingtrial/sentencingandafurther14% Two-thirds ofthestudypopulation(66%)reported currently havingnolegalissues.Fourteenpercent dwellers and58%(n=40)ofB&Boccupants. (n=39) ofrough sleepersreported previous imprisonmentincomparisonto50%(n=85) ofhostel imprisonment thantheircounterpartsstayinginhostelorB&Baccommodation.Seventy-onepercent female respondents. Rough sleepers were proportionally more likelytoreport previous experienceof male respondents reported havingspenttimeinprison comparisontoonly38%(n=44)ofthe than theirhomelessfemalecounterparts(x2=13.97;df=1;p<0.01).Sixty-twopercent (n=149)ofthe Analysis revealed thatmalerespondents were significantlymore likelytoreport havingbeinginprison outside ofDublin. homeless samplereported havingspenttimeinprisoncomparisonto41%oftherespondents from total studypopulationreported havingspentsometimeinprison.Sixty-onepercent oftheDublin Respondents were askedabouttheirexperienceofimprisonment.Fifty-fivepercent (n=193)ofthe 4.7 LegalStatus other sources. reported theirprimaryincomesource asfamily/friends,regular/occasional employmentandvarious Ten percent (n=33)reported criminalactivities,while6%(n=20)reported begging.Theremaining 6% The followingare someofthemainfindingsonresearch participants– This chapterhaspresented an overviewofthecharacteristicstotalstudypopulation(n=355). 4.8 SummaryandConclusions usadn ie 7[24] [48] [230] 7 [17] 14 [48] 66 Total StudyPopulation 5 14 Probation/Community Services Contact With Outstanding Fines Outstanding Warrants On BailAwaiting Trial/Sentencing No LegalIssues Legal Status te [9] 3 *Multiple responses were allowed Other Research PopulationProfile andCharacteristics %n NACD 2005 Drug Use Among the Homeless Population in Ireland 59 of the homeless feminisation Research Population Profile and Characteristics and Profile Population Research 2003:30). et al., Chapter Four Chapter 2003). Several factors influence the age structure in general hostels, 2003). Several factors influence the age structure et al., 2000; Corr, 2003a). 2000; Corr, et al., for e.g. the availability of specialist young people projects, hostels’ admission criteria, resettlement for e.g. the availability of specialist young people projects, practices and move-on opportunities (Warnes their last permanent of individuals in the Dublin sample reported proportion The largest & D.24; 17%), the North Inner City as being in the South Dublin suburbs (D.22 address (n=16) of (D.1 & D.7; 14%), and the South Inner City (D.2 & D.8; 14%). Seven percent as being in the UK. address their last known reported respondents by affected also disproportionately Studies have illustrated that these Dublin communities are operate. The in which local drugs task forces also areas 1998) and are drug use (Comiskey, likely to more mean that individuals are in Dublin could also centralisation of service provision service users in 2002 by the Dublin Simon of outreach A profile these areas. towards relocate population. Individuals staying in a hostel were older (mean age=37 yrs) than those who reported older (mean Individuals staying in a hostel were (mean age=31 years), staying in a B&B (mean age= 33 years), squatting sleeping rough (mean age=27 years). (mean age= 30 yrs), or staying with friends or relatives account for the majority of those who stay in has indicated that single homeless males Research This is also consistent with the policy on placement in Dublin. 2001). hostels (Crane and Warnes, aged 50 and over are has indicated that among hostel dwellers, a higher proportion UK research (Warnes than under-25 The majority of respondents identified themselves as single (78%). Only 10% of the study The majority of respondents in their living alone with children of whom half were living with children, population were accommodation. which has found that single males, and lone consistent with British research These findings are 1997). The most likely to experience homelessness (Burrows, to a lesser extent, are parents despite the is lower than other data would indicate number of those living with children reported age). accommodation and sampling strategies employed (gender, The majority of the total study population (89%) were Irish with the remaining 11% largely Irish with the remaining (89%) were The majority of the total study population Northern England, and Scotland. comprising of individuals from Ireland, out among Irish homeless populations (Holohan, 1997; This is consistent with other studies carried Feeney The average age was 35 years. However, over a quarter of the sample was less than 25 years The average age was 35 years. However, the male counterparts. significantly younger than were of age. Female respondents 2003) suggest that the homeless (Warnes, 2003a) and international literature National (Corr, also supports the finding that within the homeless Literature population is getting younger. (Kemp, 1997). a much younger sub-group population, women as a whole are There were twice as many male respondents as female respondents interviewed yielding a as female respondents twice as many male respondents were There gender ratio of 2:1. employed. Homeless which were surprising given the sampling strategies This gender ratio is not or “hidden” to reach” as “hard often regarded homeless women, are women, especially single is an that there in other countries have highlighted studies research (Jones, 1999). Nevertheless, the number of women among the homeless population with some commentators in increase sector of the have become the fastest growing supporting the view that women and children (1998) has alluded to the homeless population (Smith, 1999). Harvey ■ ■ ■ ■ ■ ■ Socio-Demographic Details: Socio-Demographic 60 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Four ■ ■ ■ ■ Homeless Accommodation: Hickey, 2000;Smith majority ofthoseusingB&Baccommodation inDublinare women withchildren (Houghton and majority ofthosewhostayinhostels (CraneandWarnes, 2001;Feeney reflects thesamplingstrategieswhichwere employed.Singlehomelessmalesaccount forthe This profile ofhomelessaccommodationandgenderdistribution ofaccommodationlargely respondents toreport hostelaccommodationandrough sleeping. rough sleeping.Although notsignificant,malerespondents were more likelythanfemale Nineteen percent (n=69)reported current B&Baccommodationwhile16%(n=56) reported Half ofthestudypopulationcurrently resided inhostel accommodation(n=176;50%). Hostel, B&B,andrough sleepingwere themostreported homelessaccommodationtypes. court system(CrisisUK1999,citedinBergin 2000). or ayoungoffenders’ institution,manyofwhomalsohaverepeated contactwiththepoliceand Research from theU.Kindicatesthataround halfofthepeoplesleepingrough havebeeninprison dwellers and58%ofB&Boccupants. percent ofrough sleepersreported previous imprisonmentincomparisonto50%ofhostel imprisonment thantheircounterpartsstayinginhostelorB&Baccommodation.Seventy-one Rough sleeperswere proportionally more likelytoreport previous experienceof accommodation followingtheirrelease (citedinFocusIreland, 2001). would behomelessuponrelease and35%ofmenreported thattheywouldnothaveany noted byPACE (2002)whichfoundthat33%ofallIrishfemaleprisonersintheDochas Centre (O’Mahoney, 1997).Ahigherincidenceofhomelessnessamongtheprisonpopulationhasbeen the prisonpopulationsample,O’Mahoney(1997)foundthat7%ofsamplewere homeless distribution alsoreiterates previous findings(ClearyandPrizeman, 1998;Corr, 2003a).Among among thehomelesspopulation(Feeney Figures forlevelsofimprisonment are similartothosecitedbyotherIrishstudiesundertaken The associationbetweenhomelessnessandcrimehasbeenwelldocumentedbyHickey(2002). in prisonthantheirfemalecounterparts. Analysis revealed thatmale respondents were significantlymore likelytoreport havingbeing Over halfofthetotalstudypopulationreported previous experienceofimprisonment. market (HomelessAgency, 2001). homelessness (Greve, 1997)asitmakesdifficult forhomeless peopletocompeteinthehousing Britain (Warnes (Feeney This iscomparablewithfindingsfrom otherstudiescarriedoutamongIrishhomelesspopulations respondents benefits. were dependentongovernment minority ofthesamplewere inemployment(regular oroccasional).Themajorityof of theoverallstudypopulationreported havingreached highereducationandafurther Respondents demonstratedloweducationalattainmentandpooreconomicstatus.Only6% address wasintheUK(DublinSimonCommunity, 2003:5). immigrants from theUK.Seventeenpercent oftheircontacts were withindividualswhoselast Community reported thatalarge proportion ofnewcontactswere returning emigrantsor et al. Research PopulationProfile andCharacteristics , 2000,Corr, 2003a).Similarresults were foundinareview ofhomelessprofiles in et al. et al. , 2003).Unemploymentispersistentlyseenasamajorcontributoryfactorto , 2001). et al., 2000; Corr, 2003a).Thehighmalegender et al., 2000) whilethe NACD 2005 Drug Use Among the Homeless Population in Ireland 61 Research Population Profile and Characteristics and Profile Population Research Chapter Four Chapter Personal drug use (n=67; 19%) was cited as the second most common reason for becoming Personal drug use (n=67; 19%) was cited as the second most common reason personal alcohol use (n=44). Alcohol use as a primary reported homeless. Thirteen percent (22% and 17% for becoming homeless was higher in Limerick and Galway reason in comparison to 11% in both Dublin and Cork. respectively) trigger and a consequence of homelessness. drug and alcohol use is known to be a Problematic drug or alcohol of the sample reported sleepers in London, almost two-thirds In a study of rough they first became homeless (Fountain and Howes, 2001). Holohan use as one of the main reasons most (1997), in a study of homeless people in Dublin, found that drug/alcohol use was the and Hickey (2000) in their study on cited cause of homelessness (24%). Houghton frequently among drug use as a primary reason B&B placement in Dublin, similarly reported emergency as long-term homeless, 16% single adults in becoming homeless (21%). Among those regarded cause of their homelessness (Houghton and as the principal problems drug-related reported not necessarily the for becoming homeless are 2001). It is important to state that reasons Hickey, the trigger factor rather than “definitive” causes of homelessness as individuals may often report 2000). the causal factor (Houghton and Hickey, Over a third reported age first homeless as 19 years or less (n=132; 38%) with 11% (n = 40) age first homeless as 19 years or reported Over a third as less than 15 years. age first homeless reporting in which 58% of the (1998) research, cited by Cleary and Prizeman’s This is lower than the figure homelessness may be in youth of 20 years. A decrease sample had become homeless by the age years in terms of ensuring a more which has been made in recent due to the substantial progress national strategy to tackling youth homelessness. The current and planned approach co-ordinated youth and adult homelessness and the role the links between on youth homelessness recognises measures. of preventative Nearly half (47%) of individuals who reported their current accommodation as rough accommodation their current Nearly half (47%) of individuals who reported of six months in contrast to less than a third sleeping had done so in excess of the last of B&B occupants (22%). hostel dwellers (32%) and just over a fifth sleepers partly because of the “silt up” access accommodation for rough lack of direct is a There not moving on to other accommodation (Cox and are existing residents of bed spaces whereby making the thereby accommodation longer, in emergency remaining Lawless, 1999). Individuals are 2000). Older single homeless homelessness slower (Houghton and Hickey, movement through needs of all (Crane for many years have the most intensive support people who have slept rough 2001). and Warnes, Over one-in-five of those reporting staying in B&B had done so for more than six months. than more staying in B&B had done so for those reporting Over one-in-five of the duration of B&B stay the (2000: 22) have commentated that the longer Houghton and Hickey B&B use of the prolonged cycle for the household. Furthermore, longer the homeless health and social implications to have purposes is reported accommodation for emergency 2000). (Houghton and Hickey, Findings revealed that 64% (n=224) were in their current accommodation for periods of less accommodation in their current (n=224) were that 64% Findings revealed 23% (n=81) in excess of one year. (n=46) for 6 months to 12 months and than 6 months, 13% accommodation services. of mobility across This indicates high levels ■ History of Homelessness: ■ ■ ■ ■ 62 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Four ■ ■ ■ Experience ofHomelessness: ■ (28%) (DublinSimonCommunity, 2003). with asignificantpercentage alsoreporting lengthoftimehomelessasbeinginexcess5years the DublinSimonCommunityin2002illustratesthatoverathird were homelessfor1-5years(37%) increased from 62%in1997to65%199868%2000.Aprofile ofoutreach serviceusersby Bergin (2000)foundthattheproportion ofrough sleepershomelessformore thanoneyearhad being inexcessofoneyear, ofwhich19%(n=10)reported beinginexcessoffiveyears. Forty-five percent ofrough sleepers(n=24)reported theircurrent lengthoftimehomelessas 2001). Thisstudyfoundamuchhighermeanof153.8weeksforthehomelesspopulation. homeless forameanaverageofoverone-and-half-years(mean84weeks)(HoughtonandHickey, In astudyofthelong-termhomelessinDublin,individualswere recorded ascurrently being homelessness (Holohan,1997;HoughtonandHickey, andGorby, 2001;Williams 2002;Corr, 2003a). This isconsistentwithotherIrishstudieswhichhaveindicatedahighlevelofverylong-term in excessofayear(52%;n=176)with2.5yearsasthemeanlengthtimehomeless. Over ahalfofthetotalstudypopulationreported lengthoftimecurrently homelessasbeing occasion butlowerthanthe67%citedbyCorr(2003a). higher thanthe40%reported byFeeney homelessness mayrepresent asingleacuteepisodeinperson’s life.Thisfigure issubstantially occasions whichindicatesthattheyare movinginandoutofhomelessness.Forothers, The findingsshowthatmanyindividualshaveexperiencedhomelessnessonanumberofdifferent male populationandamongthosestayinginhostels. Higher meanlengthsoftimecurrently homelesswere foundamongtheDublinsample, of homelessnesswasnottheirfirstandreported anaverageof7episodeshomelessness. Over ahalfofthetotalstudypopulation(n=211;59%)reported thatthecurrent experience seen aslikelytoresult inanincrease inhomelessness(Memery andKerrins,2000). refuse tolet,sellanddenyrent allowancetothoseevictedunderanti-socialbehaviourwas regarding theindirect useoftheActwhichprovides thelocalauthoritywithextendedpowersto and Lawless,1999;MemeryKerrins,2000;LawlessCox,2003).More specifically, concern increased levelsofhomelessnessamongparticularpopulationgroups, suchasdrugusers(Cox Irish studieshaveindicatedthattheuseofMiscellaneousProvisions Act(1997)hasledto dealing astheprimaryreason fortheirevictionfrom localauthorityhousing. ofanti-socialbehaviour,In terms 3%(n=11)ofthetotalstudypopulationciteddruguseor Research PopulationProfile andCharacteristics et al. (2000) tohavebeenhomelessonmore thanone NACD 2005 Drug Use Among the Homeless Population in Ireland 63 Dublin Cork Limerick Galway (n=352) (n=247) (n=35) (n=35) (n=35) %n % n %n % n %n Population City Locations Study Total Population City Alcohol Use 2-3 Times a Week4+ a Week 20Missing [3] [69] 21 23 [51] [83] [-] 3 20 [50] [1] [1] 37 17 [13] [6] 46 31.5 [1] [16] [11] 11 [4] [1] NeverMonthly or Less2-4 Times a Month 14 13 [49] 30 [46] [105] 16 12 31 [40] [30] [76] 6 20 34 [2] [7] [12] 11 9 17 [4] [3] [6] 9 31.5 17 [11] [3] [6] Table 5.1 Frequency of Alcohol Consumption by Location 5.1 Frequency Table 5.2 Frequency of Alcohol Consumption 5.2 Frequency of of alcohol consumption by city location. Overall, almost a third 5.1 illustrates the frequency Table the never consuming alcohol. A limitation of the study was the study population (30%) reported alcohol detox. This an experience of having undergone previous omission of a question regarding never consuming alcohol. additional information on those who reported would have provided a week with consuming alcohol 2-3 times population reported one-in-five of the total study However, age alcohol consumption in excess of four times a week. A higher mean nearly one-in-four reporting a week (36.8 years) than alcohol use in excess of four times was found among those who reported The mean (33.8 years, 34.2 years, 35.6 years respectively). groups among any of the other frequency consistent across population was 15 years and this remained age of first alcohol use for the total study the city locations (range 4-35 years). among the city locations. Only 11% of the Galway sample of alcohol consumption differed Frequency a week, followed by one fifth (20%) of the Dublin sample and than four times drinking more reported rates of alcohol use. (37%) in Cork. The Limerick sample displayed the highest frequency over a third than 4 times a week at 46% was 4 times drinking alcohol more of people reporting The proportion than twice that of Dublin. higher in Limerick than in Galway and more National and international studies of the homeless population refer to alcohol as the main drug of use to alcohol as the main drug refer studies of the homeless population National and international information on the focus of this chapter is to present population. In this regard, among the homeless this end, frequency (n=355). To use among those interviewed for this research the patterns of alcohol documented herein. of use and service issues are measures of consumption, problematic Patterns of Alcohol Use Patterns 5.1 Introduction Chapter Five Chapter Table 5.2 demonstrates frequency of alcohol consumption by gender. As conveyed, a greater of alcohol consumption by gender. 5.2 demonstrates frequency Table of percent alcohol consumption in excess of 4 times a week. Twenty-six of males reported proportion (n=20). to 18% of the female respondents this consumption in comparison males (n=63) reported 64 Drug Use Among the Homeless Population in Ireland NACD 2005 times aweek. sleeping rough reported ahigherfrequency ofalcoholconsumptionintermsuse inexcessof4 In termsofaccommodationtype,thosestayinginsquats(i.e.derelict/unused buildingsetc.)and which wouldwarrant furtherdiagnosticevaluation foralcoholdependence(Miller suggests ahighlevelofalcohol problems, themajorityofwhom (n=103;42%)scored 20 or above a halfofthosewhoreported consumingalcohol(n=121;49%), hadascore inexcessof16 which Chapter Five such mayalsoreflect agreater severityofalcoholproblems (Babor total studypopulation.Ashigher scores indicategreater likelihoodofhazardous orharmfuldrinking, (n=180) scored above8suggesting harmfulorhazardous drinking.Thisrepresents 51%oftheoverall In accordance withtherecommended cutoff points,ofthosewhowere consumersofalcohol,73% which wasadministered onlytothosewhoreported alcoholuseatinterview(n=247). Screening Instrument(AUDIT) 5.3 TheAlcoholUseDisorders IdentificationTest Table 5.3Frequency ofAlcoholConsumptionbyAccommodationType Table 5.2Frequency ofAlcoholConsumptionbyGender 2Ascore oflessthan8:no problem. 52 et al., detect arangeofdrinkingproblems andinparticular, hazardous andharmfulconsumption(Saunders As discussedinChapterThree, theAUDITquestionnaire isa10-itemscreening instrument designedto bevtos[][][][][-] [-] [2] 33 - [-] [3] [2] [1] - [1] 33 17 25 [3] 17 [-] [17] [2] [3] 25 31 [1] 17 25 [12] [8] 8 [15] [3] [2] 17 14 27 [13] 5 [13] [42] [3] [26] 23 Squat [83] [7] 24 19 38 [11] Observations 23 10 [40] F&Rel Missing 16 [44] [20] [69] [-] 23 4+ aWeek [27] 25 [105] [21] S.Rough 20 aWeek 2-3 Times 18 [46] 16 30 [49] 12 aMonth 2-4 Times 13 [14] [63] 14 [48] B&B Monthly orLess [3] 26 [13] 13 43 [16] Never 12 [55] 14 [57] Hostel 22 [33] 24 [33] Accommodation 14 14 Missing Observations 4+ aWeek aWeek 2-3 Times aMonth 2-4 Times Monthly orLess Never A score of 16 ormore :islikely to indicateahighlevel ofalcoholproblems. A score of8orabove:associatedwith harmful orhazardous drinkingandissuggestiveofalcoholproblems. 1993; Barbor Patterns ofAlcoholUse et al., n%n% %n n % %n n % %n 2001) n14 n6)(=6 n1)(n=6) (n=12) (n=56) (n=69) (n=174) 52 . Table 5.4presents theresults oftheAUDITscreening instrument n%n%n n % %n n21 n11 (n=352) (n=111) (n=241) aeFml Total Female Male et al., 2001). Inthisregard, nearly (Miller et al., et al., 1992; Babor 1992; Babor et al., 2001). NACD 2005 Drug Use Among the Homeless Population in Ireland 65 Study Pop. Patterns of Alcohol Use Use of Alcohol Patterns Chapter Five Chapter More male respondents reported a high reported male respondents More 53 (n=184) (n=63) (n=247) (n=352) %n%n %n % (n=171) (n=23) (n=29) (n=24) %n %n %n %n 2001). Just over a quarter (n=67; 27%) scored less than 8 indicating no alcohol problems, which problems, less than 8 indicating no alcohol (n=67; 27%) scored 2001). Just over a quarter No problem No problem Alcohol Problem (harmful/hazardous drinking) 30 [51] 13 70 [3] [120] 87 21 [20] [6] 79 29 [23] [7] 71 [17] Score DublinScore Cork Limerick Galway Alcohol Problems 50 [93] 44 [28] 49 [121] 34 No problem No problem Alcohol Problem (harmful/hazardous drinking)High Level of 24 [44] 37 76 [23] [140] 27 63 [67] [40] 73 19 [180] 51 Score Score Male Female Total % of Total score than did female respondents (Score 8+ = 76% v 63%). The AUDIT does not differentiate 8+ = 76% (Score than did female respondents score it is possible to argue points. However, cut off between males and females in terms of recommended physical harm risk of alcohol-related of 10 for a woman would be associated with a greater that a score (Dawe and Mattick, 1997). Table 5.5 Results of AUDIT Screening Instrument by Location (n=247) Instrument 5.5 Results of AUDIT Screening Table Table 5.4 Results of AUDIT Screening Instrument (n=247) Screening 5.4 Results of AUDIT Table et al., the overall study population. 19% of represents Further examination of the scores showed that in each city location a similarly high proportion were city location a similarly high proportion showed that in each Further examination of the scores alcohol users. problematic sleeping accommodation. Over half of the by hostel, B&B and rough 5.6 shows AUDIT scores Table of the B&B (39%) sleeping (52%) population surveyed and over a third hostel (55%) and rough that 44% (n=57) of drinkers drinkers. Further analysis revealed problematic population surveyed were in excess of 20 which would warrant further in hostels (32% of the total hostel sample), had a score sleepers with found among rough were diagnostic evaluation for alcohol dependence. Similar results (32%) warranting further investigation for dependency. of the total sample nearly a third A gender breakdown of the scores is illustrated in Table 5.4. is illustrated in Table of the scores A gender breakdown 53 adjusted for missing data. based on valid percentages, are the report cited throughout All percentages 66 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Five due totheiralcoholuse.Although notsignificant,drinkerswhowere stayinginahostelwere of thetotalstudypopulation,reported thattheyhadexperienced difficulties accessing accommodation accommodation duetotheiralcohol use.One-fifth(n=33;20%)ofcurrent drinkers,whichrepresents 9% Eligible respondents were alsoaskediftheyhadeverexperiencedanydifficulties accessingemergency awareness. sample indicatedthelowestpercentage withalmosttwo-thirds ofdrinkers(n=74;65%)reporting this (n=17; 68%),themajorityofcurrent drinkersreported staff were aware oftheiralcohol use.TheDublin sample reported thatstaff were aware oftheiralcohol use.Similarly, inGalway(n=13;81%)andLimerick staff were aware oftheir alcoholuse.Inrelation to thedifferent urbanlocations,alldrinkersintheCork accommodation) were asked ifstaff were aware oftheir alcoholuse.Overall,69%(n=115)reported that Those whowere current drinkersandstayinginemergency accommodation(hostels, shelters,B&B 5.4 ImpactofAlcoholUseonAccommodation Table 5.7Results ofAUDITScreening InstrumentbyAge(n=247) (46%). Three-fifths ofindividualsinthe35-44agegroup were problematic alcoholusers(60%). population withintheseagegroups were betweentheyears of20-24,30-34yearsand45-plus groups whoreported thelowestratesforproblematic alcoholuseasapercentage ofthetotalstudy Table 5.7belowconveysresults oftheAUDITscreening instrument byage.Asillustrated,thoseage Table 5.6ResultsofAUDITScreening InstrumentbyMainAccommodationType (n=214) 5 r n6]3 2]6 4]46 60 46 [43] 55 [41] 64 46 [21] 57 82 [26] 70 [24] [36] 81 [13] [9] 36 68 [9] 87 18 [6] [n=67] 30 [17] Results [n=50] 19 [2] [n=30] 32 13 [n=32] *Presented asapercentage ofthestudypopulationwithinthisagegroup [n=53] 45+ yrs [n=15] 52 35-44 yrs [29] 30-34 yrs 71 25-29 yrs 39 20-24 yrs 21 [27] 63 < 20yrs [12] 29 55 23 [96] [16] 74 Age 37 20 [34] 26 *%TSP =Percentage Total StudyPopulationinthisaccommodationtype R. drinking) (harmful/hazardous Alcohol Problem B&B No problem Score Hostel Sleeping Patterns ofAlcoholUse ai %ofPop* n % n % Valid TP TP %TSP* n % %TSP* n % %TSP* n % opolmProblematic No problem n10 n4)(n=41) (n=43) (n=130) NACD 2005 Drug Use Among the Homeless Population in Ireland 67 1 n (n=33) (Male, 41 years) (Male, 19 years) Patterns of Alcohol Use Use of Alcohol Patterns Chapter Five Chapter Allowances Used for Alcohol Rather than RentAllowances Used for Alcohol Rather than Rules and Regulations with Police Trouble Unable to Get Detox so now I’m in I was to be in by 11 o’clock but went drinking and did not get back until after one, with the prison and hostel. trouble 3 with me. It would make me violent and angry. agree sometimes it wouldn’t My behaviour, 2 1 Continue Drinking/Bringing Friends Back to DrinkContinue Drinking/Bringing Friends Back Violent, DisorderlyNoisy, Due to Drink Out/Barred- Thrown 18 3 5 Difficulties Refused Access- Presenting as Intoxicated/Not Allowed to Refused Access- Presenting Table 5.8 Reported Difficulties in Accessing Emergency Accommodation as a Result of Accommodation as a Result Emergency in Accessing 5.8 Reported Difficulties Table Alcohol Use proportionally more likely than those staying in B&B accommodation to report such difficulties (23% v (23% such difficulties in B&B accommodation to report likely than those staying more proportionally (n=5; experiencing difficulties of those Galway exhibited the highest percentage 12%). The sample in and 1 in to just 3 individuals (12%) in Limerick to just over a fifth (n=24; 21%) in Dublin 31%), compared in accessing difficulties who had reported that all of those revealed Cork (10%). Further analysis alcohol users. problematic to their alcohol use were accommodation due accommodation. users staying in emergency by alcohol reported 5.8 illustrates the type of difficulties Table of consumption, rather as a result often the behaviour, cited suggest that it is more The difficulties accommodation. in accessing emergency cause problems than the drinking practice itself, which can Other reported difficulties included; being barred or thrown out, money used to purchase alcohol out, money used to purchase or thrown included; being barred difficulties Other reported with the of services, trouble costs, rules and regulations accommodation rather than used towards police and unable to get a detox to facilitate entry into accommodation. The most common difficulty reported by over half of the individuals (n=18; 55%) was in relation to the by over half of the individuals (n=18; 55%) was in relation reported The most common difficulty accommodation services because of either their intoxicated status of access to emergency refusal behaviour as a violent and disorderly Noisy, upon arrival or bringing additional drink onto premises. quotes illustrate some access. The following of drinking behaviour was also cited as preventing result difficulties; of these reported 68 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Five individual cases. variations regarding howmuchthiswasenforced. Mostpoliciesremained flexibletoaccommodate types ofemergency accommodationstatedthattheyoperateda‘nodrink’policy, there were plans foroneinCork,andrecommendations foroneinGalway. While,service providers from other For thosethatdrinkalcohol,accommodationisprovided inwethostelsDublinandLimerick,with the Provider Perspective 5.6 AlcoholandAccommodation: people inCork,GalwayandLimerick.Thisisconveyedthefollowingquotes: homeless populationinthatalcoholwasstillperceived tobethemaindrugofuseamonghomeless The providers perception ofalcoholuseisconsistentwith thefindingsofsurveyamong 5.5 AlcoholUse:theProvider Perspective repertoires. service providers havenoticed arecent changeinalcoholbecomingpartofmore complex drugusing Hitherto, alcoholwastraditionallythedrugofchoiceamonghomelesspeopleinDublin.However, rigidly andothertimeswehave beenquitecreative. have beentimeswhenwe askedpeopletoleave.Sometimeswestickourpoliciesquite Officially, inreality itishowmuchtheyare drinking,howobvioustheyare aboutdoingitandthere flexible. DTs andtheyhaveacanofbeerjusttakeitgosomewhere quietanddrinkit,it’s night staff willturnablindeyeorinthemorningtimeifsomeonelookslikethey’re goingintothe If someonetakesacoupleofcansintothesleepingarea togothrough thenight,mostof serious, seriousproblem. The mainproblem downhere isaproblem withalcohol.There isalotofdualuse,butalcohol hostels Iwouldputthepercentage at60%ofpeoplewhohavealcohol-basedproblems. There ishighalcoholuseamonghomelesspeoplewhoare inhostels[…]Betweenthetwo What wehaveseenisthatthemajorproblem foruswouldbealcoholaddiction. heroin orgrass,whatever. noticed thattheguyswhowouldjustbestreet drinkersare startingtouseotherdrugs,maybe It wouldbe95-96%ofthepeoplewhouseourservicestreet drinkersbutwehave Patterns ofAlcoholUse (Homeless serviceprovider –Limerick) (Homeless serviceprovider –Cork) (Drug serviceprovider –Galway (Night shelterworker–Dublin) (Day serviceprovider –Dublin) (Hostel provider –Galway) ) NACD 2005 Drug Use Among the Homeless Population in Ireland 69 Patterns of Alcohol Use Use of Alcohol Patterns (Night shelter worker – Dublin) (Night shelter worker – Dublin) Chapter Five Chapter (Worker – transitional housing – Dublin) – transitional housing (Worker – Dublin) – transitional housing (Worker 2000). UK research indicates that alcohol use among older persons can often go undetected 2000). UK research In terms of accommodation type, those staying in squats and sleeping rough reported a In terms reported rough of accommodation type, those staying in squats and sleeping of alcohol consumption in termshigher frequency of use in excess of four times a week. alcohol users (52%). as problematic sleeping sample scored Over half of the rough among homeless people which illustrates that those This is consistent with other Irish research 2003a). likely to be heavy/very heavy drinkers (Corr, more or living in squats were sleeping rough Alcohol remains the primary drug of choice among the homeless population (70%). the primary drug of choice among Alcohol remains of males proportion and age. A greater of alcohol consumption varies by gender Frequency to female alcohol consumption in excess of four times a week in comparison reported alcohol use in excess of four times a week Furthermore, who reported those respondents. older. were between alcohol use and homelessness. Alcohol problems is a long standing relationship There (Kershaw common among homeless men than women, and among the older age groups more are et al., (Alcohol other generic symptoms of the ageing process in ways which reflect as it may present lower than the just slightly alcohol use among the homeless are Concern, 2002). Levels of current Irish general population (70% v 74%) (NACD/DAIRU, 2004). rates for the alcohol prevalence current Again, we don’t feel it is our right to search anyone but we ask them to hand up things like anyone it is our right to search feel Again, we don’t to stop refusing a bed are sitting round five people are what happens if alcohol. Occasionally, everyone else, they will be a wonderful time for themselves and disturbing partying and having to leave the building. being asked and they will be told why they are asked to leave the building something It would have to be really like to do permanent bans. With drinkers we don’t the street or one of the other clients. drinkers punched a member of staff one of the street like where actively using take people who are don’t drugs and alcohol. We very clear criteria around We’ve have the resources. that is simply because we don’t or who have serious mental illnesses and If somebody was found drinking alcohol, it would depend on the person. If they were an ex- it would depend on the person. If they were If somebody was found drinking alcohol, because of the licence agreement that part about enforcing alcoholic then we might be stronger it conflicts with their goals, as well. ■ 5.7 Summary and Conclusions ■ Therefore, individuals were more likely to be excluded from hostels for disturbing other residents or for disturbing other residents hostels likely to be excluded from more individuals were Therefore, by alcohol use). (which could be triggered because of violent behaviour B&Bs were seen to be less flexible around alcohol use on their premises as they felt that it was premises alcohol use on their seen to be less flexible around B&Bs were and their concerned it could disturb other residents they were children, around inappropriate were managers of transitional housing incidents. Similarly, insurance did not cover alcohol-related a ‘no-drink policy’. when enforcing stringent more 70 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Five ■ ■ ■ ■ alcohol dependent. dependence. FountainandHowes (2002),inastudyofrough sleepers,foundthataquarterwere group were alcoholdependent (50%)and29%were categorised ashavingsevere alcohol drink-related causes(Warnes, 2003). by thefactthatsomeolderdrinkershavebeenmovedoff thestreets whileothershavediedfrom sleepers whoare problematic alcoholusershasdecreased inrecent years.Thishasbeenexplained Feeney alcohol dependence. above ontheAUDITscreening instrumentwhichwarrantsfurtherdiagnosticevaluation for Over athird ofthehosteldwellingsampleandrough sleepingpopulation(32%)scored 20or fear oftheconsequencesontheirpresent orfuture accommodationneeds. may bereluctance onthepartofhomelessindividualstodisclosetheirlevelsalcoholuse for heavy drinkers(Warnes use ofhostelresidents variesgreatly andthisispartlyinfluencedbywhetherornothostelsadmit was acommonissueaffecting over50%ofhostelresidents in2002.However, therateofalcohol accommodation (hostelsandB&Baccommodation).According toDublinSimon(2003),alcoholuse problematic drinkersare notsolelyrough sleepersbutalsotendtobestayingwithintemporary This research alsohighlights,similartofindingsfrom theUK(MentalHealthFoundation,1996),that problematic drinking(39%). followed closelybyrough sleepers (52%).Nearlytwo-fifthsofB&Boccupantsexhibited Those stayinginhostelsexhibitedthehighestproportion ofproblematic drinkers(55%), alcoholism screening instrument indicatingalcoholproblems. West. Thisresearch revealed that55%ofcurrent drinkersscored 2orgreater ontheCAGE the studyundertakenbyHouriganandEvans(2003)onhealthstatusofhomelesspeoplein These figures foundamong the Galwaysampleare substantiallyhigherthanthoseincludedwithin users (71%),representing 47%ofthetotalGalwaysample. Almost three-in-four current drinkersintheGalwaysamplescored asproblematic alcohol group (CostelloandHowley, 1999;GalwaySimonCommunity, 1999). characteristics ofhomelessstreet drinkershashighlightedthisgroup asadistincthomelessrisk the serviceusingthem(AlcoholConcern,2002).Irrespective ofthetermapplied,research onthe ‘hazardous’, ‘harmful’or‘problematic’ maybeappliedtovariouslevelsorconditionsaccording to caution whencomparativelyanalysingthescaleandnature ofanalcoholproblem, astermssuch experiencing homelessnesshaveanalcoholproblem (Warnes Lower figures were foundinareview ofUKresearch, whichillustratethataround athird ofthose reported ahigherAUDITscore thanfemalerespondents. screening instrument(73%),representing 51%ofthetotalhomelesspopulation.Males Almost three-in-four current drinkersscored asproblematic inaccordance withtheAUDIT (Warnes outreach serviceusersin2002.Uptoathird ofpeoplesleepingrough intheUKare heavydrinkers According toDublinSimon(2003),alcoholusewasoneofthemainpresenting issues(22%)among et al. et al., Patterns ofAlcoholUse (2000) inastudyofhomelesshostel-dwellingmenDublin,found thathalfofthe 2003). Research from theUKhasalsoindicatedthatproportion ofrough et al., 2003:39). Under-reporting ofprevalence figures mayoccurasthere et al., 2003). Itisnecessarytoapply NACD 2005 Drug Use Among the Homeless Population in Ireland 71 Patterns of Alcohol Use Use of Alcohol Patterns Chapter Five Chapter Providers of emergency accommodation (with the exception of wet hostels/shelters) accommodation (with the exception of emergency Providers to flexible ‘no-drink policy’, however most policies were the operation of a reported that they interviewed reported service providers accommodate for individual cases. B&B individuals that reported Service providers alcohol use on premises. less flexible around were behaviour. likely be excluded for violent or disorderly would more conditions a clear understanding among services users regarding is It is also important that there which are policies and procedures of ‘acceptable’ and ‘unacceptable’ behaviour and the current behavioural Interventions which can reduce (Flemen, 1999). in operation within an organisation of at the forefront users should remain but which also seek to avoid excluding service problems of an enabling that the creation Pamneja, 2000). It is argued policy (Britton and organisational progressive their needs, is more which allows clients to express within an organisation, atmosphere behaviour patterns (Britton and Pamneja, 2000). than exclusion policies based on inappropriate Service providers similarly perceived alcohol to be the main drug of use among homeless alcohol to be the main similarly perceived Service providers change in have noticed a recent service providers people in each city location. However, complex drug using repertoires. alcohol use becoming part of more persons in the in studies of homeless reported have been predominantly problems Alcohol-related distinguished by reports of homeless individuals are past decades. The contemporary generation 1996). This is primarily due drug use in addition to alcohol use (O’Flaherty, of high rates of problem engaged in illicit drug use predominantly age group to the fact that homelessness among the (Cox and Lawless, 1999). phenomenon a fairly recent years) is (those under-25 The majority of current drinkers staying in emergency accommodation reported that staff reported accommodation drinkers staying in emergency The majority of current in accessing difficulties with only one-fifth reporting of their alcohol use (70%), aware were often the cited suggest that it is more (20%). Difficulties accommodation emergency practice itself, which can consumption, rather than the drinking of result as a behaviour, accommodation. emergency in accessing cause problems that nearly two-in-five London, Fountain and Howes (2002) found sleepers in In a study of rough Physical year. homeless services in the past one or more excluded from of the sample had been as a major cause of exclusions. Behavioural violence was identified by service providers 2003:8). than for any other drug types (Butler, pronounced more consequences of alcohol use are can often further facilitate of polydrug use on patterns of behaviour the effect Moreover, and hostility in episodes. McCormick and Smith (1995) in a study of aggression aggressive of hostility significantly higher on all measures scored substance users found that polydrug users and aggression. ■ ■ ■ 72 Drug Use Among the Homeless Population in Ireland NACD 2005 5Forthe purposeofthisstudy, “illicitdrugs”refers tocannabis,ecstasy, amphetamines, crackcocaine,cocainepowder, hero 55 Itisnecessarytoproduce different prevalence figures whichdistinguishuseatthepresent timefrom usethatmayhavebeen 54 counterparts (57%v49%). proportionally more likelytoreport thecurrent useofanillicitdrugincomparisontotheirmale accounting fortheremaining 34%(n=63).Althoughnotsignificant,femalerespondents were accounted for66%(n=120)ofthosewhoreported currently usinganyillicitdrugwithfemales (n=183) ofthetotalsamplewere currently usinganillicit drug.Intermsofgenderdistribution,males Although drugusersingeneralandillicitparticular were nottargeted forthisstudy, 52% Patterns ofDrugUse Chapter Six Table 6.1Illicit DrugPrevalence RatesbyLocationandGender last year(64%).Justoverhalfofthestudypopulationreported illicitdrugusewithinthelast month(52%). respondents reported lifetimeuse(74%),whilenearlytwo-thirds reported useofillicitdrugswithinthe Table 6.1conveysratesoflifetime,recent andcurrent illicituseacross citylocations.Almostthree-in-four 6.2.1 Current IllicitDrugUsebyLocation the HomelessPopulation 6.2 IllicitDrugUseAmong lifetime, recent andcurrent drugclassifications inclusion oftheEMCDDA(European MonitoringCentre forDrugsandDrugAddiction)templateof the drug-usecomponentincorporatedvariousstandardised drug-usescalesinadditiontothe was considered vitaltogetdifferent measures ofhomelessindividualsdrug-usingstatus.To thisend, As themainaimofstudyistoexaminenature andextentofdruguseamongthehomeless, it 6.1 Introduction lii rgUeCityLocations Illicit DrugUse urn s 5 13 9[4]4 1]2 9 6[13] 36 [9] [18] 25 50 [10] [15] [23] 28 42 64 [146] [19] 59 [15] 53 42 [183] 52 [179] 72 [26] [226] 72 Current Use 64 [197] 80 [261] Recent Use 74 Lifetime Use hallucinogens (LSD, poppers andmagicmushrooms) andsolvents. last 12monthsrefers torecent useandfinally“used”withinthelastmonthrefers tocurrent prevalence. past anddiscontinuedaftersometime.If he/shehas“everused”thedataproduced refers tolifetimeprevalence, “used”inthe By Gender By Gender By Gender Fml 7[3 2[2 3[]2 2 9[4] 29 [2] [7] [9] 20 57 41 [2] [7] [8] [5] [11] 20 33 27 57 50 [52] [2] [8] [10] [8] 72 [15] 20 47 48 31 68 [63] [61] [94] 57 [10] [13] [11] 85 54 67 50 52 [120] [78] %Female [65] [118] %Male 49 70 [16] 90 67 76 [148] [85] %Female [132] %Male 61 77 75 [176] %Female %Male 72 oa oeesDbi okLmrc Galway Limerick Cork Dublin Total Homeless Population n% n% %n %n %n %n %n 54 . 55 in, inthe NACD 2005 Drug Use Among the Homeless Population in Ireland 73 Sleeping* Patterns of Drug Use of Drug Patterns Chapter Six Chapter Hostel* B&B* Rough %n%n%n *Percentages based on the total study population in each accommodation type based on the *Percentages DublinOutside DublinAll Locations 36 48 [24] 43 [52] 40 [76] 69 67 [2] [46] [44] 78 73 72 [7] [41] [34] Location Accommodation Type 6.3.1 Total Homeless Population 6.3.1 Total rate among the total cannabis has the highest lifetime prevalence 6.3 below, As illustrated within Table and ecstasy (n=150; 42%). Lifetime use of cocaine homeless sample (n=243; 69%), followed by heroin Forty- by two-in-five of all study respondents. high, reported and various sedatives was also relatively lifetime use of sedatives lifetime use of cocaine while 40% reported (n=146) reported one percent lifetime use of amphetamines (n=125; 35%) and the same reported of the sample (n=140). Over a third (n=117; 34%). Over one-in-five of the sample had used had used anti-depressants proportion lifetime reported hallucinogens, methadone, and tranquillisers and nearly a fifth of all respondents use of crack cocaine. 6.3 Prevalence of Use Among the Homeless of Use 6.3 Prevalence Population by Drug Type Table 6.2 Illicit Drug Use Over Past Month by Main Accommodation Type Table In terms of illicit drug use by accommodation type, Table 6.2 illustrates that rough sleepers exhibited 6.2 illustrates that rough type, Table In terms of illicit drug use by accommodation use (73%) in comparison to those staying in B&B illicit of current the highest percentage rough This high level of illicit drug use among respectively). accommodation or hostels (67% and 43% dwellers both Dublin and non-Dublin samples. Nearly one-in-two hostel sleepers was consistent across (n=44; 69%) of B&B use of an illicit drug (n=52; 48%), while over two-thirds current in Dublin reported B&B occupants and hostel illicit drug users. The rate of illicit drug use among current were residents Dublin. dwellers was substantially lower outside of 6.2.2 Current Illicit Drug Use by Accommodation Type Illicit Drug Use by Accommodation 6.2.2 Current Fifty-nine percent (n=146) of the Dublin sample were currently using an illicit drug. Eighty-four percent using an illicit drug. Eighty-four currently (n=146) of the Dublin sample were Fifty-nine percent this than one drug (i.e. polydrug use), use of more reported illicit drug users (n=123) of current the Dublin homeless sample. 50% of represents of the third use (42%), while over a highest rate of current the next Cork reported Respondents from drug use. current reported and a quarter of the Limerick sample (25%) Galway sample (36%) 74 Drug Use Among the Homeless Population in Ireland NACD 2005 n=24; 14%). n=14; 20%)incomparisontolower ratesobservedamonghosteldwellers(heroin n=31;18%)(cocaine rough (heroin n=19;34%) (cocainen=14;25%)andamongB&Boccupants(heroin n=21;30%)(cocaine Similarly, higherratesofcurrent useofbothheroin andcocainewere observedforthosesleeping cannabis inthepastmonthcomparisontojustoverathird ofthosestayinginhostels(n=64;37%). sleeping rough (n=33;59%)and overhalfofthoseinB&Baccommodation(n=38;55%)hadused those stayinginhostels,B&Baccommodationandsleepingrough. Almostthree-fifths ofthose Table 6.4presents current prevalence ratesofthedifferent drugsbythree accommodationtypes; tranquillisers (n=58;16%). use ofsedatives(n=90;26%),andalmostafifthreported useofanti-depressants (n=68;19%)and had usedheroin (n=78;22%) within thefourweekspriortointerview. Overaquarterreport current In thelastmonth,lessthanahalfofsamplehadusedcannabis (n=152;43%).Almostaquarter Current usebydrugtypelargely followedthoseofbothlifetimeandrecent drugusing patterns. tranquillisers ormethadone. depressants withinthelastyear, whileoverafifthofallrespondents citedrecent useofecstasy, by almostathird ofthetotalstudypopulation.Overaquarterreported theuseofcocaineoranti- respondents (n=198;56%)withrecent sedative(n=117;33%)andheroin use(n=107; 30%)reported Similarly, cannabiswasthehighestciteddruginterms ofrecent use,reported byoverhalfofall Chapter Six Table 6.3DrugUseAmongtheTotal StudyPopulation(n=355) te rg 4 1]3[2 [9] [5] 2 1 [4] [12] [9] 1 2[9] 3 3 [16] [8] [16] [19] [11] 4 4 2 5 3 [58] [40] [35] 16[58] 16 11 10 [77] [66] 22 19 [90] [92] 26 2[9] 26 [42] [117] 12 [42] 33 [61] [78] 12 17 22 [78] [140] [125] 22 40 * Denotesanillicitdrug [107] [98] 35 [152] 30 28 [150] Other Drugs 43 [64] 42 [150] [146] 18 Steroids [198] 42 41 56 [3] Other Opiates [72] 1 21 69[243] Solvents* Crack Cocaine* 19 [15] [80] Methadone 23 4 [91] Tranquillisers 26 [101] Hallucinogens* 28 [117] Anti-Depressants 34 Amphetamines* Sedatives Cocaine Powder* Ecstasy* Heroin* [67] Cannabis* Patterns ofDrugUse ieieUeRcn s Current Use RecentUse Lifetime Use n% %n %n %n NACD 2005 Drug Use Among the Homeless Population in Ireland 75 Rough Patterns of Drug Use of Drug Patterns Chapter Six Chapter Hostel B&B Sleeping (n=175) (n=69) (n=56) %n %n %n Solvents* 0Solvents* Other Opiates [1]Steroids 3Other Drugs [2]* Denotes an illicit drug 2 [1] 2 [4] 2 1 1 [3] [1] [2] 5 3 3 [3] [2] [2] 7 - [4] - Anti-Depressants0Hallucinogens* Tranquillisers [1]Methadone 1Crack Cocaine* [1] 2 [1] 19 [32] 25 [17] 10 [17] 18 16 1 [10] 36 [28] [2] [25] 28 23 [19] 3 [13] [2] 18 [10] 7 [4] Heroin*Ecstasy*Cocaine Powder*SedativesAmphetamines* 14 18 [24] [31] 10 [17] 20 30 2 28 [14] [21] 16 [4] [49] [11] 25 34 [14] 26 [19] 1 14 [8] [18] [1] 25 [14] 7 [4] Cannabis* 37 [64] 55 [38] 59 [33] 6.3.2 Dublin Homeless Population for the Dublin homeless sample by drug type. As conveyed, rates drug prevalence 6.5 presents Table rates for the total study population. Cannabis and drug prevalence as the similar patterns emerged use had the highest cited lifetime use of a drug. heroin Table 6.4 Current Prevalence Rates of Drugs by Main Accommodation Type Rates of Drugs by Main Accommodation Prevalence 6.4 Current Table 76 Drug Use Among the Homeless Population in Ireland NACD 2005 rough sleepers(n=10;21%). the highestlevelsofmethadoneuse(n=19;30%)followedby hostel dwellers(n=28;26%)andthen (cocaine: n=14;22%)andthenhosteldwellers(heroin: n=27;25%).Conversely, B&B residents showed heroin (n=19;40%)andcocaine use(n=12;25%)followedbyB&Bresidents (heroin: n=21; 33%) accommodation andsleepingrough. Thosesleepingrough inDublinreported thehighestlevelsof type. Current cannabisusewasthemostciteddrugreported bythosestayinginhostels,B&B Table 6.6presents current prevalence ratesofdrugswithintheDublinsamplebymainaccommodation current useofcocaine(n=54;22%). (n=78) and18%(n=64)ofthetotalstudypopulation.JustoverafifthDublinsamplereported with 30%(n=74)and26%(n=64)oftheDublinsamplereporting current useincomparisonto22% Rates forcurrent useofheroin andmethadonewere higherthanamongthegeneralstudypopulation, Chapter Six Table 6.5DrugUseAmongtheHomelessPopulation–Dublin(n=247) tris4[1 8 [4] [7] 2 3 [8] [9] [7] 3 3 4 [11] [12] [11] [9] 4 4 [64] 5 4 26 [18] [71] [26] 21[53] 7 10 29 [64] [48] [76] 26 [4] 19 31 [78] [71] 32 2 29 [14] [94] [30] 6 [74] 38 [54] 12 [2] 30 22 [60] [108] 1 [85] 24 44 [99] * Denotesanillicitdrug [121] [83] 35 49 40 34 [5] [105] Other Drugs 43 [157] [127] 2 [111] Steroids 64 51 45 [3] Other Opiates [38] [183] 1 74 Solvents* 15 19 [10] Crack Cocaine* 4 Methadone [63] 26 Tranquillisers [72] Hallucinogens* 29 [77] Anti-Depressants 31 Amphetamines* Sedatives Cocaine Powder* Ecstasy* [47] Heroin* Cannabis* Patterns ofDrugUse ieieUeRcn s Current Use RecentUse Lifetime Use n% %n %n %n NACD 2005 Drug Use Among the Homeless Population in Ireland 77 - 56 Patterns of Drug Use of Drug Patterns Chapter Six Chapter B&B Sleeping Rough Hostel (n=64) (n=47) (n=109) %n %n %n %n %n %n Lifetime Use Recent Use Use Current Solvents* 31 [11]Other Opiates Steroids 6Other Drugs [2]* Denotes an illicit drug 3 [1] 31 [11] 11 - 6 [4] [2] - 6 3 [2] - [1] - 3 - [1] - Anti-Depressants 36Anti-Depressants [13]Hallucinogens* 39 [14]Tranquillisers 22Methadone [8] 6Crack Cocaine* [2] 14 [5] - - 31 [11] 25 8 19 [9] [3] [4] 11 3 8 [4] [1] [3] 6 - [2] - Heroin*Ecstasy*Cocaine Powder*SedativesAmphetamines* 42 19 [15] 53 [7] [19] 25 53 36 3 [9] [19] 28 [13] [1] [10] 22 14 22 [8] [5] 11 - [8] [4] - 8 9 [3] [3] Cannabis* 69 [25] 47 [17] 33 [12] Other Opiates SteroidsOther Drugs * Denotes an illicit drug 3 [2] 2 3 2 [1] [2] [1] 8 - 4 [4] [4] - 1 2 [1] [2] Hallucinogens* 2Hallucinogens* Tranquillisers [1]Methadone 2Crack Cocaine* [1]2Solvents* [1] 1 [1] 2 [1] - 39 [25] 30 3 [19] 2 [2] [1] 21 6 [10] 13 [3] [14] 26 [28] 1 [1] Ecstasy*Cocaine Powder*SedativesAmphetamines*Anti-Depressants 22 [14] 17 [11] 25 2 [12] 27 27 13 [1] [17] [17] 18 [6] [20] 28 2 17 11 [13] [8] [1] [12] 38 [42] 17 2 [19] [2] Cannabis*Heroin* 59 [38] 33 55 [21] [26] 40 40 [19] [44] 25 [27] 56 use of this drug. reported No hostel dweller surveyed 6.3.3 Homeless Population Outside Dublin 6.3.3 Homeless Population Outside 6.7 Drug Use Among the Homeless Population – Cork (n=36) Table Table 6.6 Current Prevalence Rates of Drugs by Main Accommodation Type – Dublin Type Rates of Drugs by Main Accommodation Prevalence 6.6 Current Table 78 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Six Table 6.9Drug UseAmongtheHomelessPopulation–Limerick(n=36) Table 6.8DrugUseAmongtheHomelessPopulation–Galway(n=36) cts*2 8 3 [1] [2] 3 [1] 6 3 [3] [7] [3] 9 [4] 20 8 11 [8] [7] [4] 22 [5] 20 11 14 - [13] [1] 36 - 3 - [2] - - 6 - - - [3] [3] - [3] - 8 8 8 [1] - 3 [4] [10] - Cocaine Powder* 11 28 [5] Ecstasy* [1] [8] 14 Heroin* [1] [6] 4 22 Cannabis* 3 [9] 17 [3] 25 [1] [2] [11] 8 [2] - 31 3 6 6 - [5] [15] [12] [2] 14 [4] [15] 42 33 * Denotesanillicitdrug - 42 11 6 [18] Other Drugs [17] - 50 [12] [15] 47 Steroids - 33 42 Other Opiates [7] [22] - 61 Solvents* 19 [7] [2] 19 Crack Cocaine* 6 Methadone [11] 31 Tranquillisers [10] Hallucinogens* 28 [14] Anti-Depressants 39 Amphetamines* Sedatives Cocaine Powder* Ecstasy* Heroin* Cannabis* tris------[1] 3 - - [1] - - 3 - - - - - [2] - - - [1] 6 - 3 [1] [1] - 3 [1] 3 - 3 [1] [3] [1] 3 9 - 3 [1] 3 [4] [2] 11 6 [1] 3 [4] [6] 11 * Denotesanillicit drug 17 [1] Other Drugs 3 - Steroids - [2] Other Opiates [8] Solvents* 6 [1] 22 Crack Cocaine* 3 Methadone [9] 25 Tranquillisers [5] Hallucinogens* 14 [13] Anti-Depressants 36 Amphetamines* Sedatives Patterns ofDrugUse ieieUeRcn s Current Use RecentUse Lifetime Use ieieUeRcn s Current Use RecentUse Lifetime Use n% %n %n %n n% %n %n %n NACD 2005 Drug Use Among the Homeless Population in Ireland 79 Patterns of Drug Use of Drug Patterns Chapter Six Chapter As demonstrated above, lifetime prevalence rates by the different drug types were largely similar across largely drug types were the different rates by lifetime prevalence As demonstrated above, higher lifetime use and Galway reported homeless samples. Respondents in Cork both Cork and Galway to only 36% of the Limerick sample. Similar in comparison 61% respectively) of cannabis (69% and use. cocaine/crack, amphetamines and ecstasy observed in terms of lifetime use of variations were (n=7; 19%) or Limerick (n=4; in Galway (n=12; 33%) than in either Cork use was higher Lifetime heroin one-third Limerick of all the city locations with over was highest in anti-depressants 11%). Lifetime use of drug, while in ecstasy was the second most used lifetime use. In Galway, its (36%) of the sample reporting the second most used lifetime drug. Cork both ecstasy and amphetamines were (n=17; 47%) sample reported use, nearly a half of the Cork (n=17; 47%) and Galway In terms of recent such use in Limerick (n=7; 20%). while only a fifth reported having used cannabis in the last year, use of sedatives and tranquillisers, in Galway reported (n=11; 31%) of the respondents Nearly a third ecstasy was generally high in each location. Recent use of cocaine, while the use of anti-depressants of crack cocaine, four highest for the Cork homeless sample. In terms and amphetamines were comparison to only one in both Cork and Galway had used crack in the last year in respondents in Limerick. respondent drug used in Cork and 6.9, cannabis was the most cited current 6.7, 6.8 and in Tables As presented drug used. Anti-depressant the most cited current were anti-depressants while in Limerick Galway, while in Cork in Galway, drug by the homeless sample medication was the second most cited current was no use and cocaine. There use of anti-depressants current (n=5) reported 14% of the respondents use in within the month prior to interview among the Cork sample with only very limited of heroin Dublin rate for the prevalence heroin to a 30% current Galway and Limerick. This is in comparison homeless sample. 80 Drug Use Among the Homeless Population in Ireland NACD 2005 users (60%)reported useof1-3 dayswithinthelastmonth. users ofcocaineandecstasyreported useinexcessof20days,whilethemajoritycurrent crack respectively reporting useof20daysormore withinthelastmonth.Lessthanone-in-four ofcurrent The frequency ofcurrent useofsedativesandanti-depressants wasalsoquitehigh,with52%and61% which relates to10%ofthe total homelesspopulation,reported frequency ofusein excessof20days. represents 11%ofthetotalstudypopulation.Sixty-twopercent (n=37)ofcurrent methadoneusers, The majorityofcurrent heroin usersreported usingheroin inexcessof20days(n=40;52%)which Chapter Six Table 6.10Frequency ofUseOverPastMonth specified drugsoverthefourweekspriortocontact. specify theirfrequency ofuse.Table 6.11illustrateshowoftenindividualsreported theuseoftheir Respondents whohadusedanyoftheciteddrugs(licitorillicit)inlastmonthwere asked to 6.4 Frequency ofUseOverPastMonth 7Frequency ofcurrent useiscategorisedin accordance withtheEMCDDA classification. 57 ovns 4 - 0[]----5 [2] 50 - [6] [1] - [2] 86 50 50 - [1] [1] [1] [4] [3] - - 14 50 14 [9] 40 43 [2] - - - 21 - - 50 - [30] - - [4] - - 56 [-] - - 10 - - - [14] [3] [4] - 24 [2] - [7] [37] - [2] [37] - 5 - 28.5 * Denotesanillicitdrug 17 61 [5] 62 - 50 [2] [2] [1] [6] Solvents* [6] [22] [2] 9 [40] [2] [6] [1] 28.5 [7] Hallucinogens* [2] 11 52 86 [43] 52 3 60 Steroids [4] [14] 3 [2] [15] 52 [-] [2] [74] Other Drugs [16] 24 [7] 28 [1] [3] [4] [42] Amphetamines* [7] 49 [7] 21 [25] [10] 5 [4] 7 Other Opiates [12] 43 9 20days+ [6] [54] Crack Cocaine* [19] [17] 8 [3] 10-19days 8 Ecstasy* [11] 31 28 [58] Tranquillisers 13 [30] 4-9days [15] [6] [4] Cocaine Powder* 20 [21] 19 [61] 1-3days Methadone [60] [35] 26 [1] Anti-Depressants 23 [8] Heroin* [77] Sedatives [82] [1] Cannabis* [151] Current Use Patterns ofDrugUse ai isn n % n % n % n % Missing Valid 57 NACD 2005 Drug Use Among the Homeless Population in Ireland 81 Patterns of Drug Use of Drug Patterns %n 39 [95] 3611 [13] [4] 36 [129] Chapter Six Chapter 58 Total of the total study population as a percentage *Expressed Dublin Outside Dublin 47Limerick Galway [17] Cork 31 [34] Location Drug Use* Prescribed 58 to them. of them being prescribed asked whether their use of the following drugs was as a result Respondents were 6.5.2 Prescribed Medication by Drug Type by Drug Type Medication 6.5.2 Prescribed drug with 15% of the most cited prescribed were anti-depressants 6.13 below, As illustrated in Table use, followed by sedatives (14%) and methadone their prescribed the total study population reporting on methadone, show that only just over two thirds an analysis of those currently (12%). However, obtaining “street” were just less than one-in-three use. This means that current prescribed reported methadone. Table 6.11 Prescribed Medication Over Past Month Medication Over Past 6.11 Prescribed Table 6.5.1 Prescribed Medication by Location Medication by Location 6.5.1 Prescribed use of the current of the total study sample reported 6.12 demonstrates that over a third Table use of current significant, those who reported medication (n=129; 36%). Although not prescribed likely to be in contact with psychiatric services (47% v 38%). The more medication were prescribed of use current the Dublin sample was slightly higher with nearly two-in-five reporting for figure likely than their male more medication (n=95; 39%). Although not significant, females were prescribed those who had medication (44% v 37%). Furthermore, the use of prescribed counterparts to report medication prescribed likely to report significantly more were been diagnosed with a psychiatric illness medication of prescribed (n=35; 37%) of those in receipt (x2 =10.25; df=1; p<0.01). Just over a third had been diagnosed with a psychiatric illness. 6.5 Prescription Medication Among Medication Among 6.5 Prescription Population the Homeless 82 Drug Use Among the Homeless Population in Ireland NACD 2005 the Dublinsamplereported usingfiveormore drugs.Thisrepresents 25%ofthecurrent drug-using highest meannumberofdrugs currently used.Furthermore, one-in-fourofcurrent druguserswithin that reported bytheDublindrugusingrespondents (1.98v3.33).OutsideDublin,Corkreported the The meannumberofdrugsreported bydrugusersoutside ofDublinwasconsiderablylowerthan the overallstudypopulation. The remaining 72%ofcurrent druguserswere usinginexcessofonedrugwhich represents 45%of sample, only28%were using onedrugtypewhichrepresents 17%oftheoverallstudy population. Analysis revealed thatamong thosewhoreported thecurrent useofdrugswithintheoverallstudy Chapter Six Table 6.13 Polydrug UsebyLocation licit andillicitbutexcludesalcohol). drugs amongthosewhoreported current drugusewithintheoverallhomelesssample(includesboth Table 6.14illustratesthepolydrugusingstatusofstudypopulation. Ithighlightsameanuseof3 6.6.1 PolydrugUsebyLocation 6.6 PolydrugUseAmongtheHomelessPopulation Table 6.12Prescription MedicationbyDrugType awy18 1-6 1-9 1 1-9 1* 1 1 2 1-10 1.89 1 NumberofDrugs 2.47 1 1.98 3 2 Galway 1 Cork Outside Dublin Dublin 3.33 [7] [3] Location 88 33 1 15 14 [1] 9 - [2] 12 [8] [52] [48] [9] 40 [32] 80 53 [43] * Total exceeds100%asmultipleresponses were allowed. 56 [5] Other Drugs 69 [2] - Other Opiates Steroids [5] [1] [66] Sedatives [90] [2] Prescribed Drug Tranquillisers [57] Methadone [62] Prescribed Drug Anti-Depressants Current Useof Drug Type-Current Use oa 1-10 1 3 1-5 1 3 1 *Multiple modesexist.Smallestshown Total Limerick 1.59 Patterns ofDrugUse rsrpinMdcto s sa%o Useasa%ofTotal Useasa%of Prescription Medication enMda oeRange Mode Median Mean ai isn % n % Missing Valid urn s StudyPopulation Current Use NACD 2005 Drug Use Among the Homeless Population in Ireland 83 the ogens . A score of . A score 59 Patterns of Drug Use of Drug Patterns Chapter Six Chapter 1989). et al., Mean Median Mode Range 1989). et al., directions (2) Any non-medical drugs (including cannabis, solvents, tranquillisers, barbiturates, cocaine, stimulants, hallucin (2) Any non-medical drugs (including cannabis, solvents, tranquillisers, barbiturates, cocaine, directions or opiates (Gavin Sleeping Rough 3.2 3 1 1-9 Accommodation HostelB&B 2.8 Number of Drugs 3.3 3 3 1 2 1-7 1-10 six or more indicates a drug problem (Gavin indicates a drug problem six or more 59 drugs or over the counter drugs in excess of to; (1) the use of prescribed to the DAST instrument refers “Drug Use” according Table 6.15 illustrates levels of problematic drug use by location. Almost two-thirds of recent drug users of recent drug use by location. Almost two-thirds 6.15 illustrates levels of problematic Table who to 36% (n=127) of the homeless population (n=127; 65%). This relates as problematic scored drug users instrument. Problematic to the DAST screening drug users according as problematic scored drug-using likely to be polydrug users than their non-problematic more proportionally were counterparts (77% v 40%). users, Limerick exceeded all other city locations in terms of problematic of recent As a percentage of the Dublin homeless in terms of the total homeless population, the percentage drug use. However, for other cities. Over two-fifths of the was far higher than the figure as problematic sample who scored in comparison to less than a fifth for those outside of as problematic Dublin sample (43%) scored drug for problematic the highest score non-Dublin locations, Cork exhibited Dublin (19%). Across percent followed by Limerick (19%). Thirty-three of the homeless sample (25%), users as a percentage as scored instrument within the Galway sample the DAST screening administered of those who were 14% of the overall Galway homeless population. which represents problematic, 6.7.1 Problematic Drug Use by Location Drug 6.7.1 Problematic 6.7 Problematic Drug Use Among Drug Use Among 6.7 Problematic the Homeless Population scale used to (DAST) is a 10-point Test the Drug Abuse Screening As illustrated in Chapter Three, to individuals who had only administered instrument was drug use. This screening identify problematic (n=216) with the definition provided used a drug within the last 12 months in accordance 6.6.2 Polydrug Use and Accommodation 6.6.2 Polydrug Use by Main Accommodation Type 6.14 Polydrug Use Table sample in Dublin and 17% of the overall Dublin homeless sample (n=43). This is in comparison to 6% 17% of the overall Dublin homeless sample sample in Dublin and sample and 3% of the overall non-Dublin homeless drug-using sample outside of Dublin of the current a slightly higher mean reported respondents that female drug-using revealed (n=3). Further analysis no. of drugs; 3.2 v 2.9). their male drug-using counterparts (mean number of drugs than Of those who reported current drug use, 19% of hostel dwellers reported use of five drugs or more in use of five drugs or more drug use, 19% of hostel dwellers reported current Of those who reported of the total of a percentage sleepers. In terms 26% of rough comparison to 23% of B&B occupants and 11%, sleepers, this represents B&B occupants and rough accommodation samples of hostel dwellers, 17% and 20% respectively. 84 Drug Use Among the Homeless Population in Ireland NACD 2005 accommodation (n=54;43%)and overaquarterinB&Baccommodation(n=35;28%). DAST screening instrument.Overtwo-fifthsofproblematic druguserswere stayinginhostel Table 6.16alsoshowsthecurrent accommodationtypeof those whoscored asproblematic onthe Chapter Six Table 6.16 KeyVariables byHomelessandProblematic Drug-UsingPopulations lower meanagethanthosereported bymaleandfemalerespondents ofthetotalstudypopulation. study population(meanage=35.3years).Maleandfemaleproblematic druguserssimilarlyreported a Moreover, asconveyedinTable 6.16,themeanagewasalsolowerthanthatreported bythetotal reported ameanageof28.2yearsincomparisonto33.6fornon-problematic drugusers. their non-problematic drug-usingcounterparts(t-test=3.72;df=195;p<0.01).Problematic drugusers across different variables.Problematic druguserswere significantlymore likelytobeyoungerthan Table 6.16illustratesacomparativeanalysisofproblematic drugusersandthetotalstudypopulation 6.7.2 CharacteristicsofProblematic DrugUsers Table 6.15Problematic DrugUsebyLocation g is oees2. 20.5 27.4 28.2 Age FirstHomeless Gender Age 35.3 eghCretyHmls . 2.4 2.5 HomelessProblematic HomelessPopulation Length Currently Homeless 36 14 25 [127] Variable 65 [5] 19 33 [9] 50 19 [21] 50 %ofHomelessPopulation 43 Total %ofRecentDrugUsers [7] Galway Limerick 78 Cork [106] Outside Dublin Dublin 68 Location vrEprecdIpiomn 5 82 55 Ever ExperiencedImprisonment urnl nL osn it6 65 33 44 68 41 19 Currently onLAHousing List Main ReasonforHomelessness(DrugUse) First ExperienceofHomelessness Current Accommodation Patterns ofDrugUse eae3. 27.1 28.9 30.4 37.4 Female Male og leig 621 28 16 19 43 Rough Sleeping B&B Accommodation Hostel 50 %n en(r)Mean (yrs) Mean (yrs) n35 DrugUsers (n=355) %% (n=127) NACD 2005 Drug Use Among the Homeless Population in Ireland 85 Patterns of Drug Use of Drug Patterns 1995). Table 6.17 below 1995). Table Chapter Six Chapter et al., (n=193) (n=151) (n=18) (n=15) (n=9) %n % n %n % n %n All Locations Dublin Cork Galway Limerick Missing [23] Mean Score [21] 8 [1] 8.6 [-] 6.3 [1] 3.8 8.4 0-56-1011-15 32 25 [61] 43 [48] 27 [84] 25 [41] 48 [37] 44 [73] 28 [8] 28 [5] 67 [5] 20 [10] 13 [3] 22 [2] 34 [2] 44 [3] [4] Score Level of Dependence As conveyed in Table 6.18, the mean score for the Dublin drug using sample was slightly higher than 6.18, the mean score As conveyed in Table Table 6.17 Dependent Drug Use by Location Table The Severity of Dependence Scale (SDS) is a five-point scale designed to measure the degree of the degree is a five-point scale designed to measure The Severity of Dependence Scale (SDS) of dependence without necessarily for general screening dependence on a variety of drugs. It allows of dependence which focuses on control of being used. It is a measure knowing which substances are of the degree the greater in stopping. The higher the score, use, anxiety of use and difficulty obtainable is 15 (Gossop psychological dependence. Maximum score by location drug users to recent instrument administered of this screening illustrates the results (n=193). 6.8 Dependent Drug Use Among 6.8 Dependent Drug the Homeless Population Analysis also revealed that problematic drug users became homeless at a younger age than the total drug users became homeless at a younger that problematic Analysis also revealed observed in length of time were age 20.5 years v 27.4 years). No differences study population (mean likely than the total study population to more proportionally were drug users homeless. Problematic problematic (n=103) of percent of homelessness (67% v 59%). Eighty-two experiences previous report of the total study population in comparison to just over a half prior imprisonment drug users reported on a local authority registration observed in term of current were differences (n=193; 55%). No main were drug users (n=83) of problematic Sixty-five percent the two groups. housing list between in comparison to 68% (n=240) of the total study population. registered Overall, 43% (n=84) of recent drug users scored between 11-15 on the screening instrument indicating instrument between 11-15 on the screening users scored drug Overall, 43% (n=84) of recent population. high psychological dependence on the drugs used, which is 24% of the total homeless the highest on the SDS screening 6.17 shows that the Dublin drug-using sample scored Table of psychological instrument with nearly half the sample scoring 11-15 indicating a high degree 30% of the total Dublin study population. used. This represents dependence on the drugs currently for the total drug-using population (8.6 v 8). 11% drug users (n=4; 44%) which represents of dependent Limerick also exhibited a high proportion of the highest percentage Limerick also reported revealed, of the total Limerick sample. As already medication outside of Dublin. on prescribed individuals currently 86 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Six urban locations the Dublinsampleisfargreater thanthosereported byhomelessindividualsinanyofthethree other respondents reported thatthiswasthefirstdrugeverinjected(88%).Therangeofdrugsusedby use. Furtheranalysisrevealed thatofthosewhoinitiatedtheirdrugusewithheroin, allbutoneofthe (6%). Aminorityofrespondents (5%)alsoreported commencing theirdrug-usingcareers withheroin the firstdrugtheyused(n=146;76%).Thirteencurrent druguserscitedsolventsasthefirstused ended questionconcerningthefirstdrugtheyeverused.Overtwo-thirds reported thatcannabiswas Individuals whowere administered theDASTandSDSscreening instrumentswere askedanopen- 6.9.1 FirstDrugUsed 6.9 DrugUsingHistory Table 6.18DependentDrugUsebyMainAccommodationType study populationwere currently stayinginB&Baccommodationwhichmayhaveinfluencedthisfinding. counterparts (8.5v7.6).Moreover, asillustratedintheprevious chapter, overathird (37%)ofthefemale although notsignificant,drug-usingfemalesreported ahighermeanthantheirmaledrug-using either oftheothertwoaccommodationtypes(7.6and7.7respectively). Furtheranalysisrevealed that (44%) andhosteldwellers(39%).Furthermore, ameanscore of9forB&Boccupantswashigherthan highest levelofdependence,with51%scoringinthe11-15pointrange,followedbyrough sleeping In termsofleveldrugdependencebyaccommodationtype,B&Bdrug-usingoccupantsscored the 0Although alcoholwasincludedasa first drugitwasnothoweverexplicitlystated to respondents. Alcohol usewasnotgenera 60 years) current usersinitiateddruguse. that there wasnosignificantdifference betweentheageatwhichmale(14.69years)and female(15.36 (range 7to43years).Thisissimilarthemeanageofreported firstalcoholuse.Analysisrevealed used drugs(n=136;68%).Themeanageforfirstdrugusewas 15yearsandthemodeagewas14 drug. Figure 6.1illustratesthat overtwo-thirds ofcurrent userswere lessthan16yearswhentheyfirst Individuals whohadusedinthemonthprevious were askedatwhatagetheyinitiateduseoftheirfirst 6.9.2 AgeFirstUsedDrug en7797.6 [17] [7] 44 9 [15] 17 [25] 39 [14] 51 [10] 7.7 29 [33] 20 [22] 39 [29] 26 35 LevelofDependence Mean 11-15 6-10 0-5 Score used oneof thedrugsinlast monthmayalsoresult inunder-reporting ofalcoholasthefirst drugused. regarded bythemajority ofindividualsasbeingadrug.Furthermore, thefactthat the questionwasaskedonlytothosewho ha Patterns ofDrugUse 60 . n%n%n n % %n otlBBRough B&B Hostel n8)(=9 (n=39) (n=49) (n=84) Sleeping lly d NACD 2005 Drug Use Among the Homeless Population in Ireland 87 1.5 Patterns of Drug Use of Drug Patterns 30+ Years Chapter Six Chapter 4 25-29 Years 4.5 20-24 Years 22 16-19 Years 68 <16 Years 0% 80% 70% 60% 50% 40% 30% 20% 10% 6.10 Impact of Drug Use on Accommodation 6.10 Impact of Drug Use on Accommodation emergency drug users (defined by licit or illicit use) and staying in current Those who were of their drug use. All those asked in Cork aware were asked if staff accommodation (hostel, B&B) were of those of their drug use. However, aware were accommodation providers that emergency reported accommodation in Dublin, just over one-in-two drug users and staying in emergency current who were staff reported only 50% (n=4) and 46% (n=6) respectively (n=59; 58%). Similarly, this awareness reported of their awareness to staff relating Galway and Limerick. Overall, figures of their drug use in awareness relating exception of Cork, than awareness lower in all locations, with the drug-using status were current (n=74; nearly two-thirds earlier in this chapter, alcohol status. For example, as presented to their current knew of that staff accommodation in Dublin reported drinkers staying in emergency 65%) of current status. drug-using their alcohol use in comparison to only 58% (n=59%) who knew of individual’s accessing also asked if they had ever experienced any difficulties were Eligible respondents drug users staying in to their drug use. Overall, 30% (n=38) of current accommodation due emergency that they had experienced reported accommodation (hostel and B&B accommodation) emergency 11% of the total study drug use, which represents accessing accommodation due to their difficulties accommodation in Cork drug users (40%) staying in emergency of the 5 current population. Two and no accessing accommodation, in comparison to 23% (n=3) in Galway difficulties reported in Limerick. reported difficulties 6.9.3 First Use of Drugs and Becoming Homeless 6.9.3 First Use of Drugs and Becoming or after becoming homeless. also asked if they had first used drugs either before users were Current they became homeless (n=176; 87%) with the remaining first using drugs before The majority reported This association is consistent with earlier 13% (n=26) commencing use following homelessness. of the chapter which highlighted that drug use was the main or one findings outlined in the previous Mean age of first drug use was lower for those who secondary factors for first becoming homeless. v 24 years). drug use prior to homelessness (15 years reported Figure 6.1 Age of First Drug Use 6.1 Age of First Figure 88 Drug Use Among the Homeless Population in Ireland NACD 2005 access, andstaywithin,emergency accommodationservices. The followingquotesreflect theimpactthatanindividual’s drugusecanhaveontheirabilityto Chapter Six Table 6.19ReportedDifficulties inAccessingAccommodationasaResultofDrugUse individuals indicatingadegree ofstabilityintheirdruguse. access iftheywere onamethadoneprogramme, whilesomehostelswouldlookfavourablyonthese homeless personsstatedthatemergency accommodationsuchasB&Bwouldrefuse as bothadifficulty bysomeindividualsandfacilitatedaccesstoservicesothers.Inotherwords, various their moneyondrugsratherthanaccommodation.Participationamethadoneprogramme wasviewed fund accommodationwasalsoreported anditwasstatedby8individualsthattheywouldprefer tospend based ontheirintoxicatedstateuponarrivingatanemergency accommodationservice.Lackofmoneyto using status.Analmostsimilarnumberofindividualsreported difficulties inrelation torefusal ofaccess The mostcommondifficulty wasthefactthataccommodationrefused basedonanindividual’s drug Table 6.19illustratesthetypeofdifficulties reported bydrugusersstayinginemergency accommodation. agtIjcig [1] [3] I lostthehouseovermymethadonebeinginfridge. [4] [2] house me. I wasaskedifondrugs,answered honestly, theyrefused accessandsaidtheywouldnot [4] [8] They saidthatIcan’t betrusted,theysaidthatalljunkiesare thesame. [7] [7] Caught Injecting Not OnaMethadoneProgramme/ NotDrugFree Wait Longer Lost Accommodation–“gotthrown out”/“barred” Lack Trust andNotReliable On aMethadoneProgramme No MoneyForAccommodation-SpentonDrugs Refused Access–“goofing”/“inabadway” Refused Access-BeingaDrugUser Difficulties Patterns ofDrugUse (Male, 28years) (Male, 18years) (Male, 24years) (n=38) [2] n NACD 2005 Drug Use Among the Homeless Population in Ireland 89 Patterns of Drug Use of Drug Patterns (Hostel provider – Dublin) (Hostel provider Chapter Six Chapter (Night shelter provider – Dublin) – Dublin) (Night shelter provider (Night shelter provider – Dublin) (Night shelter provider (Homeless service provider – Cork) (Homeless service provider (Service provider – Under 18s – Dublin) (Service provider (Accommodation service provider – Dublin) (Accommodation service provider If someone is dealing on the premises we will deal with that. If behaviour is going on we will we will deal If someone is dealing on the premises issue a warning. we will challenge it. If someone uses on the premises If you are found dealing drugs on the premises you are excluded from our building permanently. If our building permanently. excluded from you are found dealing drugs on the premises If you are our building permanently. be excluded from found shooting up in our building you would you are In London there are specific hostels for people who are on drugs and they can shoot up in safety. on drugs and they can shoot up in people who are specific hostels for are In London there it is if somebody is on whose responsibility have that facility – the law is very grey we don’t Here, to try and on it at the minute doing a lot of research We’re It is very dodgy. using on the premises. we stand on this. determine a clear policy on where It is being dictated by law. By law we all have to have a ‘no drugs on the premises’ policy. policy. to have a ‘no drugs on the premises’ By law we all have It is being dictated by law. you deal with it then, after that. is how The difference it has unit that would focus on the active drug users but was a residential if there It would be great Act, having under you have the Child Protection under age, all kinds of implications as well, they are Act makes it very you cannot do that. The Child Protection being allowed to use drugs by law, 18’s and to acknowledge them as such. to work with active drug users hard We have got guidelines from the police about finding drugs on the premises. Legally, it is okay in Legally, the police about finding drugs on the premises. have got guidelines from We can ask the person to leave with their drugs and they terms of what we do. If you discover it you of them down the toilet, witnessed and signed by must stay out for the night or you can dispose people. search don’t We covered. As far as I know we are two members of staff. Some emergency accommodation did accept homeless drug users, as long as they complied with the accommodation did accept homeless Some emergency caught using implemented if people were sanctions were of the hostel. Different rules and regulations and barring drugs or dealing. These included confiscating and disposing of drugs, written warnings to permanent exclusion). periods of 1 night (ranging from The focus groups provided a range of opinions on providing accommodation for homeless drug users. accommodation for homeless on providing a range of opinions provided The focus groups interviewed operated a ‘no drugs’ policy. All accommodation providers 6.11 Drugs and Accommodation: and Accommodation: 6.11 Drugs Perspective the Provider As the above quote highlights, it was mainly the legal aspects that were of greatest concern to of greatest the legal aspects that were As the above quote highlights, it was mainly had even consulted with the police when Some accommodation providers homeless service providers. formulating their policies. people emphasised that the law was particularly working with young homeless One service provider accommodation to young homeless drug users. providing around problematic 90 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Six it wasoftenalcoholusethatcausedproblems inthehostel,notdruguse. those onprescription drugs,asopposedtodrugusers,althoughonehostelprovider pointedoutthat Many accommodationproviders generallyshowedapreference forworkingwithalcoholusersor their accommodation. were mostadamantnotonlyabouttheir‘nodrug’policybutalsoinexclusionofdrugusersfrom It wassurprisingtofindsuchhighlevelsofdruguseamongthoselivinginB&Bs,asB&Bproviders are alsolegalproblems, insuranceissuesandsafetyconcerns.Thefollowingquotesexemplifythis. users create toomanyproblems forstaff, theyhavethepotentialtobeviolentandaggressive andthere Some accommodationproviders were reluctant toworkwithhomelessdrugusersastheyfelt are willingtoworkwithsomebody. will workwithwomenwhoare engagingormisusingalcoholprescription drugs.Ifthey somebody whoissubstanceabusingwithoutbeingonsomesortofamaintenanceprogramme. We We certainlywouldn’t havethewherewithal orstaff ingeneraltobeabletoleratesupporting drug usethingandsometimesmentalhealth. have tocalltheguards it’s fordrinkersorbehaviourwhenpeopleare undertheinfluence,not rather workwiththirtydrugusersanydaythantwoorthree street drinkers[…]generallywhenwe We workwithactivedrugusers,peopleonmethadonemaintenance,drinkers,whoever. Iwould for onethingit’s another. a druguseroranalcoholic[…]Drugusersbringthelawtoyourhouseonconstantbasis.Ifit’s not single parents, andsecondlybylawweare notcovered byinsurancetoprovide accommodationfor We hopetofindoutiftheyare drugusersbecausefirstlythere are alotofchildren, familiesand because wedon’t have theresources. We don’t takepeoplewhoare activelyusingorwhohaveseriousmentalillnessesandthatissimply a fewdrinkers. aggressive. We are not supposed totakeactivedrugusers.Drinkersyes,there wouldbequite We don’t takedrugusersatall.We can’t really control theirbehaviourinthehostel–theyare problems forstaff. have thefacilitiesandtheytendtohideneedlesinblanketstoiletrolls anditcauses major Unfortunately wecannotcopewithpeoplewhoare onhard core drugsorinjecting as wedon’t Patterns ofDrugUse (Accommodation serviceprovider –Limerick) (Transitional housing worker–Dublin) (Night shelterprovider –Dublin) (Hostel provider –Dublin) (Hostel provider –Dublin) (B&B provider –Dublin) NACD 2005 Drug Use Among the Homeless Population in Ireland 91 Patterns of Drug Use of Drug Patterns Chapter Six Chapter (B&B service provider – Dublin) (B&B service provider (Drug service provider – Dublin) (Drug service provider (Homeless service provider – Cork) (Homeless service provider (Homeless service provider – Limerick) (Homeless service provider The percentage of illicit substance misuse would be far lower here than it would be on the Dublin far lower here of illicit substance misuse would be The percentage a bit behind are scene with homeless individuals. That is because it is a smaller population and we in catching up. Clients are maybe drinking and taking drugs – which is worse because they are taking more of taking more taking drugs – which is worse because they are maybe drinking and Clients are and getting on a maintenance programme or everything rather than maybe focusing on heroin and more is more – there and pills. The range that is out there drink taking methadone. Heroin, and again it is very chaotic. just using more to them so they are on offer I think that broadly speaking there is a problem. If you look at the profile of the homeless of the If you look at the profile is a problem. speaking there I think that broadly a doubt it is getting younger and without a doubt population in the last year or two, without use. drug is more there If they are sharing accommodation with a separate kitchen it might be okay on an adult basis but kitchen it might be okay on an adult basis sharing accommodation with a separate If they are house and an to themselves, to other people in the dangers not because they are it’s with children and dinner her mother’s should be sitting at her table having No child awful danger to children. shooting up and falling on the floor and falling asleep. looking up at somebody who is just after […] so families should not be placed with drug users or for children an environment not really It’s will have to change. alcoholics. I think that is a major factor – it Nevertheless, service providers outside Dublin still felt that the prevalence of illicit drug use among felt that the prevalence outside Dublin still Nevertheless, service providers the results homeless people in Cork, Galway and Limerick was still lower than it is in Dublin. Similarly, illicit drug use in Dublin than in the other four cities. of the survey found much higher rates of current 6.12 Nature and Extent of Drug Use: and Extent of Drug 6.12 Nature Perspective the Provider that service providers was a general consensus among drug and homeless In all four cities, there The views of among the homeless population and that it was growing. was a drug problem there of the homeless which found that over a third of the survey the results reflect the service providers drug use, with almost a quarter indicating high population illustrated levels of problematic psychological dependence. There was a strong agreement among service providers, however, that drug users should not be that drug however, among service providers, agreement a strong was There sums up the general The following comment same places as children. accommodated in the given by respondents. impression 92 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Six use ofcannabisandecstasywaswidespread andnowa“normal”partofthehomelessculture. result ofacombinationcannabisandecstasyuse.However, mostserviceproviders reported thatthe ‘serious psychoticepisodes’asaresult ofcontinualcannabisuseor‘inabadstateafterseizures’ asa Some addictioncounsellorsinGalwayandCorkreported thathomelesspeoplehadpresented with Dublin ortheUK. and Cork.Itwasgenerallyconsidered thatmanyoftheheroin usersintheseareas had comefrom Outside Dublin,heroin usewas perceived tobeincreasingly visibleinLimerick,and less soinGalway or were current, heroin users. which wasreflected intheresults ofthesurvey. Manyfeltthatatleasthalftheirclientgroup hadbeen, According toserviceproviders inDublin,heroin isaseriousproblem amongthehomelesspopulation and are normalisedtoahuge degree soitwouldnotevenbeanissueforalotofpeople. problem withit[…]Formeatthemomentwouldbeecstasyandcannabisthatare widespread that isbeingsmokedbutwewouldknowanawfullotofourpeoplesmokeandhaveno clients andalotofitisaccepted.Thenumberreferrals wegetwouldnotindicatetheamount There isalotofcannabisbeingsmoked[…]Cannabisjustlikecigarettes forsomeofour perceived asaproblem. cigarettes aday”andthenyouaskaboutcannabis–“three orfouraday”[…]cannabisisnot even seenasaproblem. Whenyouaskthemhowmuchtheysmokesay“Itwenty They are usinghashlikeapacketofcigarettes –itissocommonlyusedaround theplace.Itisnot in generaltheywouldbepeoplewhohaverelocated from DublinortheUK. to begrowing butnotpresenting, mostwouldbesmokers,thosepresenting wouldbe smokersand It [heroin] wouldnotevenbeanissueforalotofpeopleandalsothenourheroin populationseems that about50%wouldhaveexperienceofusingheroin andtheywouldbeintravenousdrugusers. It ishard toquantifyexactly how manypeopleyouare dealingwith.Onatypicalday, Iwouldsay about 60%ofthepatientsthatIhaveseensofar, would useheroin. Everybody givesmeadrughistoryandthemajoritythatare activelyusing,whichwouldbemaybe Patterns ofDrugUse (Primary healthcare provider –Dublin) (Worker indrop-in centre –Dublin) (Homeless serviceprovider –Cork) (Drug serviceprovider –Galway) (Drug serviceprovider –Galway) NACD 2005 Drug Use Among the Homeless Population in Ireland 93 Patterns of Drug Use of Drug Patterns (Drug service provider – Cork) (Drug service provider Chapter Six Chapter (Drug service provider – Dublin) (Drug service provider (Drug service provider – Dublin) (Drug service provider I cannot think of any client now on methadone who is not taking something else. Cocaine would be just over the last couple of months but previous to that heroin and alcohol would heroin to that over the last couple of months but previous Cocaine would be just that we would see. in the homeless population prevalent be more It is much cheaper of late, so that is the pattern in is a small bit of cocaine and it is increasing. There that I work in which is the North Cork area. certainly in the area this area, According to the service providers, cocaine is becoming increasing popular among the general drug popular among the general is becoming increasing cocaine to the service providers, According is there In this regard, rural areas. four cities as well as the neighbouring using population in the a drug of choice. among the homeless population as use to spread potential for cocaine Several service providers commented that many heroin users had changed their primary drug of use to users had changed their primary drug of use commented that many heroin Several service providers and cocaine). using ‘speedballs’ (combination of heroin cocaine, while others were on of homeless people were that a substantial proportion in Dublin reported Service providers among those living in B&Bs. to be particularly prevalent methadone maintenance. It was perceived homeless population which found that the survey among the from This is consistent with the results the reporting with B&B residents using methadone, currently over a quarter of the Dublin sample were that only a in Limerick and Galway felt service providers highest level of methadone use. Conversely, maintenance is only available on methadone, while methadone of their clients were small proportion their treatment. and wish to continue with area in Cork for those who have moved to the polydrug use. This pattern was highlighted by several Almost one-fifth of those surveyed reported polydrug that many homeless drug users were who stressed during the focus groups service providers with benzodiazepines and anti-depressants. users, often mixing a range of illicit drugs 94 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Six Table 6.20Nature andExtentofDrugUseAmongtheHomelessPopulation 6.13 OverviewofKeyFindings ■ 6.14 SummaryandConclusions urn netr 1 7--- 11 11 - 9 6 6 14 - 9 47 14 17 19 68 27 46 64 30 methadone, otheropiates,steroids andotherdrugs. 25 heroin, hallucinogens(LSD,poppersandmagicmushrooms), solventstranquillisers,sedatives,anti-depressants, 36 83 **Drug Useisalldrugsexcl.alcoholasfollows:Cannabis,ecstasy, amphetamines,crackcocaine,cocainepowder, 25 19 35 50 powder, heroin, hallucinogens(LSD,poppersand magicmushrooms) andsolvents. 24 *For thepurposeofthisstudy, “illicitdrugs”refers tocannabis,ecstasy, amphetamines,crackcocaine,cocaine 64 56 19 Current Injectors 25 43 Ever Injected 66 28 dependence) 42 18 psychological 49 (high degree of Drug Use 42 36 69 Dependent 53 and DrugUse 51 Alcohol 72 Problematic 59 70 Drug Use** 72 Problematic Alcohol Use 80 Problematic 52 Alcohol Use 64 Current Current IllicitUse* 74 Recent IllicitUse* Lifetime IllicitUse* Variable studies similarly reported cannabisasthemost commonlyusedillicitdrug. Smith substantially higherthanthatfound byHolohan(1997),Feeney context inwhichtheresearch takesplace(O’Gorman,2002).Thisfigure forlifetimedruguseis studies amongthehomelesspopulation duetomethodologicaldifferences orthelocation or lifetime use(18%)(NACD/DAIRU, 2003).Lifetimeprevalence rateshavevariedsignificantlyacross commonly usedillegaldrug,howeverlessthanafifthofthegeneral Irishpopulationreported reported evertakinganillegaldrug(19%)(NACD/DAIRU,2003).Similarlycannabiswasthe most the generalpopulationwithalmostone-in-fiveofIrish population(15-64years)having Lifetime prevalence ofanillicitdrugamongthehomelessissubstantiallyhigherthanfigures for Cannabis wasthemostreported lifetimedrug(69%). Nearly three-in-four homelessindividualsreported lifetimeuseofanillicitdrug(74%). et al. Patterns ofDrugUse (2001). However, these studiesfocusedonspecificgroups ofhomelesspeople.These Population City Total Study Locations n35 n27 n3)(=6 (n=36) (n=36) (n=36) (n=247) (n=355) %%%% % % %% ulnCr ieikGalway Limerick Cork Dublin et al. (2000), Condon(2001)and NACD 2005 Drug Use Among the Homeless Population in Ireland 95 et (2001) et al. et al. Patterns of Drug Use of Drug Patterns Chapter Six Chapter 2001). Rates of current heroin use are higher than those found by Cleary and use are heroin 2001). Rates of current et al., 2000; Smith in a study of homeless women found a high level of misuse of prescribed medications (i.e. using in a study of homeless women found a high level of misuse of prescribed Over a quarter of respondents in this study had used sedatives (26%). Over a quarter in this study had Over a quarter of respondents (n=68; anti-depressants fifth reported use of sedatives (n=90; 26%), almost a current reported also were 19%) and tranquillisers (n=58; 16%). Use of tranquillisers and anti-depressants sleepers. higher among B&B occupants than was observed among hostel dwellers or rough among the homeless population is more The use of sedatives/tranquillisers and antidepressants 2003). The than 6 times that found among the general Irish population (3.9) (NACD and DAIRU, the high high level of use among those staying in B&B accommodation is not surprising given 2000). Smith and Hickey, of women which access such services (Houghton proportion (2000) who reported use of an illegal drug. The current heroin prevalence rates further affirm the rates further affirm prevalence heroin illegal drug. The current use of an (2000) who reported Dublin based within the general drug using population but not only largely notion that opiates are also within the homeless drug-using population. Dublin had the highest percentage of current illicit drug users (59%). Findings revealed a 30% illicit drug users (59%). Findings revealed of current Dublin had the highest percentage rate among the Dublin homeless sample. This is in comparison to prevalence heroin current the Cork sample. use in Galway and Limerick and no use among only very limited current by Holohan (1997), Condon (2001) and Feeney This is substantially higher than the figures The majority of current illicit drug users reported use of more than one drug (84%). Overall, use of more drug users reported illicit The majority of current the sleepers reported rough 50% of the Dublin homeless sample. One-in-five this represents (20%). use of five drugs or more by Houghton and Hickey (2001) in a study examining the This is consistent with a study undertaken and service use of a sample of long-term homeless which found that almost needs, circumstances substantiates other it In this regard, than one illicit drug. using more half of those interviewed were homeless individuals, especially rough which has indicated that national and international research programmes such as polydrug use. Treatment sleepers, engage in high-risk drug-using patterns, their polydrug-using practices of clients, often classifying may not always be designed to address primary drug of use (EMCDDA, 2000). The evidence of polydrug use in fatal to their use in regards risk at increased users are has been highlighted by (Byrne, 2002) and homeless polydrug overdose as ‘haste’, ‘isolation’ and ‘fear of detection’ often influenced by factors such as their practices are (Henkel, 1999; Ryan, 2002). al., Prizeman (1998) in a survey of 50 homeless service users in Dublin City (15%). Prizeman (1998) in a survey of 50 homeless Over half of the total study population reported current illicit drug use (52%). Current use of illicit drug use (52%). Current current study population reported Over half of the total of both lifetime and followed those homeless population largely illicit drugs among the patterns. drug-using use among the recent the primary illicit drug of current Cannabis is (22%). using heroin currently (43%). Almost a quarter were homeless population (5.6%) found that one-in-eighteen drug population study in Ireland Findings of the national use in the (3%) reported year while one-in-thirty-three previous cannabis use in the reported considerably lower (NACD and illegal drugs were rates for other month. Prevalence previous in the last adults aged 15-64 years had used heroin DAIRU, 2003). For example, only .1% of all cited above, among the homeless population under month in comparison to a rate of 22% as population which has illustrated on the homeless investigation. This supports other Irish research 1998; Feeney used illicit drug (Cleary and Prizeman, cannabis use as the most frequently current ■ ■ ■ ■ 96 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Six ■ ■ ■ ■ However higherrates(39%)were foundamonghomelesswomeninDublin(Smith ever injectedadrug. Howes (2001)inaUKstudyon rough sleepingfoundthat40% oftherough-sleeping sample had were alsoattendeesofthesyringeexchangeprovided byMerchants QuayIreland. Fountainand their drug-usingcareers. Apossibleexplanationprovided wasthatmanyoftheclients interviewed majority ofthosewhohaduseddrugsalsoreported havinginjecteddrugsatsomepointduring located withinthehomelessresource serviceofMerchants QuayIreland, foundthatthevast were observedwithinthisstudy. Corr(2003c),inastudyontheinformationand advice facility by Feeney Lifetime prevalence figures forintravenousdruguseare considerablyhigherthanthosereported reported injectingheroin inthelastmonth,allofwhom were from theDublinsample(27%). almost halfwithintheDublinsample(46%).Nineteenpercent ofthetotalstudypopulation Over athird ofthetotalstudypopulationreported havingeverinjected(35%)increasing to to 5,865inDec2001),more than7,000in2004. methadone treatment hascontinuedtoincrease overthe last fewyears,(from 2,859inDec1997 dependence inIreland. The numbers ofindividualsregistered centrallywhoare inreceipt of regional variations.Methadoneiscurrently themost widelyusedtreatment modalityforopiate urban problem, research hasalsoillustratedthatitishighlyscattered andlocalised,withdistinct particular heroin use,isprimarily anurbanproblem. Whilerecognising thatopiateuse islargely an The drugtreatment datafrom theHealthResearch Board clearlyindicatethatdruguse,in No current methadoneusewasfoundamonghomelessindividualsoutsideofDublin. Less thanafifthofthetotalstudypopulationreported current methadoneuse(18%). streets, andontheotherhand,treatment andrehabilitation. minimisation whichhelpsrough sleeperstomanagetheirdruguseaspartofmovingoff the range ofsupportaround their drug/alcoholuse.Debateexistsregarding balancebetween harm However, thehighratesofcurrent druguseamongrough sleepersre-emphasise theneedfora cited thatalmosthalfhadusedheroin and/orcrack(47%)withhighdailyornearlyfrequency. research. FountainandHowes(2002),inastudyofdruguseamongrough sleepersin London, The proportion ofrough sleeperswhohadusedanyofthese drugsislowerthanfindingsfrom UK also consistentwithintheDublinsample. those sleepingrough thanamongeitherhosteldwellersorB&Boccupants.Thisfindingwas Higher ratesofcurrent heroin (34%),cocaine(25%)andcrackuse(7%)were foundamong increasing tothree-quarters ofthe18-34agegroup. dwelling samplehadengagedinillicituseofatleastonedrugtheprevious yearwiththisfigure This ishighincomparisontoastudybyFeeney while overtwo-thirds (n=44;69%)ofB&Bresidents were current illicitdrugusers. Nearly one-in-twohosteldwellersinDublinreported current useofanillicitdrug(48%), increases withage(EMCDDA,2000). medicines suchasbenzodiazepinesismore commonamongwomenthanmenandthedifference psychotropic drugsexceedthatoftheirmaledrug-usingcounterparts.Forexample,theuse of more thantheprescribed dose).Internationalstudieshaveestimatedthatwomen’s useof Patterns ofDrugUse et al. (2000) andCondon et al. (2001), documentingratesof12%and24%respectively. et al. (2000) inwhichoverathird ofthehostel et al., 2001) than NACD 2005 Drug Use Among the Homeless Population in Ireland 97 Patterns of Drug Use of Drug Patterns 2000). Using a different Chapter Six Chapter et al., (2001), in a study on homeless et al. (2000) was if an individual had taken a drug every et al. (2000) found that approximately half of the male hostel dwellers in the 18-34 age (2000) found that approximately et al. 2001). However, this finding provides additional information on the association between additional this finding provides 2001). However, The majority of those experiencing homelessness first used drugs before becoming The majority of those experiencing homelessness first used drugs before homeless (87%). (Kennedy is well established in the literature between drug use and homelessness The relationship et al., drug use and homelessness within an Irish context. day for two weeks or more in the previous 12 months. Smith previous in the day for two weeks or more drug of hostel-dwelling women were women in Dublin, illustrated that a higher percentage 7% of 188 male hostel dependent in comparison to those in B&B accommodation. In Glasgow, and stimulants (Kershaw dependent on both opiates were residents sleepers, found Fountain and Howes (2001), in a sample of rough instrument (CAGE), screening on the main substance they had used. It is not possible to similarly as dependent that 80% scored use among this study sample as individuals of dependence on primary drug ascertain the degree drug. not asked to state their primary were Thirty percent of the Dublin sample indicated a high degree of psychological dependence on of the Dublin sample indicated a high degree Thirty percent (36%) the highest level of dependence occupants scored used. B&B the drugs currently sleepers (30%). closely by rough within the total study population, followed Feeney dependent drug users. Dependence was most common for cannabis (14%). However, were group dependent users. The definition were ever using heroin reported of those who almost two-thirds of dependent use employed by Feeney Thirty-three percent of those who reported they used drugs within the Galway sample of those who reported percent Thirty-three population. 14% of the overall Galway homeless which represents problematic, as scored but nevertheless consistent with, the finding by Hourigan and Evans (2003) This is slightly lower, voluntary services in Galway and Mayo. In their in a study among sixty-five individuals accessing the over 6 indicating study sample scored drug users, 35% of the current were of those who study, need for intensive assessment. Problematic drug users were significantly more likely to be younger and report their first likely to be younger and report significantly more drug users were Problematic and drug using counterparts their non-problematic homeless episode at a younger age than the overall study population. for Drug Monitoring Centre to the European one of the countries continually reporting is Ireland of young people (EMCDDA, 2000). use by new groups in heroin and Drug Addiction increases A third of the total study population scored as problematic drug users (36%). Over two-fifths as problematic scored of the total study population A third outside Dublin in comparison to less than a fifth as problematic scored of the Dublin sample drug use (46%). problematic sleepers reported one-in-two rough (43% v 19%). Almost has is far higher than UK research as problematic sleepers who scored of rough The proportion found that surveys sleeping, on rough of the literature in a review indicated. Randall (1998), Older rough sleepers had drug problems. of rough one-in-five around consistently reported (Randall and sleepers use drugs while younger rough alcohol problems, sleepers tend to have 1999b). Brown, ■ ■ ■ ■ ■ 98 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Six ■ ■ over halfhadnotusedheroin untiltheybecamehomeless. upon becominghomeless.Forexample,almostthree-quarters hadnotusedcrackcocaineand Fountain andHowes(2001)foundthatthemajorityofrough sleepersonlystartedusingdrugs were cited. of administration,increased frequency/quantity, andassociatedlifestylebehaviourchanges three-in-four current users(77%).Initiationintodruguse,changesinprimaryandroutes asaresult ofbecominghomelesswereChanges indrug-usingpatterns reported byover Pamneja, 2000). important thatthestaff feel competent intheuseoforganisational drugpolicy(Brittonand their peershavebeeninvolvedinthedecisionprocess (KnightandHonor, 2002). Itisalso positive attitudewithinthewiderusergroup asagreement isfurtherenhancedbythefactthat organisation policescanbe highly effective (BrittonandPamneja,2000).Thiscanhelpconveya as alastresort (Flemen,1999). Theinvolvementoftheserviceuserindevelopment application ofaseriesgradedsanctionswithpermanentexclusionfrom servicesonlyemployed about thelegalaspectsofworkingwithdrugusers,however, bestpracticerecommends the undetected (HammersleyandPearl,1997citedinFlemen1999).Organisations are concerned that itencouragesindividualstodenysubstanceproblems andenterserviceswiththeirproblems or pastdrugusemayrepresent abarriertoimmediateor future accommodationneeds,means between different patternsandlevelsofdruguseorthetypes ofdrugsused.Thefactthatcurrent Flemen (1999:9)argues thatemployinga‘blanket’policyforalldrugusersdoesnotdifferentiate practices, possessionofdrugs/injectingequipment(Flemen1999;HowleyandCostello,2001). drugs havefrequently beenexcludedfrom provision byvirtueoftheirdrug-usingstatus,injecting been excludedthanthosenotdependent(FountainandHowes,2001).Homelesspeoplewhouse UK research hasindicatedthatthosedependentondrugsandalcoholare more likelytohave cited difficulty. their druguse(30%).Thestigmaassociatedwithbeingauserwasthemostcommonly staying inemergency accommodationreported difficulties accessingsuchservicesdueto status inallcitylocations,withtheexceptionofCork.Almostathird ofcurrent drugusers of respondents’ drug-usingstatuswaslowerthanawareness relating totheircurrent alcohol accept homelessdrugusersiftheycompliedwiththerulesandregulations. Staff awareness All accommodationproviders interviewedoperateda“nodrugs”policyalthoughsomedid Patterns ofDrugUse NACD 2005 Drug Use Among the Homeless Population in Ireland 99 drug as their main route (4%). Over one-in-five of current heroin users reported smoking users reported heroin (4%). Over one-in-five of current as their main route 61 just beneath the skin. as their main route of administration (n=16; 21%) which represents 5% of the homeless population. of administration (n=16; 21%) which represents as their main route users, injecting the drug. Current cocaine users (n=34; 63%) reported of current Almost two-thirds various tablets, for example, sedatives (n=6), anti- injecting also reported although in the minority, (n=1). (n=1), tranquillisers (n=1) and steroids depressants users of cannabis and crack, while by current administration reported of Smoking was the main route methadone, users of sedatives, anti-depressants, by current reported ingesting was the main route opiates and other drugs. In terms of current other hallucinogens, steroids, tranquillisers, ecstasy, sniffing. 50% (n=4) reported ingesting and the remaining amphetamine use, 50% (n=4) reported 61 to an injection between skin and fat layers. Also called “subcutaneous” or “sub-Q” it is injecting the “Skin-popping” refers Current injectors were asked in some detail about their injecting behaviour (n=66). Firstly they were asked in some detail about their injecting behaviour (n=66). injectors were Current injectors usually of current 7.1 illustrates that almost a third Table they usually injected. asked where injecting in various public places; reported (n=19; 32%). Others injected at their place of residence (n=6; 9%). public toilets (n=4; 7%) or “anywhere” (n=7; 12%), park (n=9; 15%), street injecting within their likely to report significantly more that female injectors were Analysis revealed of percent (x2=6.89;df=1;p<0.01). Sixty-three than their male injecting counterparts place of residence with 37% of the male compared place of residence, that they usually inject at female injectors reported accommodation type was related current that the respondent’s Further analysis revealed respondents. 7.3.1 Place of Injecting 7.3 Current Injecting Behaviour and Practices 7.3 Current the direct comes not from drugs, such as heroin, associated with the use of illicit Much of the trouble it its use (Hamilton, 2001). In this regard, surrounding circumstances of the drug, but rather the effect of homeless was important to include various questions which would examine the injecting practices IV drug use (n=66), current individuals. As outlined above, 19% of the total study population reported the Dublin sample. from all of whom were 7.2 Route of Administration Over Past Month 7.2 Route of Administration of drug asked their main route users (i.e. licit or illicit use within the last four weeks) were Current last month injecting in the population surveyed reported administration. Overall, 19% of the homeless the Dublin sample (27%). from injectors were (n=66). All current daily users (n=40; 52%). users were heroin of current over half chapter, As highlighted in the previous injecting intravenously and one use, the majority (n=57; 74%) also reported heroin In terms of current 16% of the homeless population In other words, injecting intramuscularly. reported respondent reported users heroin current in the last month. In addition, three injecting heroin surveyed reported ‘skin-popping’ Drug use can be associated with a number of health consequences and presents an important challenge an important and presents with a number of health consequences Drug use can be associated of nature This chapter examines the extent and and medical services alike. to public health professionals homeless population. complaints among members of the drug-using risk behaviours and health Risk Behaviour and Health Risk Behaviour 7.1 Introduction Chapter Seven Seven Chapter 100 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Seven Figure 7.1 InjectingCompany across categoriesofaccommodation. comparison to25%offemaleinjectors(n=6).There were nosignificantdifferences ininjectinghabits injectors (x2=6.96;df=1;p<0.01).Sixtypercent ofmaleinjectors(n=22)reported injectingalonein that malerespondents were significantlymore likelytoreport injectingalonethantheirfemaledrug partner (n=21),and20%(n=12)reported theyare usuallyin agroup whentheyinject.Analysisrevealed respondents reported thattheyinjectalone(n=28;46%),34%reported thatnormally theyinjectwith All respondents were askedwithwhomtheyusuallyinjected. Figure 7.1illustratesthatnearlyhalfthe 7.3.2 InjectingCompany Table 7.1PlaceofInjectingbyGender (5.5% respectively). a hostel(n=4),andtworespondents were staying,onewithfriendsorrelatives, andoneinasquat reported injectingintheirplaceofresidence were B&Boccupants(n=13),while21%were stayingin to whetherclientsreported injectingattheirplaceofresidence. Sixty-eightpercent ofthosewho ulcTie 3 1 [4] [7] 7 [9] 12 [3] [1] 15 5 [2] 4 [2] 9 [2] [3] 9 9 [5] [19] 8 [7] [7] 14 32 [1] [11] 19.5 [12] 3 20 Total 52 [2] [6] [3] Female [7] (n=1), wasteground (n=1),canalnotspecified(n=1). 9 13 * “Other”placeofinjectingrefers to;squats(n=3),car(n=2),behindchurch (n=2),phonebooth 19.5 [1] [8] Missing [5] Male Other* 22 4 Home ofFriends/Relatives [5] Public Toilet Anywhere 14 Street Park Place ofResidence Place ofInjecting Risk BehaviourandHealth With Partner With In Group 34% 20% n%n%n n % %n Alone 46% NACD 2005 Drug Use Among the Homeless Population in Ireland 101 [1] 33 [2] 4 [2] [3] %n 5722 [37] [14] 100 [65] Risk Behaviour and Health Behaviour Risk Chapter Seven Chapter %n % n %n * “Other” injecting site refers to feet (n=1), shoulder (n=1) and neck (n=1) * “Other” injecting site refers Other* Total Missing Arm Groin Arm and HandLeg Hand 11 [7] Injecting Site Injectors Current Always 93Always 5Sometimes [38]2Never [2] 48100 Total [1] [12] [41] 16 36 100 76 [4] [25] [50] [9] 9 100 15 [66] [6] [10] Inject Self Male Female Total Table 7.3 Injecting Sites Table Current injectors were firstly asked to state at what part of the body they currently inject. This was to inject. firstly asked to state at what part of the body they currently injectors were Current 7.3, illustrates sites. Table injecting in any particularly dangerous ascertain whether individuals were almost one-in- injecting in the arm (n=37; 57%), while injectors reported that the majority of current of the occurrence as it can increase which is cause for concern injecting in the groin four reported as an injecting site by 7 injectors (11%). also reported were blood clots (n=14; 22%). Arms and hands neck. included; leg, hand, feet, shoulder and reported Other areas 7.3.3 Levels of Risk Behaviour Table 7.2 Inject Self by Gender Table Current injectors were also asked whether they usually inject themselves (as opposed to being injected also asked whether they usually inject were injectors Current always reported injectors of current over three-in-four 7.2 shows that just by another person). Table never injecting themselves. This reported 15% (n=10) also (n=50; 76%). However, injecting themselves in comparison to not injecting self of female injectors (n=9) reporting with 36% was highly gendered significantly less injectors were of the male population of injectors. Female only one member (2%) although not p<0.001). Analysis revealed, injecting themselves (x2=13.61; df=1; likely to report injected themselves (mean older than those that never injected themselves were significant, those that age of 28 years v 25 years). Regarding injecting risk behaviour, all injectors were asked about the sharing of injecting equipment in were all injectors injecting risk behaviour, Regarding injectors reported illustrates that over half of current 7.4 below Table the four weeks prior to interview. paraphernalia, that is spoons and filters (n=35; 53%). Almost one-in-four sharing of injecting the recent lower at 17% were lending injecting equipment while rates for borrowing injectors reported current 102 Drug Use Among the Homeless Population in Ireland NACD 2005 times, 6-10timesandmore than10times. frequency was“once”(n=7).However, 3injectorsreported twice,andoneinjectoreachreporting 3-5 percent (n=47)said“never”.Ofthosewhodidreport reusing aneedlethemostcommonreported current injectors“howoftenhadtheyusedaneedleaftersomeoneelseit”.Seventy-eight Another measure todetermine theintensityofsharinginjectingequipmentwasemployedbyasking equipment incomparisontoonly27%(n=3)ofB&Boccupantsand9%(n=1)hosteldwellers. accommodation. Forty-sixpercent ofinjectingrough sleepers(n=5)reported borrowing usedinjecting report borrowing others’injectingequipmentthan individualsstayingineitherB&Borhostel across categoriesofaccommodation. However, rough sleeperswere proportionally more likelyto Further analysisrevealed that there wasnosignificantdifference inreported injectingriskbehaviour borrowing others’injectingequipment. were proportionately more likelytoreport lendingotherstheirusedinjectingequipmentand Although there wasnosignificant genderdifference inthelevelsofsuchsharing,male respondents Chapter Seven current injectingpopulation. four percent (n=14)ofmaleinjectors reported nodifficulties asopposedto12%(n=3)of thefemale injecting difficulties incomparisontotheirfemaleinjectingcounterparts(x2=3.98;df=1;p<0.05). Thirty- difficulty (26%).Maleinjectorswere significantlymore likelytoreport having“never”experienced that ofthe66current injectors,only17reported neverhavingexperiencedaninjecting-related All injectorswere askedwhether theyhadeverexperiencedanyinjectingdifficulties. Figure 7.2shows 7.3.4 InjectingDifficulties Table 7.4Current SharingBehaviourbyGender injecting equipmentratherthanborrowing othersequipment(x (n=11). Analysisrevealed thatcurrent injectorswere significantlymore likelytoreport lendingused Figure 7.2EverExperiencedInjectingDifficulties orwdue VEupet1 7 6[]1 [11] [15] 17 23 [35] 53 [4] [4] [13] 16 16 52 [11] [7] Total [22] 27 17 54 Female Male Multiple responses allowed. *Refers tobehaviourfourweeksprioradministrationofsurveyquestionnaire. Borrowed usedIVEquipment Lent UsedIVEquipment Shared IVParaphernalia Current SharingBehaviour* Risk BehaviourandHealth Never 26% n%n%n n % %n Sometimes 2 =12.58;df=1;p<0.01). Always 32% 42% NACD 2005 Drug Use Among the Homeless Population in Ireland 103 % 63 54 46 (n=66) %n 36 [24] Current Injectors Current Risk Behaviour and Health Behaviour Risk with almost one-in-three 62 Chapter Seven Chapter Lent Used IV EquipmentAccidental Overdosed Used EquipmentBorrowed 23 17 20 Street Injectors Street IV ParaphernaliaShared Inject Alone Never/Sometimes Inject Self 53 24 Variable InjectingDifficulties Polydrug Use 74 Abscesses/Infections Accidental Overdose 32 20 [21] [13] Injecting Difficulties71Scarring/Bruising Injecting Difficulty [47] Dirty Hit Injectors Current 64 [42] reporting the experience of abscesses or infection in the three months prior to interview (n=21; 32%). the experience of abscesses or infection in the three reporting (n=13; 20%). Male injectors accounted for accidental overdose one-in-five of injectors reported Finally, months. in the last three an accidental overdose 69% of those who reported 62on your needle can cause bends (a dirty hit). in and Dirt, bacteria, fungi and other micro-organisms Table 7.6 Overview of Injecting Risk Behaviour Table 7.3.5 Overview of Injecting Risk Behaviour an overview of injecting risk behaviour practices among the cohort of homeless 7.6 provides Table and injecting risk behaviour can contribute towards a range of factors injectors. As conveyed below, and among homeless injectors. Practical issues, such as not having appropriate commonplace were reported were safe storage facilities for clean injecting equipment when experiencing homelessness, tortoise”, in having One individual equated his situation to that of “a as influencing risk behaviour. “to carry the load on his back”. Table 7.5 Injecting Difficulties within the Past Three Months within the Past Three 7.5 Injecting Difficulties Table Table 7.5 illustrates the experience of various injecting difficulties reported by current injectors within by current reported experience of various injecting difficulties 7.5 illustrates the Table or bruising of the scarring injectors reported of current months. Almost three-quarters the last three Although injecting (n=42; 64%). difficulty reported while nearly two-thirds injecting site (n=47; 71%), scarring/bruising of injecting likely to report more proportionally injectors were not significant, female (71% v 57%). site than their male counterparts Only two-thirds (n=24, 36%) of injectors reported having a ‘dirty hit’ (n=24, 36%) of injectors reported Only two-thirds 104 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Seven “Out ofHome” ofDrugUseasaResultBeing Figure 7.3 NegativeChangesinPatterns the totaldrug-usingpopulation. changes (criminalactivities,street work).However, thethemeshighlightedcannotbegeneralisedto and routes ofadministration,toincreased frequency/quantity, andtoassociatedlifestylebehaviour These commentshighlightthediversityofbehaviourchanges,rangingfrom changesinprimarydrug becoming more ‘risky’.Figure 7.3belowpresents someofthecommentsmadebyrespondents. they becomehomeless,andwere more oftenassociatedwithdrug-usingpracticesandbehaviour they hadbecomehomeless.Changesreported hadlesstodowithpeoplestartingusewhen Over three-quarters ofcurrent users(n=156;77%)reported thattheirdrugusehadchangedsince 7.4.1 ChangesinDrugUse Changes inBehaviourandPractices 7.4 DrugUseandHomelessness: heroin inmylifeuntilIcameonthestreets. Onedaysomeonewillprobably handmeaspike. It’s goneupalot–there’s nothingelsetodowhenyouare onthestreets. Ihadnevertouched when Iwashungryandlonely. I waslookingforsomethingtokeepmecomfortable.So takinggeartokeepmewarm, I’m along-termuser. I stayedoff thedrugsforsixmonthsandIjustcouldn’t cope.Theyshouldgiveusfree heroin. First itwasonlycannabisanddrink.ThenIintroduced toheroin andstartedusingit… you’ll takeanythingtoknockyourselfout,soyoucansleepthrough thenight. It gotworse.Iwouldtakeanythingespeciallyatnightbecauseitbesocoldandifit’s wet, At homeIwasonlysmokinghash.Sincebecamehomeless,startedusingheroin. time, greater accesstodrugsastheyare easiertoget. I amusingawiderselectionofdrugssincebeinghomeless.different drugsatthesame money thenIwouldbuyabitofcocaine. looking formoneytobuydrugs24/7.Imostlyuseheroin whenonthestreets. IfIhaveenough I usemore drugswhenonthestreets, asthere’s nowhere toputyourheaddownandyou’re Risk BehaviourandHealth Continues over page (Male, 20years) (Male, 23years) (Male, 32years) (Male, 46years) (Male, 40years) (Male, 25years) (Male, 33years) NACD 2005 Drug Use Among the Homeless Population in Ireland 105 (Male, 26 years) (Male, 30 years) (Male, 46 years) (Male, 28 years) (Male, 35 years) (Female, 19 years (Female, 41 years) (Female, 19 years) (Female, 28 years) (Female, 26 years) Risk Behaviour and Health Behaviour Risk Chapter Seven Chapter I have cut down a lot. The price of drugs in Ireland is too much. in Ireland I have cut down a lot. The price of drugs My use has ceased except for cannabis. I am using much less drugs since I left home. My father My use has ceased except for cannabis. I am using much less drugs since I left home. was using drugs, so I needed to get out of the environment. smoke much at all, I smoke less since being on the streets. really I don’t willing to help me and I changed for the better… were Staff environment. I was in a different being able to take a walk and come back, it all helped me stop. My methadone there, meals were 120 to 40 mls since becoming homeless. from dose reduced it. afford use as much because you can’t I don’t My drug use got better since coming to the hostel, it opened my eyes not to do heroin. It got worse, then I started selling heroin. I sold my body for drugs, I lost weight from not eating, body for drugs, I lost weight from I sold my selling heroin. It got worse, then I started I shoplifted. to another. one drug I jumped from I used everything. everywhere. I went up, down, sideways, for heroin. picked up the drink, then got a taste I tried to stop using and than if you go home to your normal home. When you’re I’ve seen a lot of people do worse things exposed to a lot more. homeless, you’re I’m a junkie. Since homeless I became an alcoholic, now Figure 7.4 Positive Changes in PatternsFigure of Drug Use as a Result of Being Homeless It is important to note that, although limited in comparison to the negative aspects above, there were in comparison to the negative aspects above, there It is important to note that, although limited some 7.4 below, within Figure As conveyed by respondents. also various positive changes reported homeless, their drug-using patterns or behaviour had homeless individuals stated that having become in the minority and as such would not were these responses However, changed in a positive direction. of the total study population. be representative 106 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Seven Figure 7.5 ChangesinInjectingPracticesasaResultofBeingHomeless highlights, asanexample,thisinitiationintoinjecting; injecting behaviouruponbecominghomeless.Thefollowingquotebyafemalecurrent injector more frequently andlesssafely. Anumberof individualsalsoreported thattheyonlycommencedtheir homeless. Themajoritystatedthattheywere usingdifferent typesofdrugs,greater quantities,using current injectors(n=44;69%)reported thattheirinjectingpracticeshadchangedsincebeing their injectingpracticeshadchangedinanywaysincetheyfirstbecamehomeless.Overtwo-thirds of In addition,individualswhohadinjectedinthelastfourweekswere askedwhethertheybelievedthat 7.4.2 ChangesinInjectingBehaviour explicitly themannerinwhichtheirinjectingbehaviourhaschangedsincebecominghomeless. Figure 7.5belowpresents aselectionofquotesfrom homelesscurrent injectorswhichillustratemore I injectmore often.Iinjecttabletsinthepark. It’s harder togetaninjectingsiteasitissocoldonthestreets. I startedusingmyneckforinjecting. homeless, it’s becomeafull-timegig. It gotrampant,Iwouldn’t haveinjectedallthetimebefore Ibecamehomeless,butsince I onlystartedwhenbecamehomeless. last aslong. It hasbecomelesshygienic.Thediscomfortofnothavingsomewhere togomakesthehitnot rough. It’s amiraclethatIamHIV negative. I usedmore andtookmore chances.Ishared needleswithpeopleHIVthrough sleeping us….that’s howIstartedinjecting. because IwasasmokerI’dusemore soinsteadyou’dcookitalluptogetherandsplitbetween Because youare homelessyoutrytogetmore valueformoney, youbuytwobagsbetweenthree, Risk BehaviourandHealth (Female, 20years) (Female, 23years) (Female, 26years) (Female, 21years) (Female, 29years) (Male, 23years) (Male, 40years) (Male, 47years) NACD 2005 Drug Use Among the Homeless Population in Ireland 107 Risk Behaviour and Health Behaviour Risk Chapter Seven Chapter 7.5.1 Physical Health Complaints 7.5.1 Physical Health the listed health any of from suffering currently whether they were asked to report were All respondents among both the total levels of physical complaints 7.7 below outlines the reported complaints. Table higher reported drug users users (n=127). The problematic and problematic study population (n=355) epilepsy and ear, eye of the following; blood pressure, levels of physical complaints with the exception higher among the total study population. only marginally were and diabetes. Rates for these complaints dental issues (43%) in comparison to almost reported Just over two-fifths of the total study population of both the total population and drug users (62%). Ninety percent of problematic two-thirds physical complaints. one or more from suffering reported drug-using group problematic complaints in 5 or more from suffering 100; 28%) were Over a quarter of the total population (n= was also noted in the drug users (n=47; 37%). A difference of problematic comparison to over a third population was 3 (range: The mean number for the total study mean number of conditions reported. 0-15). drug users (range: problematic 0-15) in comparison to 5 complaints for the complaints by homeless accommodation type, rough In terms of experience of physical health than those staying in hostel a slightly higher mean number of complaints (mean=4) sleepers reported in B&B drug users staying problematic However, accommodation and B&B (mean=3 complaints). 6 complaints) than rough a higher mean number of complaints (mean = accommodation reported (4 complaints). sleepers (5 complaints) or hostel dwellers 7.5 Physical Health 7.5 Physical 108 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Seven (n=66; 52%). had anaverageageof31.3years.Thisisincomparisontojust overhalfofproblematic drugusers The averageageofthosewhohadamedicalcard was37.2years,whilethosewhodidnothaveacard thirds ofthetotalstudypopulation (n=219;62%)reported beinginreceipt ofacurrent medicalcard. Respondents were alsoaskediftheyhadacurrent medicalcard. Table 7.8illustratesthatnearlytwo- 7.5.2 MedicalCard Table 7.7PhysicalHealthComplaints 4“Other”physical healthcomplaintsrefer toanaemia(n=1), lymphoma(n=1), abscesses(n=1),constipation (n=1), heart attacks(n 64 “Other” physicalhealthcomplaintsrefer tolowbloodpressure (n=4), cancer(n=4),liverdisease cirrhosisofliver( 63 ibts3[1 [4] 3 [11] [10] [11] [8] 3 8 9 [13] 6 10 [23] [17] [27] [26] 13 6.5 [26] 8 7 [27] [35] 7 [26] 21 10 [20] 20 [57] 16 [40] [34] [66] 31 16 [50] 27 [20] [3] 19 [89] 16 14 [88] 2 25 [40] [62] 25 31 [8] 17.5 *Multiple responses were allowed [112] [61] Tuberculosis 2 31.5 48 Diabetes Rheumatic Disease [155] Gastro-Intestinal Tract 44 Heart Disease Epilepsy Urinary Tract Other Peptic UlcerDisease Bronchitis Problematic High BloodPressure Total Study Skin [79] Asthma 62 Foot [69] [154] Eye andEar 54 Dental 43 [173] Bones &Joints Headache 49 Physical HealthComplaints blood clots (n=1),cirrhosis thyroid (n=1),eczema(n=1), Raynaud’s Disease (n=1),seizures(n=1), notspecified(n=1). lymphoma (n=1). (n=1), heartattack seizures (n=1), haemorrhoids(n=1),pneumoniahigh cholesterol (n=1), arthritis(n=1),DVT(n (n=1), kidneyfailure (n=1),physicaldisability (n=1),blindnessthickblood (n=1), backproblems (n=1),dizzyspells( constipation (n=2),thyroid (n=2),eczema (n=2),Raynaud’s Disease(n=2), lungs(n=2),bloodclotsanaemic (n=1),absces 63 64 Risk BehaviourandHealth ouainDrugUsers Population 3[5 [12] 9 [45] 13 n%n%n n=2), n=1), ulcer =1), ses =1), NACD 2005 Drug Use Among the Homeless Population in Ireland 109 Risk Behaviour and Health Behaviour Risk %n %n %n %n %n %n Population Drug Users Users Population Drug Population Drug Users Chapter Seven Chapter Male 36Female 48 [84] 40Total [51] 65 [135] 76 [52] 69 [34] [86] Vaccination Hep BVaccination Study Total Problematic Hepatitis BHepatitis C 48 50 [170] [175] 81 [101] 82 [102] Ever Tested Ever Tested Study Total Problematic Current Medical Card Card Medical Current 62 Yes 38No [219] [136] 52 [66] 48 [61] Study Total Problematic Table 7.10 Vaccination for Hepatitis B by Gender 7.10 Vaccination Table Table 7.9 Test for Hepatitis B, C for Hepatitis B, 7.9 Test Table 7.6 Blood-borne Infections and Results 7.6.1 Hepatitis B, C Testing for hepatitis B or C. In asked to state whether or not they had ever been tested Individuals were 7.9 shows the hepatitis B vaccination. Table asked whether they had ever received addition, they were having ever been tested for hepatitis B, (n=170; 48%) reported that less than half the respondents to over having ever been tested for hepatitis C. This is in comparison while half (n=175; 50%) reported drug-using population. of the problematic four-fifths Table 7.8 Current Medical Card Medical 7.8 Current Table Forty percent of respondents (n=135) had received the vaccination for hepatitis B. Table 7.10 shows the vaccination for hepatitis B. Table (n=135) had received of respondents Forty percent proportionally were that in terms of gender distribution, although not significant, female respondents B than their male counterparts. likely to have been vaccinated against hepatitis more Findings also revealed that more than one-in-two rough sleepers of the total study population than one-in-two rough that more Findings also revealed found posession were card current (n=32; 58%). Higher rates of medical card having a current reported (n=18; 69%). sleeping rough drug users who were among problematic 110 Drug Use Among the Homeless Population in Ireland NACD 2005 and 8%respectively). total studyandtheproblematic drug-usingpopulationreported apositivehepatitisBstatus(7% Lower numbersreported apositive hepatitisBstatus.Lessthanone-in-tenrespondents ofboththe included; hospitalcheck-ups,vaccinations(interferon), bloodtests,liverchecksandtriple therapy. also reported bytheproblematic drug-usingpopulation(n=7;11%).Thetypeoftreatments cited population, 13%(n=11)reported currently receiving treatment. Asimilarleveloftreatment contactwas Furthermore, ofthe82individuals whoreported apositivehepatitisCstatusamongthetotalstudy Chapter Seven Table 7.11 Results Hepatitis(BandC) C positive(x Analysis revealed thatrespondents whohadeverinjected were significantlymore likelytobehepatitis sample were from Dublin. sample. Similarly, themajorityofthosereporting ahepatitisCpositivestatusamongtheproblematic problematic druguserstestedforhepatitisC(n=102),representing 51%oftheproblematic drug-using the CorkandLimericksamples.Thisisincomparisontoapositivestatusof64%(n=65)among This refers to21%ofthetotalDublinhomelesspopulation,11%Galwaysampleand6%from Dublin sample(n=74),with5%(n=4)from Galway, and3%(n=2)from CorkandLimerickrespectively. study population.Ninetypercent ofthosewhoreported apositivehepatitisCstatuswere from the (n=175), nearlyone-in-tworeported beinghepatitisCpositive(47%),whichrepresents 23%ofthetotal extent towhichclientsreported beingaware ofhavingblood-borne viruses.Amongthosetested Individuals were alsoaskedabouttheircurrent hepatitisBand/orCstatus.Table 7.11illustratesthe length oftimewhichhaslapsedsincethetestwasundertaken. them oncetested.Alternatively, itcouldalsobethat theirstatusatpresent isunknowngiventhe could suggestthatasubstantialnumberofindividualsmaynothavehadtheirresults disclosedto problematic drug-usingpopulation(n=9)statedthattheywere unsure oftheircurrent status.This Eleven percent ofthosetested(n=20)withinthetotalstudypopulation,and9%among (x significant relationship betweenhavingapositivehepatitisCstatusandcurrent useofanillicitdrug positive, themajoritywere currently usersofillicitdrugs(87%).Analysisalsorevealed thattheirwasa positive incomparisontoonly4%ofnon-injectors.Furthermore, ofthosewhowere hepatitisC 2 eaii pstv)4 8]6 [65] [8] 64 8 [82] [12] 47 7 Hepatitis C(positive) Hepatitis B(positive) Total StudyPopulation =52.41;df=1;p<0.001). 2 =77.41;df=1;p<0.001). Sixtypercent ofthosewhohadeverinjectedwere hepatitisC Risk BehaviourandHealth oa td Problematic Total Study ouainDrugUsers Population n%n%n NACD 2005 Drug Use Among the Homeless Population in Ireland 111 Risk Behaviour and Health Behaviour Risk %n %n Population Drug Users Population Drug Total StudyTotal Problematic Chapter Seven Chapter HostelB&BRough Sleeping 60 46 [33] [79] 73 81 80 [50] [21] [40] 91 [32] Total Study Population Total 7.7 Psychiatric Health 7.7 Psychiatric Health Psychiatric Health 7.7.1 Concerns Regarding their psychiatric having concerns regarding (n=169; 48%) reported Nearly a half of all respondents for these concerns (n=133; 78%). Analysis revealed having sought help health with over three-quarters experiencing likely to report significantly more drinkers were as problematic that those who scored counterparts (x2=4.06;df=1;p<0.05). drinking psychiatric concerns than their non–problematic likely to report more also proportionally drug users were Although not significant, problematic drug-using counterparts (50% v 40%). psychiatric health concerns than their non-problematic Table 7.12 HIV Test by Main Accommodation Type by Main 7.12 HIV Test Table Over half of the total study population (n=179; 52%) had received a HIV test. This is in comparison to a HIV test. This is in comparison study population (n=179; 52%) had received Over half of the total a shorter drug users reported users (n=100; 80%). Problematic drug of problematic over four-fifths population (12 months v 17 months). since last tested than that of the total study mean length of time HIV testing among both the higher levels of reported 7.12 below illustrates that B&B occupants Table who were sleepers of rough populations. Over four-fifths drug-using total study and problematic a HIV test (n=21; 81%). drug users had received problematic 7.6.2 HIV Testing and Results 7.6.2 HIV Testing In terms of HIV status, respondents were provided with the opportunity to volunteer their result. Of with the opportunity to volunteer their result. provided were In terms of HIV status, respondents a within the total study population (n=104), 6 individuals reported their result those who volunteered problematic a negative status, five of whom were reported positive HIV status and 98 respondents drug users. 112 Drug Use Among the Homeless Population in Ireland NACD 2005 cited includedcounselling,communitypsychiatricservicesandGP. (total studypopulation;26%v15%)(problematic drug-usingpopulation;12%v20%).Othertreatment reported takingprescribed medicationforpsychiatrichealthcomplaintsthanthemalerespondents problematic drugusers.Intermsofgenderdistribution,alarger proportion offemalerespondents on prescribed medicationfor theirpsychiatrichealthcomplaintsincomparisonto15%(n=19)of most commontreatment. Overall,19%ofthestudypopulation(n=66)statedthattheywere currently More specifically, respondents were askedwhattypeoftreatment. Prescribed medicationwasthe study populationand17%oftheproblematic drug-usingpopulationrespectively. treatment incomparisontoonly60%ofproblematic drug users(n=22).Thisrelates to21%ofthetotal Of thosediagnosedwithapsychiatricillness,70%(n=76)reported thattheywere currently receiving Chapter Seven Table 7.13ExperienceofPsychiatricServices population. diagnosed withapsychiatricillness.Figures were largely similarfortheproblematic drug-using assessment, 30%(n=107)hadbeenadmittedtoapsychiatrichospitaland(n=108) As Table 7.13conveys,42%(n=150)ofthetotalstudypopulationhadundergone apsychiatric Three mainquestionswere askedinorder toascertainrespondents generalmentalhealthstatus. 7.7.2 ExperienceofPsychiatricServices vrDansdwt sciti lns 3 18 9[37] [37] 29 29 [56] [108] [107] 44 30 30 [150] 42 *Multiple responses were allowed Ever DiagnosedwithaPsychiatricIllness Ever AdmittedtoaPsychiatricHospital Ever Undergone aPsychiatricAssessment Psychiatric Health Risk BehaviourandHealth oa td Problematic Total Study ouainDrugUsers Population n%n%n NACD 2005 Drug Use Among the Homeless Population in Ireland 113 Risk Behaviour and Health Behaviour Risk Population Drug Users Total StudyTotal Problematic (Drug service provider – Dublin) (Drug service provider Chapter Seven Chapter Sleeping Sleeping (Homeless service provider – Limerick) (Homeless service provider %% (Accommodation service provider – Dublin) (Accommodation service provider – Dublin) (Accommodation service provider Hostel B&B Rough Hostel B&B Rough Anyone working in homeless services is doing dual diagnosis because certain health problems, Anyone working in homeless services is doing dual diagnosis because certain health go hand in hand. and drug-use psychological distress that I would have. the biggest concern The mental health thing is probably Often the ones that present with mental health problems drink alcohol as well, take methadone mental health problems with Often the ones that present bi- mental health issues like schizophrenia, drugs. They would have and possibly deal in street and depression. polar depression Mental health is a big issue. Ever Undergone a Psychiatric AssessmentEver Undergone Ever Admitted to a Psychiatric Hospital 47Ever Diagnosed with a Psychiatric Illness 33 35 35 39 22 30 23 56 23 37 37 31 38 23 34 27 27 Psychiatric Health “Dual diagnosis” which is the co-occurrence of drug and/or alcohol use and mental health problems “Dual diagnosis” which is the co-occurrence in all four cities. issue for both homeless and drug service providers surfaced as the most pressing 7.8 Psychiatric Health and Drug Use: 7.8 Psychiatric Health Experience the Provider Table 7.14 Experience of Psychiatric Services by Main Accommodation Type Table Figure 7.14 below, illustrates psychiatric experiences by the three main accommodation types; hostel main accommodation experiences by the three illustrates psychiatric 7.14 below, Figure sleepers and B&B residents. dwellers, rough a psychiatric having ever undergone reported population groups hostel dwellers within both More study Among the total rough. staying in B&B accommodation or sleeping assessment than those having been admitted to a psychiatric of those staying in hostels reported population, 35% (n=61) sleepers and B&B 23% (n=13) and 22% (n=15) of rough hospital in the past, in comparison to only drug-using population. observed for the problematic Similar patterns are respectively. residents in terms of sleepers drug-using B&B occupants exceeded hostel dwellers and rough Problematic ever diagnosed with a psychiatric illness. 7.7.3 Psychiatric Health and Accommodation 7.7.3 Psychiatric 114 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Seven ■ ■ Injecting RiskBehaviour: and varioushealthissuesconcernsforproblematic drugusers. This chapterhaspresented an overviewofriskbehaviourpracticesamonghomelessdruginjectors 7.9 SummaryandConclusions which wasprepared todealwithdruguseandmentalhealthproblems simultaneously. they received littlesupportformpsychiatricservicestodealwiththeissueandthere wasnoservice serious constraints,theystatedthatitwasdifficult torefer homelessdruguserstopsychiatricservices, While mostserviceproviders acknowledgedthatstaff in psychiatricserviceswere workingunder ■ like thechickenandeggsituation. The response is“whentheygettheirdrugproblem sortedout,we’lllookatthemthen”.So,itis way formakingsure yourhospitaldoesnothavetodealwiththeconsequences. Therefore, thepatientwhoisadmittedinasuicidalstateoutagain24hours.Thatsimple It’s unfortunatethatwestillhavepsychiatrichospitalswhichwillnot dispensemethadoneatall. months priortointerview(20%). the site(32%),whileone-in-five current injectorsreported accidentaloverdose inthethree commonly reported difficulty (71%).Almostone-in-three reported abscesses orinfectionsof experienced anydifficulties. Scarringandbruisingofthe injectingsitewasthemost the lastthree months.Maleinjectorswere significantlymore likelytoreport nothaving Only 26%ofcurrent injectors reported notexperiencing aninjecting-related difficulty within (Lawless, 2003). as femaledrugusersoftenseektheirassistanceduetoareluctance orlackofabilitytoselfinject (Cox more likelythanmaleinjectingdruguserstohaveasexualpartnerwhoisan user usually olderandhavelongerinjectingcareers (CoxandLawless,1999).Femaledrugusersare Injecting aloneisconsidered 2002).Self-injectorsare ahighriskfactorforfataloverdose (Ryan, significantly more likelytoinjectalonethantheirfemalecounterparts. Almost halfofrespondents reported thattheyusuallyinjectalone(46%).Maleswere drug usersinjectinginpublicplaces(Frey introduction ofaninjectingroom addressed thewidercommunityharmsassociated withhomeless considered particularlyappropriate forhomelesspeople. An Australianstudyfoundthatthe injecting rooms andhostels for injectingdrugusersare twoharmreduction interventions thatare Those whoinjectinpublicplacesare more ‘riskoriented’(KleeandMorris,1995;839).Safe injecting inpublicthantheirfemalecounterparts. Fifty-four percent ofcurrent injectorswere street injectors.Maleswere more likelytoreport needles, safetyfrom overdose andreduction instreet injecting(CostelloandHowley, 2000). hostel forhomelessdrugusersinDublinfoundthatsuchafacilitywouldenabletheuseofclean et al., Risk BehaviourandHealth 1999). Thiscanhaveconsiderableimpactintermsofinjecting behaviourandpractices et al., 1999). Afeasibilitystudyontheprovision ofa (Drug serviceprovider –Dublin) (Drug serviceprovider –Dublin) NACD 2005 Drug Use Among the Homeless Population in Ireland 115 1999; (2001) and et al., et al. Risk Behaviour and Health Behaviour Risk (2004), in an ethnographic study (2004), in an ethnographic Chapter Seven Chapter et al. strongly related to a worsening housing situation. to related strongly (1997) showed that lending of used injecting equipment (1997) showed that lending of used injecting et al. (2001) respectively. Among homeless women, Smith Among homeless women, Smith (2001) respectively. et al. (2000) and Condon injecting with other injecting drug users, people are (2004:10) suggest that in situations where Lawless 2003). Homelessness has being identified as a risk factor for overdose among opiate users as a risk factor for overdose Lawless 2003). Homelessness has being identified in particular (EMCDDA, 2002). Over two thirds of current injectors (69%) reported that their injecting practices had changed reported injectors (69%) of current Over two thirds of homelessness. as a result of the clients In a study of homelessness among drug users, Cox and Lawless (1999) found that 66% they that their drug use had changed since being out of home, the majority stating that reported that their injecting erratically while over half reported or more frequently either using more were sleepers in the UK found behaviour had changed. Fountain and Howes (2002:11) in a study of rough had started at least using one new drug while homeless. Furthermore, respondents that four-in-five in drug use was it was found that an increase Over one-in-two current injectors reported sharing injecting paraphernalia reported injectors in the previous Over one-in-two current rates lending injecting equipment (23%) while four weeks (53%). Almost one-in-four reported lending likely to report significantly more lower at 17%. Injectors were were for borrowing others’ equipment. used injecting equipment rather than borrowing risk behaviour especially in Irish studies have indicated high levels of drug-related Findings from 2000). The above Lawless, 1999; Costello and Howley, the young homeless population (Cox and by Feeney 58% lifetime sharing rates reported high in view of the 67% and extremely are figures et al. injecting equipment (33%). Use of drug had ever shared that a third Cleary and Prizeman reported study sleepers in London found that 85% of the injectors in the services among a sample of rough who were while 28% of the respondents had used a needle exchange in the last month, methadone treatment and/or had used it daily or almost daily had reported dependent on heroin (Fountain and Howes, 2001). Gossop that sharing of they found injecting equipment. Moreover, used common than borrowing was more as the injecting paraphernalia, in particular spoons and water containers was twice as common less discriminatory about the sharing of sharing of injecting equipment, indicating that IDUs are are approaches injecting paraphernalia than is the case for needles and syringes. Harm reduction injecting equipment likely to share more particularly pertinent for homeless drug users as they are 2000). Taylor of needles (Costello and Howley, and dispose due to having no safe places to store et al. better ways of distinguishing each others’ equipment is required. Injecting difficulties are common among drug users in general (Cox and Lawless, 2000). Knowledge drug users in general (Cox and Lawless, common among are Injecting difficulties which is injected by others, a behaviour when they are is often acquired on injecting techniques (Linnell, 2002; 15). Taylor of trial and error learnt by a process which was combined with video footage on injecting practices in Scotland, documented that with video footage on injecting practices which was combined vein. The gender differences 79 unsuccessful attempts to locate a witnessed researchers drug users suffer which has shown that women other Irish research highlighted also substantiates likely to more male counterparts and are complaints than their injecting-related more from injecting because of smaller and less visible veins (Geoghegan complain of difficulties ■ ■ 116 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Seven ■ ■ ■ Physical Health: ■ ■ that justoverahalf(54%)had medicalcard (DublinSimonCommunity, 2003).Similarfigures were For example,aprofile ofoutreach serviceusersin2002bytheDublinSimonCommunity reported These findingsneverthelessreflect generalmedicalcard posessionratesamonghomeless people. to report acurrent medical card (51%v64%). Problematic druguserswere proportionally lesslikely thanmembersofthestudypopulation number ofhealthcomplaintsthantheirmaledrugusingcounterparts (Geoghegan Hickey, 2000;Smith The majorityofthoseusingB&BaccommodationinDublinare womenwithchildren (Houghtonand complaints thanproblematic rough sleepersorhosteldwellers. Problematic drugusersstaying inB&Baccommodationreported ahighermeannumberof had physicalhealthproblems. status ofhomelesspersonsinGalway, HouriganandEvans(2003)foundthat59%oftheirsample homeless peopleexperiencedatleastonephysicalorpsychiatric problem. Inastudyonthe health most riskofhealth-related problems (EMCDDA,2002).Holohan (1997)reported that66%of Homeless peoplehavemultiplehealthproblems (Holohan,1997)whileinjectingdrugusersare at population (37%v28%). suffering from 5ormore complaintsincomparisontooveraquarterofthetotal study also observed(mean;5v3complaints).Overathird ofproblematic drugusersreported than wasfoundamongthetotalstudypopulation.Ahighermeannumberofcomplaints Problematic drugusersreported higherratesforthemajorityofphysicalhealthcomplaints mean timeforalldruguserssincetheirlastvisittothedentistwastwicethatofnon-drugusers. et al., self-assessed oralhealthproblems, withlessuseoftreatment servicesthannondrugusers(Sheridan their objectivehealthstatus.Research hasindicatedthatdrugusershaveasignificantlyhigherlevelof highlights thatanindividual’s perception ofpersonalhealthandwell-beingcanoftenbedifferent to homeless peopleinDublin.Shefoundthat98%ofthoseexaminedneededdentaltreatment. This Condon (2001)conductedanoralhealthsurvey, whichincludedadentalexamination,among234 total studypopulation(62%v43%). Problematic drugusersreported higherlevelsofdentalcomplaintsthanmembersthe of literature byMoore (Holohan, 1997;Feeney and joints,eyeearcomplaints,epilepsy, skinproblems andinjuriesfrom accidentsandassaults counterparts tosuffer from arthritis,heartdisease,tuberculosis, hepatitisC,problems withbones of homelessindividualswhichshowthatpeopleare more likelythantheirhoused population (Bines,1994).Thesefindingsare inlinewithotherresearch undertakenonthehealth The physicalandmentalhealthofhomelesspeopleisconsiderablyworsethanthatgeneral complaints. Headaches, bonesandjointsdentalissueswere themostcommonlycitedphysical as homelessoncoroners’ reports variesbetween42and53 years(Warnes, 2003). mortality ratesasresearch intheUKhasillustratedthataverageageofdeaththoserecorded continuity ofcare andexacerbatemanyhealthissues.Healthproblems are alsoassociatedwithlow 2001). Inastudyondentalhealthaccesstotreatment, Sheridan Risk BehaviourandHealth et al., et al. et al., 2001). Research hasindicted that femaledrugusersexperienceagreater (1997; 26)foundthattemporaryaccommodationcanoftencomplicate 2000; Condon et al., 2001). Theseresults are notsurprisingasareview et al. (2001) foundthatthe et al., 1999). NACD 2005 Drug Use Among the Homeless Population in Ireland 117 2000; et al., Risk Behaviour and Health Behaviour Risk Chapter Seven Chapter 1998). 1997). Irish harm reduction interventions have been 1997). Irish harm reduction et al., et al., 1993; Loxley et al., (2001) found that screening positive for hepatitis C was significantly associated with (2001) found that screening (2001) found that a quarter of homeless women had tested positive for hepatitis C, of (2001) found that a quarter of homeless women et al. et al. 2000; Hourigan and Evans, 2003). Problematic drinkers were significantly more likely to report having psychiatric concerns likely to report than significantly more drinkers were Problematic drug users not significant, problematic drinking counterparts. While their non-problematic psychiatric health concerns likely to report than their non- more proportionally were drug-using counterparts. problematic to as “dual referred of drug and/or alcohol use and mental health problems, The co-occurrence alike. Among diagnosis”, is an issue of concern for the homeless population and service providers in cold weather shelters in London, 38% of the sample had a ‘dual diagnosis’ of residents a group services also have 1997). It is estimated in the UK that a half of clients in drug and alcohol (O’Leary, Concern, 2002). Dual diagnosis can lead to loss of (Alcohol mental health problems Crowley, 2003). High rates of depression have been reported as one of the main psychiatric as one have been reported 2003). High rates of depression Crowley, 1998; Feeney complaints among the homeless population (Holohan, 1997; Cleary and Prizeman, et al., Nearly one-in-two of the study population reported having concernsNearly one-in-two of the study population reported about their psychiatric a psychiatric having undergone reported health. Less than half of the respondents admitted to a psychiatric hospital have been assessment (42%), while less than a third (n=30%), or have been diagnosed with a psychiatric illness (n=30%). of homeless which conveys that a high proportion These findings again substantiate other research people have psychiatric health complaints (Holohan, 1997; McKeown, 1999; Feeney Higher rates of hepatitis B vaccination were found among problematic drug users than the found among problematic Higher rates of hepatitis B vaccination were likely to more proportionally were respondents total study population (69% v 40%). Female the hepatitis B vaccination than their male counterparts. have received consistent with those found by study population are Levels of hepatitis B vaccination for the total investigation had been vaccinated against hepatitis B Corr (2003a) in which 47% of the sample under to their male counterparts. likely to have been vaccinated compared with female clients being more Over half of problematic drug users were hepatitis C positive (51%) compared to 23% of the to 23% hepatitis C positive (51%) compared users were drug Over half of problematic likely also significantly more had ever injected were total study population. Individuals who to be hepatitis C positive. Condon found by Holohan (1997). Findings also revealed higher rates of current medical card posession medical card higher rates of current Findings also revealed found by Holohan (1997). population (69% v sleeping rough than the general rough sleeping were among drug users who found that of the health status of female drug users, Lawless (2003) in a study 58%). However, when in actual fact it had expired. having a medical card report individuals tended to whom the majority was not receiving treatment (80%). Some research suggests that HCV infection suggests (80%). Some research treatment whom the majority was not receiving rates found among young recent lower prevalence is associated with duration of injecting, with onset injectors (Crofts the use of IV drugs and being a rough sleeper. Of those tested, 18% tested positive for hepatitis C. sleeper. the use of IV drugs and being a rough Smith unsafe injecting practices but not succeeding in reducing criticised for concentrating on reducing risk factors associated with Hepatitis C (Smyth ■ Psychiatric Health and Well-Being: Psychiatric Health and Well-Being: ■ ■ Blood-Borne Infections: Blood-Borne Infections: ■ 118 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Seven ■ ■ mental healthproblems hadbeeninapsychiatrichospitalatsometimethepast(Bines,1994). sleeping rough compared tothegeneralpopulation.One-in-foursinglehomelesspeoplewith eight timeshigheramonghostelandB&Bresidents andeleventimesashighamongpeople diagnosed (O’Leary, 1997).UKresearch has foundthatexperienceofmentalhealthproblems are 1993), itisoftenthecasethatmentalhealthproblems ofstreet homelessclientswillnotbe it isbelievedthatmentalillnessmostcommonamongpeoplesleepingrough (Anderson emergency socialaccommodation fortheirpermanentabode Fernandez (1996:215)states Hostels are oftenemployed asamainaccommodationoptionforpsychiatricservices.As ofeverdiagnosedwithapsychiatricillness. hostel dwellersandrough sleepers interms the totalstudyandproblematic drugusingpopulation.However, B&Boccupantsexceeded assessment orhavingeverbeenadmittedtoapsychiatrichospital.Thiswasconsistentfor Results foundthatmore hostel dwellersreported havingeverundergone apsychiatric et al., population, femalesare more likelytoreport andseektreatment forpsychiatriccomplaints(Smith This isconsistentwithfindingsfrom otherstudieswhichhavehighlightedthatwithinthehomeless were proportionally more likelytoreport prescribed medicationthantheirmalecounterparts. Prescribed medicationwasthemostcommonpsychiatrictreatment cited.Femalerespondents than modify, existingservicesandwillrefer thoseonwhodonotmeetstrictprogramme criteria. and/or alcoholuseas“pingpong”therapywhereby or psychiatricservices.Norden (2001:16)refers toconcurrent mentalillnessandproblematic drug and mentalissues.Manytendtofallthrough thesystemwithoutbeingtreated bydrugservices so thetermisoftensimplyusedtodemonstrateindividualswhopresent withbothalcohol/drugs 1997). However, Manley(1998)argues thatinpracticeindividualsrarely receive aformaldiagnosis, accommodation, behaviouralproblems andanunwillingnesstoco-operatewithservices(O’Leary, 2000). Risk BehaviourandHealth many long-termhomelessmentallyillare forced toresort to service systemsandagenciesmaintain,rather (cited inMcKeown,1999).Although et al., NACD 2005 Drug Use Among the Homeless Population in Ireland 119 ct with (Male, 48 years) (Male, 24 years) . 65 a worker but were unaware that they worked for the multi-disciplinary team. unaware a worker but were I will avoid some hostels because of drug users. I have a fear of needles. The service is good but drug addicts are running it now. You can’t relax. They take money off you. They take money off relax. can’t You now. running it The service is good but drug addicts are use the pool table, cos they push you out of the way. I can’t 65 Respondents may have been in conta an underestimate. It is likely that levels of contact with the multi-disciplinary team are 8.2.2 Factors Influencing Use of Homeless Services 8.2.2 Factors Influencing Use of Homeless to state what attracts them to using particular homeless services. also asked All participants were (n=59; 17%), reason allowed. Food was the most commonly reported were Multiple responses (n=47; 13%) stated (n=57; 16%). Over one-in-ten of the respondents of the service followed by staff to to go” and that they had no other options available “somewhere just merely that services were (familiarity/ service environment company, included; advice/information, them. Other responses hours, cost etc.). (e.g. opening convenience) and specific service features cited the absence of drug/alcohol users very few respondents this study, of In terms of the specific remit stated no drug users or as a factor influencing use of homeless services. Only 3% (n=12) of responses the absence of alcohol users was noted by only 4 individuals (1%). whereas injectors would be a factor, of the non-drug-using homeless population demonstrate how members The following quotes from drug and alcohol use among service users can influence the use of homeless services. 8.2.1 Contact with Homeless Services 8.2.1 Contact with Homeless Services months asked about their contact with various homeless services in the three were All respondents contact with population (n=243; 69%) reported of the total study two-thirds Over prior to the interview. given that accommodation services within the specified time period. This is not surprising emergency a further 19% (n=69) were living in hostels (n=175; 50%) and a half of the total study population were (n=160; centres of contact with drop-in also high levels were staying in B&B accommodation. There by nearly with the Homeless Persons Unit was reported 45%) and food services (n=154; 43%). Contact services outreach in contact with street (n=114; 32%), while over a quarter were of respondents a third by 15% (n=54), 14% reported and day services were (n=100; 28%). Contact with transitional, settlement with the multi- contact (4%) also reported Fourteen individuals (n=48) and 13% (n=45) respectively. months prior to interview disciplinary team within the three 8.2 Homeless Services 8.2 Homeless Services This chapter focuses on issues regarding service provision and practice. Levels of contact with and practice. Levels of contact service provision on issues regarding This chapter focuses for suggestions illustrated in addition to presenting generic services are homeless, drugs and specifically, conveyed. More service needs is also of related analysis A self-reported improvements. and delivery of in the provision is to highlight issues which may be of concern the aim of the chapter barriers towards In this regard, needs of the drug-using homeless population. services to meet the overall for homeless drug users and the provided accessing services, adequacy of existing services to work with homeless drug users will be examined. capacity of organisations Service Provision 8.1 Introduction Chapter Eight Chapter 120 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Eight Figure 8.1 RefusalofAccesstoHomelessServices(Drugs/AlcoholIssues) refusal from homelessservicesduetodrugandalcoholissues. of drugsonthepremises. Figure 8.1presents different reasons provided byrespondents intermsof reported thattheywere usuallyrefused accesstohomelessservicesasaresult oftheuseandsupply services (48%),incomparisontooverathird forproblematic drinkers(38%).Problematic drugusers (n=121; 34%).Almostone-in-twoofproblematic drugusersreported beingrefused accesstohomeless Just overathird ofrespondents reported havingeverbeingrefused accesstohomelessservices 8.2.3 Difficulties AccessingHomelessServices are notqualifiedtodealwithme. Due tothefactthatIsuffer from psychiatricproblems, I fallthrough thecracksasdifferent services service] before itclosesandonlyopensthosehourseach day. I havetoattendthemethadoneclinicandnomatterwhatcan’t makeitbackupto[ahomeless illustrated bythefollowingquotes: access tohomelessservices,althoughintheminority, were alsonotedamongrespondents, as around systembenefitsandallowances.Theimpactofdrugusepsychiatrichealthissues on for couples,servicesnotansweringphones,rulesandregulations, lackofvacanciesandproblems waiting/continuously engaged,novacancies),findingithard togetappointments,accommodation who reported difficulties, commonissuesreported included;free phoneservice(length accessing homelessservices(52%)incomparisonto47%ofproblematic drinkers.Amongthose difficulties (n=206;58%).However, overone-in-twoproblematic drugusersreported difficulties services althoughoverhalfoftherespondents reported thattheyhadnotexperiencedany A higherpercentage reported difficulties accessinghomelessservices(42%),thanrefusal to I wasbarred forgoofingoff […]alsobarred forsellingtablets. I wasbarred from [service]-TheytriedtosayIwasusinginthetoiletbutwasn’t. I wascaughtinjectingandthenbarred. thought Igavehimdrugs. I passedonalightertosomeonewhowentintothetoilets.Hecameoutstonedsotheymustof always givesyouneedlessoIstayawayfrom there tokeepclean. hostel cossomethingtriggersinmyheadtogetabagofneedles.WhenI’mthere someone It isdearbutit’s clean,tidyandyouhaveyourownroom andnobodyisondrugs.Idon’t likea Service Provision (Male, 28years) (Male, 25years) (Male, 23years) (Male, 23years) (Male, 21years) (Male, 27years) (Male, 46years) NACD 2005 Drug Use Among the Homeless Population in Ireland 121 Service Provision Service (Male, 55 years) (Male, 55 years) (Male, 23 years) (Male, 28 years) (Male, 52 years) (Female, 26 years) (Female, 30 years) Chapter Eight Eight Chapter People on methadone should not be mixed with people on drugs. It is very hard when you start when you with people on drugs. It is very hard People on methadone should not be mixed in a place If you’re everywhere. you drugs and they’re on methadone and someone is offering it easier. with other people just on methadone it makes a lot better by having a building we could use, which is could cater for homeless drug addicts You for using. supervised and you would not be arrested for drugs. Drug users should not be allowed to bring drugs into hostels. They should be searched They know they have drugs and turn a blind eye to it. They still push us away. the gear. coming off They could start helping people who are old men and mixing get on, they are need separate hostels. Drug users and alcoholics don’t You hitting them. supermen and with younger men, thinking they are only want to drink the scumbags who need to separate the genuine homeless from You and get smack. I think drug users, alcohol users, non-alcohol users and non-drug users should be in separate I think drug users, alcohol users, non-alcohol accommodation. Figure 8.2 Improvements to Homeless Services (Drugs/Alcohol) to Homeless Services 8.2 Improvements Figure All participants were asked how homeless services could be improved. In terms of general comments In terms of could be improved. asked how homeless services All participants were respondents In particular, of services was recommended. quantity increased improvements, regarding such as; couples, homeless groups accommodation for different the need for specialised stressed resources mental health issues. More drinkers, drug users and individuals with families, young people, to encourage the issue of homelessness in order to target also thought to be important were systems were in opening hours and appointment-based pathways out of homelessness. Less restriction delivery of homeless services. comprehensive also stated as well as a more by both users and also stated and/or alcohol were policy on the use of drugs regarding Improvements made to the issue of drugs and/or alcohol use which, 8.2 illustrates references non users alike. Figure homeless services. would seek to improve to respondents according 8.2.4 Improvements to Homeless Services – Service User Perspective – Service User Perspective to Homeless Services 8.2.4 Improvements 122 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Eight on theirpremises, andclientswhodidnotcomplywere sanctioned. possession anddealing.However, allagenciesstatedthattheydidnotallowdruguseordealing Few oftherepresentatives from homelessagenciesinterviewedhadofficial policiesonillicitdruguse, Policies the Provider Perspective 8.3 HomelessServicesProvision: community complaintsaboutanti-socialbehaviour. Service providers alsoencouraged clientsnottouseoutsidetheirpremises inorder tolimit implemented atthediscretion ofstaff. Policies around otherdrug-related incidents(e.g.behaviouralproblems) were more flexibleand homeless serviceproviders. that theywouldrefuse homelessdrugusers.Thisrespondent’s commentsare typicalofmany Unlike someaccommodationproviders, nodayserviceswhoparticipatedinthefocusgroups stated use intheshowerortoiletandtheygetaweekprobably ortwoweeks. Even thoughourpolicyisveryflexibleondruguseyougettheyoungpeoplewhocomeinand we sayokay, notonthepremises. We justbarthemthen.Ifsomebodywantstogooutandusewesayokay. We don’t condoneit– being overreactive […]we’vehadlotsofincidentspeopletradinginsomekindheavystuff. In theservicewewouldbarforsuspicionofuseordealingandthatisbecauseitillegal.It’s not way. We wouldbequiteflexibleinthatarea –wewouldhaveabitofroom tomanoeuvre. caught three timesitcouldbe amonth.Itjustdepends–wetryandgetthemessageacross that if theyare caughtonceitcouldbeaday, iftheyare caughttwiceitcouldbeaweek,iftheyare wouldn’t beallowedin[…]Iftheyare seenusingtheycanbebarred foradayorweek.Itdepends, We haveapolicyoutside,iftheyare seenusingordrinking orsellingfightingwhateverthey within theconfinesofouraccommodation. I wasjusthavingthisconversationtheotherdaywithastaff memberaboutwhatisacceptable practical andwhatcanwork. Our policiesare documented forstaff andwewouldspendalotoftimereviewing policies, whatis can stayawake and keepittogetherdon’t useonthepremises. one policywhichmainlyhelps, you cancomeinasoff your headasyouwanttobelong At theotherendofdaywe workwitheveryonenomatterwhattheyare onandwehaveonly Service Provision (Homeless serviceprovider – Limerick) (Homeless serviceprovider – Dublin) (Homeless serviceprovider – Cork) (Day serviceprovider –Dublin) (Day serviceprovider –Dublin) (Day centre provider –Dublin) NACD 2005 Drug Use Among the Homeless Population in Ireland 123 Service Provision Service (Shelter worker – Dublin) Chapter Eight Eight Chapter (Settlement worker – Dublin) (Settlement worker – Dublin). (Homeless service provider – Cork) (Homeless service provider (Primary health care provider – Dublin) provider (Primary health care (Accommodation service provider – Dublin) (Accommodation service provider But often there are clients coming and telling us that they had cocaine and a lot more of the us that they had cocaine and a lot more clients coming and telling are But often there to know hard it is really coming and saying they’ve been taking coke as well. But drinkers lately are well or is it mental health? using, unless you know the person really what kind of substances they are You wouldn’t really know whether it was methamphetamines or speed or coke and again it is know whether it was methamphetamines or speed or coke and again really wouldn’t You about the behaviour that is going with it and paranoia. Some people will tell you that they use drugs but it is all kinds and sometimes if you work with Some people will tell you that they use drugs very not not using as they are or are to know what they are somebody it is very difficult forthcoming. Their needs the difference. not black and white. That’s chaotic lifestyle. It’s Their lifestyle is a more support – to try and link in with the other more – offer flexible need to be more You greater. are services as much as you can – to make the next appointments. Chaotic drug users – I hate to use the word excluded because there is not anybody excluded from is not anybody excluded because there I hate to use the word Chaotic drug users – if they are settlement settlement workers you cannot work towards we are our policy but because priority. is a different There chaotically using drugs. work because they miss appointments. really it doesn’t Chaotic drug users, in terms of settlement, support than we can offer they need a different and we feel different Obviously their priorities are not drug counsellors. because we are Challenges to Service Provision Challenges to Service Provision felt that the number of homeless in the four cities stated, homeless service providers As already of polydrug users. This in particular the proportion people engaging in drug use was increasing, of the survey which found that 45% of homeless people in the results is reflected perception found it particularly challenging to service providers polydrug users. As a result, interviewed were drugs. of different the signs and symptoms firstly detect drug use and secondly recognise adaptable and able to that they needed to be more stressed providers homeless service Furthermore, users. deal with a wide range of issues simultaneously when working with homeless drug Due to the nature of their work, settlement services were the only homeless services who did not find the only homeless services settlement services were of their work, Due to the nature only willing to work with stated that they were drug users, and they current it suitable to work with stabilised drug users. 124 Drug Use Among the Homeless Population in Ireland NACD 2005 challenge wasaddressing theirownpreconceptions ofhomelessdrugusers. Staff workingsuccessfullywithhomelessdrugusersinashelterDublinstatedthatsignificant Chapter Eight they believedthathomelessservices donotadequatelymeettheneedsofhomelessdrugusers. While manyhomelessserviceproviders feltserviceshadimproved forhomelessalcohol usersoverall, Barriers toServiceProvision Another specificchallengerelated tohomelessdruguserswasthefeararound deathbyoverdose. particular youngerclients,awayfrom drugsortooffer alternatives. Finally serviceproviders found itparticularlydifficult tomotivatesomehomelessdrugusers,in specific drug-related incidentsreported duringthefocus groups. Homeless serviceproviders were alsoconcernedaboutstaff andclientsafety, althoughthere were no and theother.” Someofthemwere pure mythssothestaff hadtodoalotofworkaround that. possibly workwithdrugusersbecausealotofthestuff they’re usingtodayisbecauseofthis,that drinkers. Thestaff thathadbeenthere forquiteawhilewere inthatmodeof“wecouldn’t The staff themselveshadtodoalotofwork.Thehostelwastraditionallyaccommodationfor other onelateron.It’s verydifficult todealwithalltheissuesatonce. It’s thewholebigmeltingpotofeverything.You cannotdealwithoneissueandcomebacktothe Why are they notproviding theproper facilitiesforpeopleaddicted todrugs?There are loads of homelessness. Thatispossibly something thatshouldbepassedbacktotheHomelessAgency. The mainthingistheHomeless Agencyhasnotproperly dealt withthedrugissueand because weare drugfree assuchit’s becauseoftheconsequencesiftheyODduringnight. concern whysomanyofthemare actuallybeingrefused services from theresidential units–it’s not morning. You don’t wanttobetheperson whofindsthatperson.Thatwouldbethegenuine If someoneODs[overdoses] duringthenightyouare not going tofindthatpersonuntilthenext and theirsociallife. The wholeculture isifyoutakethedrugsoutofitkids,theylooseanawfullot,theirfriends, Most casesitishard tomotivate themtoactuallyevenlookattheirdruguse. Interviewer: Whatare themain challengesinworkingwithyounghomelessdrugusers? I supposesafetyisthebiggestoneespeciallyinrelation totheotherclients. Interviewer: Whatare thereasons fortheresidential programmes notacceptingactivedrugusers? Service Provision (Accommodation serviceprovider –Dublin) (Service provider –under18sDublin) (Service provider –under18sDublin) (Homeless serviceprovider – Dublin) (Homeless serviceprovider – Dublin) (Homeless serviceprovider –Cork) NACD 2005 Drug Use Among the Homeless Population in Ireland 125 Service Provision Service Chapter Eight Eight Chapter (Service provider – under 18s) (Service provider (Day service provider – Dublin) (Day service provider (Accommodation provider – Dublin) (Accommodation provider (Homeless service providers – Galway) (Homeless service providers (Service provider – under 18s – Dublin) (Service provider – under 18s – Dublin) (Service provider We did form a policy which identified that we would work with drug users but it never worked out. did form a policy which identified that we would work with drug users We did not feel comfortable with them. The majority of the staff didn’t Primarily because the staff and felt very unfit. have training, experience or education in that area, people who are you would know instinctively, experience comes in where That is exactly where user is not that someone is a heroin experienced would feel comfortable but the simple reason like it initially but I did have to accept that. in my case I did not really the problem, Some of the staff might have a limited knowledge of drugs. Most would have a good knowledge Some of the staff would have a originally set up to deal with alcohol. Some of the staff of alcohol. Again, we were I would have. Again, most of the people that I work with better knowledge of drug addiction than someone who is addicted knowledge of alcohol addiction. If we do come across would have more them on. to other drugs we tend to refer place would have varying levels of drug member in our And experience as well, every staff course but in terms of actually feeling training, I think the majority of them did a drugs awareness are comfortable to go on a shift especially because our place has independent units which of experience. self-contained, the training does not give them the reality I realised very quickly when I started working with homeless people that I did not know anything I realised drug users. But most either serious drinkers or were about alcohol or drugs and all the clients with them. and they would carry prejudices people that I have worked with didn’t facilities for people who are addicted to alcohol but not so many proper facilities for people who facilities to alcohol but not so many proper addicted are facilities for people who Hall that should be passed back to Parkgate to drugs. So that is possibly something addicted are they not doing it? – why are Lack of training can result in many staff being unwilling to work with homeless drug users. Even staff being unwilling to work in many staff Lack of training can result with this training in drugs issues may still not feel competent in working members who have received client group. drug users members towards and the negative attitude of some staff lack of experience Therefore, also acted as barriers to service provision. A minority of agencies, mainly in Dublin, felt that their staff were competent in dealing with homeless competent in dealing were mainly in Dublin, felt that their staff A minority of agencies, had little or no drugs stated that a lot of their generic workers most agencies drug users. Conversely, worker. training and very few had a dedicated drugs 126 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Eight reduction, are more likelytoalienatecertaingroups ofhomelessdrugusers. Furthermore, homelessservicesthatadoptanabstinence-orientedapproach, asopposedtoharm adequate training. Lack ofresources andfundingrestrictions were givenasthetwomainreasons forlackof users whichcouldresult insome ofthemnotbeinglinkedintoanyservices. Service providers inGalway complained thattheyhadnooutreach servicetargeting homelessdrug drug users. Another barriercitedwasthatthere are nodayservicesspecificallytargeted attheneeds ofhomeless okay, letstryandencouragethemtoeatsoastheir physicalhealthcanimprove. we do–getthemabitofhelpfrom thehealthpromotion unittomakesure theyare injecting should facilitatethematwhere theyare rightnowandthat mightbeasadrugusersowhatcan trying togetthemcleananddrugfree whentheyare notready forthat.We I supposeitdependsonwhatyourgoalis,aimis.Sometimeswegetcaughtupin the harmreduction andIthinkthatcanbequitehard forsomepeople. drinking orusingdrugsandtostoppeoplefrom doingthisandthattheydidnotsignonfor Some peoplesignedontoworkwithhomelessbecausetheywantedstopfrom lower bracket–theyhavealotmore experience–wecan’t afford it–thisiswhere theproblem is. Because we’re notpaidthesametypeofmoneyas[anotherhomelessservice]we’re onamuch staff intheproper waybecausethefundsare notthere. Our fundsare athird ofwhat[anotherhomelesshostel]isgettingsowecannotafford totrainour is makinganycontactwithanditabouttryingtoaccessthem. You havegotthegroup thatwejusttalkedaboutare excludedthatare out there thatnobody answer isbutthere isagapthere forpeoplewhoare in anightshelter. I supposemaybetheyare doingthesamethingalldayevery dayandI’mnotsure whatthe I workwithwhoare chaoticduringtheday. of servicesthatcouldbeonoffer tothem[…]Ithinkthere isagapthere intermsofthe people the day, specificallyforhomelessdrugusers.You couldquestiontheavailabilityofdifferent kinds Our clientswould,Ithink,argue thatthere isnothingforthemintermsofwhattheydoduring Service Provision (Accommodation serviceprovider –Dublin). (Accommodation serviceprovider –Dublin) (Accommodation serviceprovider –Dublin) (Accommodation serviceprovider –Dublin) (Accommodation serviceprovider –Dublin) (Homeless serviceprovider – Galway) (Homeless serviceprovider –Galway) NACD 2005 Drug Use Among the Homeless Population in Ireland 127 Service Provision Service Chapter Eight Eight Chapter (Outreach worker – Dublin) (Outreach (Night shelter provider – Dublin) (Night shelter provider (Homeless service provider – Galway) (Homeless service provider it is that they would be identified as active drug users, kind of setting them up If a residential accepted drug users, it would be very effective. From assessment From users, it would be very effective. accepted drug If a residential but certainly under about even 18/19 year-olds As well we would have reservations for a fall [...] Respondent 1: because you programme, you have a very good idea of who is going to succeed on a residential to is a kid who is a drug user – you would like is a kid with a chance and here thinking, here are so much per give both of them a chance but they have got only one place and the place costs as a year and that is the way it is, so on that basis you give it to the non-drug users. I think unit would be good. stepping stone, that a residential Respondent 2: in being able to identify themselves by putting them in a hostel for drug users and 18 year-olds be dealt putting a name on them, it is setting them up on the track. Personally I think they should is horrific. I think the idea of a hostel for drug users with individually, Respondent 3: […] You talk to the clients themselves about hostels; the majority of them will tell you that you need to themselves about hostels; the majority talk to the clients You with one eye lie there stoned you have to the place. Even when you are be stoned to sleep in doing your boots or they’re somebody is robbing open because as soon as both eyes shut in those places. cannot relax something. You drinking and drug to intervene in someone’s If, at this level, you see a window of opportunity the four or five are here is no way of saying – okay, patterns – and someone wants to stop – there crisis provision. is no service beyond emergency steps that can help you […] There One of the problems there is that people are there on a long-term basis which was not the on a long-term basis which there is that people are there One of the problems […] I’m to be a short, one night or two night respite original idea behind it – it was supposed nights in meant to see people three accommodation – I’m not emergency meant to be offering people […] Move but I’m dealing with the same people for the last two years, the same a row accommodation which is technically meant to be another on could be to another emergency service. emergency Although no individuals under eighteen years were recruited for administration of the survey, there for administration of the survey, recruited Although no individuals under eighteen years were accommodation for homeless drug to providing in relation was much debate among service providers was no accommodation specifically pointed out there While one respondent users of this age group. felt that such a specialised of service providers young homeless drug users, the majority targeting service would stigmatise this group. Accommodation to accept homeless drug of accommodation services willing in the number Although the increase poor. that the quality of these services was often pointed out service providers users is positive, some Furthermore, many felt that there is no continuum of care for homeless drug users and that there are for homeless drug users and that there is no continuum of care many felt that there Furthermore, of the four cities. accommodation in any emergency no move-on options from 128 Drug Use Among the Homeless Population in Ireland NACD 2005 providers were concernedaboutthelackofaftercare workers. expressed aneedtoextendtheopeningofdaycentres totheweekends.InGalway, homelessservice providers inLimerickhighlightedthatthere wasnoeveningoutreach serviceforrough sleepersand couples andserviceproviders feltthatthelong-termuseofB&Bwasunacceptable.Homeless service and there isalackofsupportforhomelesswomen.Furthermore, there wasnoaccommodationfor pointed outthathomelessclientsare drawnintothecitycentre becauseoflackgoodlocalservices Several othergapsinserviceprovision were mentionedthat affect allhomelesspeople.InDublinitwas Chapter Eight Dublin asapositiveapproach tocrisisinterventions: Focusing onanindividual’s behaviour, ratherthandrug use,wasfrequently notedbyrespondents in Service providers were askedtodescribetheirsuccessesinworkingwithhomelessdrugusers. Successes homeless drugusersisflexibility. According toseveralhomelessserviceproviders, akeyfeature ofsuccessfulserviceprovision to and Corkfeltthattheirmulti-disciplinary teamshadvastlyimproved socialcare forthis target group. Given themultitudeofissueshomelessdruguserspresent with,homelessserviceproviders inDublin to address theirimmediatehousingneedprobably, yes. the drugsissueIdisagree, Ithinkaresidential unitforunder18sisnotthewaytogo.Ithinkifit’s main purposeforit(a)isbecausetheyare homeless(b)istoaddress thedrugsissue.To address Respondent 4: active druguserssoithelpstodispelmythsaboutandfearsthattheymighthave. use andIwouldsaysomeofthemare quitewaryofpeoplethatare cominginwhowouldbe users andpossiblyamongpeoplewhoare workingwiththem–amore openmindaboutdrug people andIthinkthatisgood[…]Itcreating amore open-minded attitudeamongservice they need.Lookingattheirbehaviourandanywayofchangingit.Sothere isnostereotyping kind ofmovingawayfrom what theyare dependentonandlookingmore attheclient andwhat The group workisbasedaround behaviouranditisnotaboutdiscussingdrinkdrugs.So not thedruguse. One ofourmainsuccessesindealingwithhomelessdruguserswasfocusingonbehaviourand I thinkflexibilityisthekeyandthenyoumanagetogetsomeone on. I thinkoneofthestrengths inalloftheservicesisflexibility. health nurseand healthpromotion officers. Aswellasthatwehavethecommunity welfare lucky inthatthere isaGP, anaddictioncounsellor, mental healthnurses,psychiatrists,apublic eighteens. Itisallegedlythefirst oneinthecountry–there are twoinDublin.[...]We are very The biggestthingnowisthemulti-disciplinary teamwhichisverysuccessful.Itonlyforover Service Provision If youare talkingaboutaresidential drugunityouneed toidentifywhatisthe (Accommodation serviceprovider –Dublin) (Accommodation serviceprovider –Dublin) (Homeless serviceprovider –Galway) (Homeless serviceprovider –Cork) NACD 2005 Drug Use Among the Homeless Population in Ireland 129 Service Provision Service Chapter Eight Eight Chapter (Outreach worker – Dublin) (Outreach (Night shelter worker – Dublin) (Drug service provider – Galway) (Drug service provider (Emergency hostel worker – Dublin) (Emergency (Primary health care provider – Cork) provider (Primary health care (Primary health care provider – Dublin) provider (Primary health care I have talked to different homeless people and services providers in hostels and lots of them said homeless people and services providers I have talked to different drugs in that [service]”. go near [that service] – there’s “we won’t We would also have the problem if more and more drug addicts come into the building then our and more if more would also have the problem We drug had to be closed down because more At one stage our service drinkers will not stay. street drinkers decided not to come in. coming in so the street users were I have worked with drinkers […] who consider themselves morally superior to a recreational like any drinkers, even how serious it is, and also IV drug users just don’t that’s cannabis user, though they might drink themselves. They need specific shelters where everything is geared for their needs. You do need to have needs. You for their everything is geared They need specific shelters where exchange and you do need to have sterile water. sharps boxes, you do need to have a needle needs. for that person’s Everything should be specifically designed If you are just homeless you don’t want to be sharing with a load of drug users. You’ve your own drug users. You’ve want to be sharing with a load of just homeless you don’t If you are at first they should be separate but once the drug issues and they have their own issues. I think happening for them – I don’t willing and stabilising or things are users start showing that they are think they should be kept separate after that. officers. So, if I see somebody and they have a skin problem and they need new clothes because and they need new and they have a skin problem So, if I see somebody officers. – I can get on to the homeless or they need a shower every day or whatever of their skin condition down and he write a letter and say this person is coming and officer welfare unit, the community Then we can sort that out. for this treatment. needs this specifically This view was reiterated by another respondent who explained that if a service is dominated by by another respondent This view was reiterated accessing services. homeless drug users it can deter other homeless people from Many service providers felt that separate services were important as younger homeless people could important felt that separate services were Many service providers often pointed out that a service providers be easily influenced by older drug users. Furthermore, lifestyle. Several ex-user sustaining a drug-free is also not conducive to an drug-using environment as the also felt that drug users and drinkers should also be accommodated separately respondents often antagonised each other. general feeling was that these two groups There was much debate during the focus groups in relation to whether service provision should be to whether service provision in relation much debate during the focus groups was There feeling was that chaotic to accommodation services, the prevalent specialist or generalist. In relation users should be able to share stable drug but more drug users should be accommodated separately, to out that any accommodation provided it was pointed accommodation with non drug users. However, needle exchanges and sharps boxes in rooms. by providing active drug users needed to meet their needs Separate or generic? 130 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Eight “ghettoised” and“stigmatised”homelessdrugusers.Asonerespondent explained: Conversely, aminorityofserviceproviders didnotagree withspecialistservicesastheyfelt to homelesspeoplewasusingmulti-disciplinaryteams,preferably allworkinginthesamelocation. As already mentioned,serviceproviders thoughtthatthe most appropriate wayofproviding services support andcommitmentoftheappropriate fundingbodies. programmes duetolackofnecessaryresources andfunding.Therefore, theystressed theneedfor Service providers emphasisedthatitwasdifficult toimprove existingservicesanddevelopnew Service Development of care andsettingoutclearsettlementplansforhomelessdrugusers. It wasfeltthatamulti-disciplinaryteamscouldalsoassistserviceproviders inoffering acontinuum increase thenumberofacutebedsinpsychiatrichospitalsorder todealwiththisissue. address theissueofdualdiagnosis amongstthisgroup. Serviceproviders alsopointed outaneedto It wasalsoadvisedthatmulti-disciplinaryteamsshouldinclude designatedpsychiatricworkersto somebody is. users anditiskindofsettingthemupforafall[…]drugusebehaviour, itisnotwhat I thinktheideaofahostelfordrugusersishorrific.Ithorrificbeingidentifiedasactive direction totakeintermsof providing aone-stopshop. would feelmore athomeorlessintimidatedtoseesomebody. Itjustseemstobethebest use anyservice.We couldmaybe pullintheaddictionservicestobebasedhere aswell.People If wehavethemallunderoneroof, soifsomebodywalksintothecentre theycouldbegoingto where theyknowthere willbemaybeaGP”. going tohavethatdaycentre thatwesaid,we’llhaveitwhere there willbesupportsforpeople, actually abouthavinglegislativeteethattachedtothatplansowecansay–“right,we’re An awfullotofthatstuff isactually there inthehomelessactionplan–theyhaveidentifieditis you are workingwithpeople.Ithinkthatiswhere weneedtobegoing. lot injustdealingwiththeimmediateproblem –youneedtohaveaclearplaninyourhead when process uptotransitionalandbeyondthatagainintocommunitysupport.Ithinkwefalldown a If youcanhavesomethingthatisprovided where thestaff are involvedfrom thevery startofthe diagnosis expertsbutthere are nodesignatedworkers. maybe possiblytheexistingalcohol addictioncounsellorsconsiderthemselvestobedual As farasIamaware there are nodualdiagnosisworkersintheWestern HealthBoard although Service Provision (Homeless serviceprovider – Limerick) (Homeless serviceprovider –Galway) (Under 18serviceprovider –Dublin) (Worker indrop-in centre –Dublin) (Homeless serviceprovider – Cork) NACD 2005 Drug Use Among the Homeless Population in Ireland 131 Service Provision Service Chapter Eight Eight Chapter (Outreach worker – Dublin) (Outreach (Night shelter worker – Dublin) (Worker in drop-in centre – Dublin) centre in drop-in (Worker (Primary health care provider – Cork) provider (Primary health care (Homeless service provider – Galway) (Homeless service provider (Homeless service provider – Galway) (Homeless service provider We also need low-threshold night shelters specifically for the drug addicted person. Not a shelter night shelters specifically for the also need low-threshold We where drinkers or whatever but they need specific shelters going to mix with street they are where needle exchange and do need to have sharps bins, for their needs. You everything is geared needs. Everything should be specifically designed for that person’s sterile water. There is a need for all services to have a sharps box and they can – it costs a lot of money and no is a need for all services There us. to take boxes off one is prepared A client needs an individual room with a locker where he can put his stuff for the day. It’s soul It’s for the day. he can put his stuff with a locker where A client needs an individual room on you, with a sleeping bag tucked with a big rucksack having to try to walk around destroying If you had somewhere town. get things done around under your arm and everything and try and was still back that night your stuff you knew when you came where you could leave your stuff, would give them a bit of It would be as clean as you wanted it to be, at least it going to be there. is no dignity. At the moment there dignity. The locker system down there – it is very practical – it makes a big difference but unfortunately – it is very practical – it makes a big difference The locker system down there people to that during the day […] That would make a big difference not able to access people are in their day-to-day experience of being a homeless drug user. You have to gather all the collateral information, the hostel are ready to kill you because you have ready are all the collateral information, the hostel have to gather You make a have the information which allows you Then you weeks or longer. done nothing for three only no beds. Again, they are are the hospital to try to admit them and there decision – you ring up moral, unfair problem. ethical, major, that they have. That is such a major, working with the resources It will have to be a place where people will be allowed to drink, because there is a homeless people will be allowed to drink, because there It will have to be a place where population in Galway but it would have to also bring in chaotic drug users. drinker street Although they acknowledged there were legal complications, service providers in Dublin recommended legal complications, service providers were Although they acknowledged there they can use drugs on the premises. hostel for homeless drug users where setting up an emergency In fact, service providers in Dublin and Galway felt harm reduction measures should be located in all measures harm reduction in Dublin and Galway felt In fact, service providers homeless services. Several respondents stressed a need for individual rooms in hostels for homeless drug users, providing a need for individual rooms stressed Several respondents bins). (such as sharps measures locker facilities and harm reduction Accommodation hostel in the city that would a need for a low threshold in Galway expressed Service providers alcohol and drugs. accommodate homeless people who used 132 Drug Use Among the Homeless Population in Ireland NACD 2005 be increased. for homelessclientsonmethadonemaintenance,orthose whohavebecomedrugfree, neededto There wasalsoabroad consensusamongserviceproviders thattheavailabilityoftransitionalhousing drug userswhomayhaverelapsed afteratreatment programme. Service providers inallfourcitiesalsoexpressed theneed forhalf-wayhouses,targeted athomeless degrees ofsupport. emphasised thenecessityofmove-onaccommodationfrom emergency hostels,offering different To ensure thathomelessdrugusersreceive acontinuumofcare, homelessserviceproviders Chapter Eight need tobesustained,sothere shouldbealotmore transitionforpeopleonmethadone. people onmethadonethatyou wouldnotevenknoware on methadone.Peopleonmethadone is veryhard becauseDublinCorporationwon’t housepeopleonmethadone.There are lotsof A lotofpeoplecomethrough ourdoorsthatwouldbeonmethadone.To getaccommodation facilitated bystaff andasoberhousefollowingontosupportthat.Itworksinothercountries. different treatments. Theydon’t comeintothatregion atall.Iwouldliketoseeahalf-wayhouse majority ofpeopleIhavemet,theyfailed–seethemselvesasfailingfourorfiveseven primary treatment andthenyouare considered forahalf-wayhouse.IntheHomelessUnit the have here intheMunsterregion isthatyouhavetocompleteatreatment programme. Complete over totheStatesandhaveseenitoperating.Theyahalf-wayhouse.Theonlyfacilitieswe What Iwouldliketoseehere is–theyhaveitintheUKanddefinitelyAmericaIbeen is questionable. working withthem.It’s difficult forourselves–weprovide keyworkingbutthelevelweprovide if theygooutat9.00a.m.cancomebackintheafternoonandyoudothatkindofkey rooms. Maybenothavingtogetoutat9.30a.m.inthemorningmaybe12.00day– Some clientsneedtobesomewhere inbetween–highsupport,smaller, abouttenbeds,single number ofbeds.Butthere needstobethatstep-by-stepprocess. every shelterhastheabilitytocopewiththat.Theydon’t havethespacethatweor do wellbutitisreally encouraging.Ithinkthere needstobemore ofthatsystem.Obviouslynot through intotransitionandseethemdoingwell.You are alwaysgoingtogetpeoplewhodon’t the lastyear. Ithasbeenreally encouragingtoseethemcomefrom rough sleeperrighttheway It doesworkforalotofclients.We havemovedalotofclientsintotransitionalaccommodationin where activedruguserscouldgoandtheyhadongoingsupportuseinthere. Going backtotheemergency accommodation,Ithinkitwouldbefantasticifwehadsomewhere Service Provision (Homeless serviceprovider –Cork) (Night shelterworker–Dublin) (Settlement worker–Dublin) (Outreach worker–Dublin) (Hostel worker–Dublin) NACD 2005 Drug Use Among the Homeless Population in Ireland 133 Service Provision Service (Hostel provider – Dublin) (Hostel provider Chapter Eight Eight Chapter (Outreach worker – Dublin) (Outreach (Drug service provider – Dublin) (Drug service provider (Homeless service provider – Dublin) (Homeless service provider (Homeless service provider – Galway) (Homeless service provider What I would like to see is – if somebody was on a methadone maintenance programme and it maintenance programme see is – if somebody was on a methadone What I would like to doing okay and they wanted to dabble, they were continuing they weren’t was working for them, that that maintenance programmes, specifically for people on methadone to get accommodation them. would be available for go that they know [drugs they can is nowhere drugs or drink there to stay off If somebody is trying not going to be pushed on them. not going to be in their face or [are] or drink] are What we found as well is that eventually when they do get houses and it is so long since they What we found as well is that eventually when house that they seem to have no concept of how to look after the house – they are in a were in the house and all sort of things going on that allowing people to come in and cut up heroin working with them to was a worker there if there in having them evicted again. Whereas result be a better chance of them keeping would them into the house and support them – there resettle into some sort of normal family life. the house, looking after it and getting back the person in that for supporting take responsibility If some local authority tenancies [...] would helping them to pay their properly, the property accommodation and helping them to maintain of the issues that they want etc. but also helping them to try and maintain their lifestyle free rent, alcohol use or whatever. – their drug or to get away from I think to have more programmes which would link in with private landlords […] that they have which would link in with private landlords programmes I think to have more falls short, that would be a brilliant idea, as such to back this up if someone some agreement you could catch because it would be an indication also that somebody is maybe slipping and that in on the deal as well that would be a really it actually snowballs so you have the landlord it before good idea. For those homeless drug users who become drug free and obtain stable accommodation, it is still and obtain stable accommodation, it drug free For those homeless drug users who become explained: adequate settlement support. As one provider essential that they receive for homeless drug users could also be resettlement to some homeless service providers, According authorities and private landlords. facilitated by gaining the support of local 134 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Eight provision includingdifficulties accessingdetoxandmethadonemaintenanceprogrammes. issues raisedwere reflective ofareas whichare constantly debatedintermsofaccessingdrugservice difficulties inrelation toaccessingdrugservices.Ofthosewhodidreport difficulties, manyofthe 86%). Themajorityofrespondents (n=114;75%)reported thattheyhadneverexperiencedany instrument were eligibletoanswerquestionsregarding difficulties accessingdrugservices(n=162; As already stated,onlyindividualswhoreported ascore of3ormore ontheDASTscreening 8.4.2 Difficulties AccessingDrugServices drug-free programmes (n=11;7%). facilities, inpatientdetoxfacilities(n=12;8%),communityaddictionteams(n=11;7%)orresidential Less than10%ofapplicablerespondents reported contact witheitheroutpatient(n=14;9%)detox attended Narcotic Anonymousoverthepastmonth(n=29;19%),8%oftotalstudypopulation. 26%), representing 11%ofthestudypopulation.Aconsiderablenumberalsoreported having study population.One-in-fouroftherespondents reported contactwithdrugoutreach services(n=40; having hadcontactwithcounsellingserviceswithinthelastmonth,whichrepresents 4%ofthetotal in B&Baccommodationand29%ofthosesleepingrough respectively. Thirtypercent (n=46)reported contact byaccommodationtype,thisrepresents 11%ofthe totalhosteldwellers,28%ofthosestaying contact withmethadonetreatment (median=28;range18-51years).Intermsofsyringeexchange was 28years(median=27;range18-51years)incomparisontoameanageof29forthose study sampleand86%ofcurrent injectors.Themeanageofthoseincontactwithsyringeexchanges with asyringeexchangewithinthe4weekspriortointerview, whichrepresented 17%oftheoverall Among thosewhoscored 3ormore ontheDASTscreening instrument39%.(n=61)reported contact within thelastmonth. 55% (n=42),thanfemalerespondents 45%(n=35)reported contactwithmethadonetreatment services total studypopulationrespectively. Althoughnotsignificant,ahigherproportion ofmalerespondents methadone maintenanceserviceswasreported by50%(n=77).Thisrepresents 23%and22%ofthe The majorityofrespondents reported contactwithdrop-in centres (n=80;52%),whilecontactwith contact withadrugservicewithinthelastthree months,representing 36%ofthetotalpopulation. who woulddefinethemselvesasrecreational users.Underthiscondition,80%(n=129)reported ensure thatquestionsregarding contactwithdrugserviceswere notinappropriately askedtothose questions regarding contactwithdrugservicesoverthelastthree months(n=162;86%).Thiswasto Only individualswhoreported ascore of3ormore ontheDASTscreening instrumentwere asked 8.4.1 ContactwithDrugServices 8.4 DrugServices Service Provision NACD 2005 Drug Use Among the Homeless Population in Ireland 135 Service Provision Service (Male, 22 years) (Male, 25 years) (Male, 23 years) (Male, 23 years) (Female, 23 years) (Female, 30 years) Chapter Eight Eight Chapter The waiting lists are very long. When I was on a programme I came off it and then wanted to go I came off very long. When I was on a programme The waiting lists are and got refused. I had no address back on maintenance but could not because I was put It was too long of a waiting list. It was only when I went into hospital with an infection waiting a year. after straight onto a programme of me life. want a maintenance for the rest I wanted detox – just two weeks of it. I didn’t I need a benzo detox, it’s a big problem in Dublin and no one can do me a benzo detox. in Dublin and no one can do me a big problem it’s I need a benzo detox, The waiting list for methadone was nearly 18 months and it took nine months to get an was nearly 18 months and it took The waiting list for methadone assessment for methadone. take They wouldn’t programme]. worker got me onto [a treatment When I was 16, an outreach people using. locally to stop meeting somewhere have preferred else. I would me on anywhere I ended up using more. Figure 8.4 Difficulties Accessing Methadone Treatment Services Treatment Accessing Methadone 8.4 Difficulties Figure Figure 8.3 Difficulties Accessing Drug Services Accessing 8.3 Difficulties Figure However, when respondents were specifically asked if they had ever experienced any difficulties specifically asked if they were when respondents However, (n=69; 46%). having experienced difficulties almost half reported accessing methadone treatment, including the length of waiting lists and cited by respondents highlights the main difficulties 8.4 Figure required. motivated and were services when they were the inability of individuals to access treatment 136 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Eight homeless drugusers. stated. Figure 8.5conveyssomecommonresponses which wouldspecificallytarget theneedsof and accesstoneedleexchanges.Reducingtheneedforpeopletraveldrugserviceswasalso in lengthofwaitinglists,increase indayservicesanddrop-in centres aswellincreased availability to caterforthehomelesspopulation.Themostcommonlycitedrecommendations includedreduction Respondents were alsoaskedtostatethemannerinwhichdrugservicescouldbeimproved upon 8.4.3 Improvements toDrugServices–ServiceUserPerspective support. Ifyouare homelessyoushouldalsobegivenpriorityforresidential. The homelessshouldbegivenpriorityformethadone.Those that aren’t homelesshavefamily to beclean. Drug servicescouldcontacttheCorporationandgetplaces.We couldsignanagreement They needtoendcatchmentareas aspersonsfrom Kildare mustgotoTrinity Court. love togetonit[methadoneprogramme] butdon’t haveanaddress. But Ithinkeveryoneshouldbetakenonevenwithoutanaddress –Iknowpeoplewhowould There are placesoutthere thatwon’t takepeoplethatdon’t haveanaddress andadoctor. Clinics shouldworkouthowtheywiththealcoholicsandjunkies. building where youcanuse to minimisetheriskofoverdosing. They giveyousyringesbutstillhavetogooutintothestreets anduse.There shouldbea onto theprogramme. We shouldhaveeasieraccesstoprogrammes andashortwaitbetweenfirstvisitbeingtaken facilities tostopneedlesonthestreet. They shouldlegaliseheroin inclinicstostopdirtyheroin onthestreets. We needinjecting Figure 8.5Improvements toDrugServices(ServiceUserPerspective) Service Provision (Female, 23years) (Male, 39years) (Male, 27years) (Male, 34years) (Male, 23years) (Male, 23years) (Male, 52years) (Male, 28years) NACD 2005 Drug Use Among the Homeless Population in Ireland 137 Service Provision Service (Prescribing GP – Dublin) (Prescribing Chapter Eight Eight Chapter (Drug service provider – Cork) (Drug service provider (Drug service provider – Dublin) (Drug service provider (Drug service providers – Galway) (Drug service providers (Drug service provider – Limerick) (Drug service provider Some people will not go on methadone for love nor money. They don’t want it. They are taking want it. They are They don’t Some people will not go on methadone for love nor money. try and work to very difficult very, It’s not using the gear. They’re using the gear. drugs. They’re with somebody like that. Respondent 1: There is no Harm Reduction model. is no Harm Respondent 1: There the Harm Reduction Model. understanding around is no Respondent 2: And there If you are looking for maintenance there is an attitude in the Health Board that if you introduce it or that if you introduce is an attitude in the Health Board looking for maintenance there If you are a lot of people are Okay that is true, but then there the problem. make it available you will increase or methadone. heroin need they have around who go to Dublin to fulfil whatever I think within the area Well, I am not sure that their needs are different but how we meet those needs may have to be but how we meet those different that their needs are I am not sure Well, have needs because they also have the accommodation issue. They modified. They have greater being picked up to vulnerable to everything from more the issues of not being safe and of being than the more physically assaulted. Their needs are having to become involved in crime or being needs of those that may have some accommodation. Of course every person dealing with substitute prescribing is likely to encounter the problem of is likely to encounter the problem prescribing Of course every person dealing with substitute no specific policies around certainly in my ward are homelessness at some stage and there of homeless persons to the treatment is no specific approach homelessness. That is to say there is a homeless unit which is dedicated of any other person. There the treatment which varies from and/or accommodation, but treatment who require to seeking, if you like, to assisting persons the homeless, so it is facilities for prescribing that unit does not have any dedicated substitute a service. only in the position of any other advocate requesting really Another challenge reported was engaging with homeless individuals who did not want to give up drugs. was engaging with homeless individuals who Another challenge reported Service providers in Cork and Galway found it frustrating to work within the confines of an abstinence- in Cork and Galway found it frustrating Service providers oriented model: According to drug service providers, the main challenge in working with homeless drug users was the main challenge in to drug service providers, According trying to meet their multiple needs: Challenges Policies that they no drug agency interviewed reported numbers of homeless drug users, Despite increasing remarked: to deal with homeless clients. As one GP had a policy on how 8.5 Drug Service Provision: Provision: 8.5 Drug Service Perspective the Provider 138 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Eight homeless drugusers. it as‘theserviceoflastresort’. There isnootherserviceinIreland specificallytargeted attheneedsof some serviceproviders complainedaboutthequalityofserviceprovided there. OneGPdescribed In discussingonedrugserviceinDublinthatspecificallycatersfortheneedsofhomelessusers, Barriers toServiceProvision resourced, short-staffed andsometimesofpoorquality. Many serviceproviders feltthat thedrugserviceshomelesspeopleaccessedwere oftenunder- up bythefollowingrespondent: Other problems withserviceprovision, suchasbadmanagementandlackoftrainingwere summed unit, under-resourced andunder-staffed: This pointisfurtherillustratedbythefollowingnursewhodescribedhowshewastryingtorunadetox I thinkthisisabiggap. certain housingoptions.There isalittlebitaround alcohol butspecificdrugprojects are nothere. no specificresponse todrugsassuch.We haveemergency hostelsforhomelesspeople,wehave I thinkoneofthedifficulties IfindinCorkasopposedtoanywhere elseIhavebeenisthatthere is require tobeablemanageisnotbeingputintothesystem. They comeandwetrytoaccessaccommodationappropriate resources butthesupportthey There isnopointinproviding aserviceifyoudon’t havequality. Itispointless. It wouldbeanissueformebecauseinreality anyorganisation here –ourresources are beingcut. Respondents: Interviewer: Respondent 1: Interviewer: You couldgoonfor ever–butthey’re themajor ones. Respondent: Interviewer: our counsellorinNovember. us, thenurses.I’mageneralnurse.Ihavenotraininginaddiction. We havenocounsellor. We lost It’s crazy. Theservice,Ihavetosay, isabsolutelylaughable.Theonlypeoplewhoare inthere are Service Provision Would therest ofyouagree? How wouldyouratedrugservicesinthewaytheycaterforhomelesspeople? What doyouthinktheweaknessesare [indrugserviceprovision]? The weaknessesare badmanagement,consultation,and lackoftraining. Yes. Out ofhundred –Iwouldlay itaboutfive. (Drug serviceprovider –Limerick) (Drug serviceproviders –Dublin). (Drug serviceprovider –Dublin) (Drug serviceprovider –Cork) (Residential worker–Dublin) (Outreach worker–Dublin) NACD 2005 Drug Use Among the Homeless Population in Ireland 139 Service Provision Service Chapter Eight Eight Chapter (Outreach worker – Dublin) (Outreach worker – Dublin) (Outreach (Drug service provider – Cork) (Drug service provider – Cork) (Drug service provider (Drug service provider – Limerick) (Drug service provider Would people be concerned about any stigma associated with going to their local people be concerned about any stigma associated Would 15.00. We decided that we would leave a bucket out there because there were an awful lot of clients were there because decided that we would leave a bucket out there We put another all week and it was filled up [with needles]. We there So we left a bucket using there. one in on Friday and that was full up. I cannot see the point in having every needle exchange open from 2.00 – 5.00 or from 9.00 to 2.00 – 5.00 or from I cannot see the point in having every needle exchange open from in the city that is doing night-time work […] I think one somewhere should be at least 5.00. There that has to be recognition up at night-time and weekends. There needs to be something set there all very well saying that drug users need needles at the weekend and the night-time as well. It’s see is the next they can go into the exchanges during the day but knowing drug users all they can and spike would be about the price of a barrel here around and night-times turn on. Weekends € Interviewer: pharmacy to get needles? have to travel fifteen miles from number one is attitude. They might would. Hurdle they I’m sure talking about would be huge stigma – you are there another village to get their medication. Yes, perspective. a client from Because of the nature of the business, if you are homeless, or you are dealing with people in homeless, or you are of the business, if you are Because of the nature or six weeks down and not to be waiting a month a very instant response addiction, they need the line. that could be by appointment. People who are They could have access to our service, but going to keep appointments. not chaotic are and are homeless and on the street Two serious gaps highlighted in low-threshold services in Dublin were the absence of any needle services in Dublin were serious gaps highlighted in low-threshold Two needles safely, exchanges in the evening and at weekends, and the lack of facilities to dispose of face in accessing clean injecting equipment. homeless drug users especially given the difficulty Low Threshold Services Low Threshold in Galway although service providers no needle exchanges in Cork, Galway and Limerick, are There the up, however, a need for such a service. If such a system was set and Limerick expressed have to be respected: confidentiality and anonymity of clients would Waiting lists and appointments in drug services were reported to deter homeless drug users from reported services were lists and appointments in drug Waiting accessing drug treatment. 140 Drug Use Among the Homeless Population in Ireland NACD 2005 keeping appointmentsandharshsanctioningforfailingurinalysis. accessing methadonemaintenancetreatment includedlackofpermanentaddress, waitinglists, methadone maintenancetohomelesspeopleinIreland. Difficulties homelessdrugusershadin In severalfocusgroups, theparticipantscitedanumberofanomalieswithprescribing of and thosethatare unwillingtodealwithhomelessclientscanavoidthem. homeless clientsasitallowslevel2GPstochoosetheir(usuallythemore stableandreliable), Chapter Eight described the1998MethadoneProtocol asa One serviceprovider, withyearsofexperienceprescribing methadonetohomelessdrugusers, Methadone Maintenance 6The DepartmentofHealthandChildren introduced anewprotocol fortheprescribing ofmethadonemaintenancein October 66 they’re knockeddownto20– that’s aterribleregime. to 100mls.–they’re probably dabblingandmessingaround ontopofthatandalla sudden They’re settingsomeoneupallthetime.Someofclientsthatyoutalkto–they’vegot used put themonharmreduction straight away. Theygofrom thelevelofsay100mls.to20 terrified ofbeingsuedthatassoonaclientcomesinandstarts showingdirtyurinestheywill Some ofthedoctorsare grand–theyletyoudothisandthatalotofthedoctorsare so words aboutit. enforce anytimeconstraintsbutthebossdoesandwehavealready hadoneortwobattlesof constraints andinvariablywillsortofpushtheboatoutintermsbeingalittlebitlate.Idon’t One thingthathe[homelessclient]isfindingitvirtuallyimpossibletostickanytime they are reluctant aswelltoworkwithpeoplewhoare homelessbecauseofthehostel situation. more obstaclesputintheirway. Thenasitgoesonthrough thewholethingwithpharmacy, I finditishard togetsomebodyupandrunningiftheydon’t haveasteadyaddress. There are it isworldwidetomyknowledge. do notwanttodealwiththisgroup, theyhavetobelookedafterbyparamedics.Thatisthe way kind ofmedicalcare servicesatallandthisistheexperienceinternationallygeneraldoctors group, itwillbeharder notonlytogetmethadoneforthemundertheprotocol buttogetany what youwillbelookingatinthefuture isanincreasing detachmentofgeneralpracticeforthis There are fewsolutionstotheproblem ofthehomelesswithProtocol. Isuspectthatprobably Education, Prevention andPolicy: 9:4:311-324. black market. Formore information refer toButler, S.2002 ‘TheMakingofthe MethadoneProtocol: theIrishSystem?’ Drugs: 1998. Thisresulted instrictregulations toreduce theproblems of doubleprescribing andtheavailabilityofmethadoneon Service Provision ‘red herring’ 66 . In hisview, itdiscriminatesagainst (Drug serviceprovider –Dublin) (Drug serviceprovider –Dublin) (Outreach worker–Dublin) (Prescribing GP–Dublin) NACD 2005 Drug Use Among the Homeless Population in Ireland 141 Service Provision Service (Pharmacist – Dublin) Chapter Eight Eight Chapter (Drug service provider – Dublin) (Drug service provider (Drug service providers – Galway) (Drug service providers (Homeless service provider – Cork) (Homeless service provider (Homeless service provider – under 18s – Dublin) (Homeless service provider One of the greatest needs I would say, for our homeless clientele and any of our for our needs I would say, One of the greatest It is like, if you have someone come to you and say that they want to detox, But it also comes back to the other thing that while there are obvious advantages to a very high obvious advantages are to the other thing that while there But it also comes back getting a job and prevent them is very destructive in your life, it can prevent level of supervision it attend every going to have to if they are outside what is very local, them taking up a residence hold them back in other ways. it can actually day, daily attendants and of course the logistics of coming from required Now many of those are at weekends to clinics for an hour in the mornings clearly especially Inchicore, from Swords, the homeless problem. This is how you acquire is a problem. We do see and find a means to spur them on to projects, and other programmes and it is very and other programmes do see and find a means to spur them on to projects, We is also beds and on to courses […] There of getting residential to move them on in the sense hard units would not be able to units, a lot of the residential residential with different a big gap there take chaotic drug users. The first point is that it is very, very difficult to get somebody a detox bed and that is what is to get very difficult The first point is that it is very, also needed for the whole population in the Southern needed for the homeless in Cork and it is Health Board. Respondent 1: People may not necessarily want to try to would be an easily accessible detox. clientele really, and they health is at such risk that they definitely need a break but they know that their come off, need to detox. Respondent 2: locally and if is nothing there miles away, do, they are is not much they can there realistically of how long have you been in the area. somebody is homeless you get into this whole rigmarole Furthermore, several service providers pointed out during the focus groups that expecting homeless that expecting out during the focus groups pointed several service providers Furthermore, stable accessing them from methadone clinics on a daily basis may prevent drug users to attend accommodation or employment. Other problems mentioned with methadone prescribing were not specific to homeless drug users. were mentioned with methadone prescribing Other problems on about the length of time clients were concerned were These included that some service providers users rather than stabilising them, and several heroin methadone, others felt it was a way of controlling drugs. and other prescription of methadone complained about the over-prescription service providers Treatment units in enough detox beds and residential were did not feel that there Overall service providers the drug-using homeless population. Dublin and Cork to meet the demand among detox no accessible were that there in Galway and Limerick stressed service providers Furthermore, places for homeless drug users in their areas. 142 Drug Use Among the Homeless Population in Ireland NACD 2005 treatment intheSouthernHealthBoard. Catchment areas canprove themainobstacleforhomelessdruguserswishingtoaccess Chapter Eight difficult tocomplywiththeroutine andstructure ofatreatment programme. It wasreported thathomeless drugusersthatdoaccessresidential treatment, sometimes findit treatment andgettingaplacewastoolongthesedelaysputhomelessdrugusersatincreased risk. Most serviceproviders agreed thatusuallythelengthoftime betweenaninitialassessmentfordrug resources are putinto methadonemaintenanceinIreland. Some ofthoseworkinginresidential drugtreatment feltthat thiswasbecausetoomuchemphasisand is verydifficult. treatment centre inLimerickcityorcouncilwhichmeans theyhavetobereferred andthat The problem isthattheyhavetogointoresidential treatment andthere isnoresidential so, theSouthernHealthBoard willonlycoverthoseintheSouthernHealthBoard catchmentarea. of thecountryandstillare, whatisrestricting usisintherecent cutbacksinthelastsixmonthsor has causedusmajorproblems, becausewhereas weare prepared toacceptpeoplefrom allparts I justwanttogobackverybrieflythere, thecatchmentarea, thecatchmentarea issomethingthat of lifeIdon’t knowif they havethecopingskillsforthattypeofprogramme ornot. I sometimeswonderaboutitbecause iftheyare verybattered andbruisedfrom theirexperience regular druguserorteenagerdoingthesethings. sitting attableisdifficult, doingroutine thingscanbedifficult, butthatcanbedifficult fora At someleveltheyare –ifthey don’t haveastructure andtheycomeintoresidential –youknow heroin tofinallyrealise thatyouare addictedtoit. hard togetyoungpeopleinvolved–itcantakeanythinguptwo-and-a-halfyearsofsmoking list. There’s benzos,gearandmethadonetobegotinthefirstplacesothatsenseitcanvery anyway butforaproblematic, chaoticdruguserkeepingthatappointmentisthelastthingon but alsowhatwewere talking aboutearlieron–youngpeoplefindithard toholdappointments But itishard togetyoungpeople in.Notevensomuchfrom theserviceprovision point ofview escalated soitcouldbeawholedifferent story. Often bythetimetheirnamecomesuponlistamountofdrugsthattheyare usinghas whether youwillagree withmeornot.Ijustfeelthatallthemoneyhasgonetomethadoneclinics. Can Ijustsaythatthere isnotenoughemphasisputondetoxing,stabilisationandbeingclean– Service Provision (Homeless serviceprovider –under18sDublin) (Homeless serviceprovider –Limerick) (Drug serviceprovider –Limerick) (Drug serviceprovider –Dublin) (Drug serviceprovider –Dublin) (Drug serviceprovider –Cork) (Residential worker–Dublin) NACD 2005 Drug Use Among the Homeless Population in Ireland 143 Service Provision Service (Prescribing GP – Dublin) (Prescribing Chapter Eight Eight Chapter (Residential worker – Dublin) (Residential worker – Dublin) (Drug service provider – Cork) (Drug service provider (Drug service provider – Cork) (Drug service provider (Service provider – under 18s – Dublin) – under 18s – (Service provider But you are dealing with a lot of other issues as well – the obvious routes for heroin – there’s benzos – there’s for heroin dealing with a lot of other issues as well – the obvious routes But you are way to deal with that kind of thing. is no sure messy because there when it gets really etc. That’s Opiate detox is meaningful in an environment where opiates are the main drugs of use, it is are opiates where Opiate detox is meaningful in an environment concomitant as it is with cocaine alcohol use is heavy, meaningless in a context where relatively of unstable people, so the thing is that a methadone using, daily hash smoking. I have a fair load doing. of how you are measure dose tends to be a public official happen. Our success it doesn’t a lot of the time it is just a fallacy, By getting somebody drug free the ones who got and who stay clean are The people who do detoxes rate is absolutely atrocious. the know how it happened. The ones who do it are and we don’t the net – it happened through They are ones who have the family support, have the home to go back to, have the job maybe. of people but for the homeless people the suitable for those sorts the ones who do it, we are stacked against them. odds are do they go to Following on then is if you have got somebody into a detox bed the next step is where they started. after that – we have no dry houses […] They end up back to the same situation where I know it is not just a black-and-white issue like if you get caught once you are out, but when you once you are black-and-white issue like if you get caught I know it is not just a to get of slip-ups and I find it very hard bed because their residential get them back they lose them back. will only a lot of places that are etc. There What happens with relapsers gaps certainly. are There saying. were give people one bite of the cherry as you Service providers noted that many homeless drug users were polydrug users and were using a range polydrug users and were noted that many homeless drug users were Service providers use. heroin towards still geared are services in Ireland drug treatment of drugs. However, for homeless clients. deemed unsuitable were in Ireland and detox programmes Overall, residential opinion was typical of many: This respondent’s Aftercare was discussed at length by participants in the focus groups. following treatment The lack of aftercare if they did programmes set up to fail treatment drug users were felt that homeless Service providers that homeless drug The consequences are following treatment. not have accommodation secured lifestyle. not conducive to a drug-free to hostels that are users return Subsequently, many service providers complained that treatment programmes in Ireland placed too in Ireland programmes complained that treatment many service providers Subsequently, enough. not flexible policies are drug users and their relapse many demands on homeless 144 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Eight drive ofcompetentstaff: According tomostrespondents, anysuccessorachievementswere basedonthecommitmentand Successes Consequently mosthomelessdrugusersfearleavinganytypeofresidential drugtreatment. been asuccess. Drug serviceproviders inGalway feltthatincorporatingcounsellingwithmethadoneprescribing had drug users. In Limerickdrugserviceshadbeensuccessfulinaccessingfunding fortreatment forhomeless circumstances, Ithinkthatisstrength. Icannotthinkofany otherstrengths. They gothrough heavenand hellfortheirclientstotryandgetthemsomewhere. Inverydifficult places haveatleasttwoorthree goodworkersthatIcanthinkofwhoare really intotheirwork. Respondent 3: somewhere andtheyknowthat. Respondent 2:We doallwe canforthem.We’re neveroff thephonestryingtogetthem Respondent 1: Interviewer: Whatwouldyousayare thestrengths ofservice provision forhomelessdrugusers? door saying“youhavedonewhatyoucametodo,needgonow”. of peoplegetsousedtoittheyjustdon’t wanttoleave.We are kindofpushingthemoutthe think aboutit–theyhaveabedspace.Theyloveisjustcomfortzone.Alot have aroof overtheirhead–theyabsolutelylovethestructure –theygetfeddon’t haveto Our clients,whoare homeless,are somucheasiertodealwithbecausetheyare sorelieved to people whousemethadoneare connectedtoaddictioncounsellors. counsellors really clickwiththeirclients.Thegoodthingisthatthosepeopleormostofthe with usandhavebeenaskedtoleave.Thegreat thingis–I’veseenthatmostofthose have amassivecaseload.Theydodealwiththosepeoplethatsortoffailedineverysense addiction counselloraswell.It’s theOutreach AddictionServiceandtheyare verygood–theyjust The peopleIhavebeendealingwithwhodogotothemethadoneclinichere –theyallseean becoming homelessbecauseoftheirdruguseandgettingthem intotreatment. Thatisagoodthing. able topayforfourorfivepeoplethisyearthathadahomeless elementorthatwere at risk of There isfundingallocatedtothosethatare homelesswhowanttoaccesstreatment –sowewere Service Provision Strengths Icanthinkof–there are somegoodworkersoutthere. Mostcommunity Good workers. (Drug serviceprovider –Limerick) (Drug serviceproviders –Dublin) (Drug serviceprovider –Galway) (Drug serviceprovider –Dublin) NACD 2005 Drug Use Among the Homeless Population in Ireland 145 Service Provision Service Chapter Eight Eight Chapter (Night shelter worker – Dublin) (Drug service provider – Dublin) (Drug service provider (Drug service provider – Limerick) (Drug service provider (Drug service provider – Limerick) (Drug service provider (Drug service provider – Limerick) (Drug service provider – Limerick) (Drug service provider We need consumption rooms. We have the guards coming along – we have security coming have the guards We need consumption rooms. We not They’re gone to another area. gone for a day but they’re along – moving them. They’re they where else. So they need somewhere a mess somewhere just leaving stopping using. They’re have maybe they can Somewhere A few good nurses there. supervised place. can use. Properly badly needed. showers etc. It’s I know there will be a great deal of objection to it but I feel a safe environment where a person where deal of objection to it but I feel a safe environment will be a great I know there they can inject and dispose of their needles safely where can go, with the nurse, with the doctor, – or even a mobile shooting gallery. very valuable thing in the city centre would be a very, They should be able to go into their local pharmacy [for a needle exchange] or link in with an They should be able to go into their local pharmacy [for a needle exchange] or link needle exchanges need systems and service. They should have choice. However, outreach need to be safe. in place and staff structures They need perhaps counselling or something like that to overcome situations in their lives. A lot situations in their lives. like that to overcome They need perhaps counselling or something you think of older people but – when you think of homeless very young really of these people are their addiction – it would be around very young […] a lot of time it is centred a lot of them are could think of ways of encouraging them to take the next step out or whatever. if we great We need appropriate and adequate resources to be able to meet their needs. to be able and adequate resources appropriate need We Staff need to be adequately trained in the broader sense to be aware and supportive. If staff are and supportive. If staff sense to be aware need to be adequately trained in the broader Staff with x, y or z needs and you do whatever you of them a human being in front is that there aware limits as are to say – there way and hear what the person has can – if you do that in a respectable what makes a difference. to what you can do but that’s Low Threshold Services Low Threshold injecting felt that consideration should be given to the establishment of a safe Some service providers homeless drug users drug taking as well as offering the levels of public facility in Dublin to help reduce in which to inject. a safe environment Furthermore, drug services providers in Galway and Limerick feel that needle exchanges should be drug services providers Furthermore, locations in these areas: piloted in different Many service providers also felt that any type of service provided to homeless drug users should also felt that any type of service provided Many service providers adopt an holistic approach. incorporate some form of counselling and Similar to homeless services, drug service providers felt they could only provide appropriate services appropriate provide felt they could only drug service providers Similar to homeless services, trained staff. appropriately funding and with sufficient to homeless drug users Service Development 146 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Eight more flexibleandlessstructured. programmes, itwasrecommended thatprogrammes are designedwhichare more accessible, As serviceproviders feltthathomelesspeoplefounditdifficult tofollowexistingtreatment Treatment considered aspartofamore comprehensive drugtreatment programme. Although methadonemaintenanceisnotavailableinCork,someserviceproviders feltitshouldbe should beflexible,takeaholisticapproach andassisthomelessdruguserstoaccessaccommodation. Service providers advocatedthatanydevelopmentsinmethadonetreatment forhomelessdrugusers Methadone Treatment Programmes It canbemonthstogetanappointment;itneedsfasttracked andeasieraccess. but itcannotbeusedinisolation. it needstobeawholecomprehensive planwhereas methadonemightbeoneofthosesolutions I thinkmethadoneisonlyoneveryspecifictreatment sosupplyingmethadoneisnottheanswer– more peopleonit,soknowing theserviceisnotavailablelikeadeterrent initself. If there wasmethadoneavailableaspartofsomerehab programme there wouldcertainlybealot their practicalneeds,socialneedsoverandabovemethadonetreatment. But Ithinkatthisstagethere shouldbemore beingdone totakeonboard theclients’needs– need tobesustained,sothere shouldbealotmore transition forpeopleonmethadone. people onmethadonethatyouwouldnotevenknoware onmethadone.Peoplemethadone is veryhard becauseDublinCorporationdon’t housepeopleonmethadone.There are lotsof A lotofpeoplecomethrough ourdoorsthatwouldbeonmethadone.To getaccommodationit convenient time. guaranteeing theminimumofciviliseddispensingtopersonsirrespective oftheirlocationatsome at leastaflexiblenetworkwhichincludedbuses–theAmsterdam solution–thatwouldbeatleast It shouldhavebeenobviousthatthere wasgoingtobeaneedformobiledispensingservicesor Service Provision (Homeless serviceprovider – Cork) (Drug serviceprovider –Dublin) (Drug serviceprovider –Cork) (Drug serviceprovider –Cork) (Settlement worker–Dublin) (Pharmacist –Dublin) NACD 2005 Drug Use Among the Homeless Population in Ireland 147 Service Provision Service Chapter Eight Eight Chapter (Drug service provider – Cork) (Drug service provider – Cork) (Drug service provider (Drug service provider – Dublin) (Drug service provider – Dublin) (Drug service provider – Dublin) (Drug service provider At around the three-month mark of an individual’s programme we would be looking at we would programme individual’s mark of an the three-month At around need to link into to to live, what sort of services we would they want accommodation, where would probably and the suitability of that accommodation some kind of accommodation secure of their recovery. be an issue in terms [There’s a place in London] – if you are really bad you will be taken in there – you can stay for a bad you will be taken in there really a place in London] – if you are [There’s meals a day – you get a bed and you get a weeks – in that time you get three maximum of three with you. If you want to go back issues if you want one who will work through counsellor in there and you If you don’t that is grand – they will put you back out onto the street. out onto the street in England and they they will have a hotline on to every residential want to go on to residential into residential. will fast track you through they get used to living by themselves, get your things housing where I would like to see sheltered to move. ready get your bit of work or your training and you are together, They need a kind of care prior to doing a rehab programme if you like, and they need some place programme prior to doing a rehab They need a kind of care first of all, maybe on detox if that is needed […]. Some they can go in and get respite where straight other people might want to go into re-settlement programme, might do a rehabilitation to a lot of the services. have access don’t to help those kind of people who get lost, they Try away. what is available have to try and arrange accommodation yourself and that is determined by You available. Sometimes it is interesting very little is very, the Corporation, Council etc. There from was accommodation that what is available in the short term would be most unsuitable. If there want to avoid. that you would available it would be in some areas Finding suitable accommodation for homeless drug users is probably the most crucial step in preventing the for homeless drug users is probably Finding suitable accommodation programmes. should be incorporated into treatment felt that this and service providers relapse Given the difficulties homeless drug users experience in accessing treatment, service providers homeless drug users experience in accessing treatment, Given the difficulties care. the need for respite recommended Aftercare employment housing, retraining, addressing aftercare highlighted the need for more Service providers and social support. 148 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Eight alcohol treatment, incomparison to14%forCork(n=5)and3%Limerick(n=1). (n=69; 28%).OutsideDublin,justoverafifthoftheGalwaysample reported requiring drugand The needfordrugandalcoholtreatment wasalsoreported byoveraquarteroftheDublinsample hostel dwellers(n=39)andB&Boccupants(n=16). rough sleepersreported thattheyrequired drug/alcoholtreatment incomparison toonly23%ofboth as problematic drugusersaccording totheDASTscreening instrument.Twenty-nine percent (n=16)of service need.Thisisalsorelatively highinviewofthefactthat36%(n=127)totalsamplescored Twenty-four percent (n=83)ofthetotalstudypopulationreported drugand/oralcoholtreatment asa support mechanisms,andone-in-three oftheDublinsample. homeless population.Justoverone-in-fourofthetotalstudypopulationreported theneedforsocial etc.) whichhavesoughttofacilitateaccessto,anddeliveryofhealthcare servicesforthe Dublin in viewofrecent developments(suchas;primaryhealthcare teams;“fast-track”medicalcard system one-in-three oftheDublinsample reporting theneedforhealthcare services.Thisis considered high care serviceswasreported byoveraquarterofthetotalstudy population(n=102;29%)withmore than Training andemploymentopportunitieswere thesecondmostcitedserviceneed.Accesstohealth locations reported stableaccommodationastheirprimaryserviceneed. Multiple responses were allowed.AsconveyedinTable 8.6,themajorityofrespondents across allcity All individualswere askedtosubjectivelystatewhethertheyrequired anyofthelistedserviceneeds. 8.7 AssessmentofServiceNeeds with eitherapsychiatricclinicorcommunitynurseinthethree monthspriortointerview. (n=88) ofrespondents respectively. Sixteenpercent ofthetotalstudypopulation(n=58)hadcontact 23%). Contactwithlocalauthorityoffices andsocialworkerswasreported by26%(n=90)and25% with hospitalclinicsandnearlyone-in-fourrespondents hadcontactwithA&Edepartments (n=79; over aquarter(n=97;28%)reported contactwithGardaí. Twenty-seven percent (n=94)hadcontact reported contactwithcommunitywelfare officers overthethree-month periodpriortointerview, while 29% (n=22)were currently receiving methadone.Asubstantialnumberofindividuals(n=150;43%) third ofthosewhoreported contactwithGPswere problematic drugusers(n=75,37%),ofwhomonly the mostcitedservicecontactwhichwasreported byoverahalfofrespondents (n=201;57%).Overa All respondents were askedabouttheirlevelofcontactwith variousgenericservices.GPserviceswere 8.6 ContactwithGenericServices Service Provision NACD 2005 Drug Use Among the Homeless Population in Ireland 149 2003). Service Provision Service et al., Chapter Eight Eight Chapter Dublin Cork Limerick Galway (n=355) (n=247) (n=36) (n=36) (n=36) %n % n %n % n %n Total Study Total Population City Locations (2002) also found that the uptake of homeless services was far higher than it was et al. of drug and alcohol services. Fountain and Howes (2001) found in their sample of rough sleepers that the longer respondents Fountain and Howes (2001) found in their sample of rough to have used services for homeless people. likely they were had been homeless, the more Fountain There were high levels of contact reported with emergency accommodation, drop-in centres accommodation, drop-in with emergency of contact reported high levels were There cited the absence of drug/alcohol users as a factor few respondents and food services. Very influencing use of homeless services (3% and 1% respectively). for all homeless people, it is particularly While accessing accommodation can be problematic such as young people, families, drug users and those with mental for certain groups, difficult highly influenced by personal are 2003c). Contact with services (Corr, health problems characteristics of service users and service delivery factors and availability (Warnes Service Need Treatment 14Treatment Other* [50] (n=3), caravan (n=2), rented access to children/custody were; * “Other” service needs reported 16(n=1), hygiene (n=1), food and washing facilities (n=1), accommodation (n=1), budgeting advice [38] skills (n=1), clothes (n=1), home help (n=1), parenting drug and alcohol treatment “unforced” (n=1), stability (n=1). 5 9 [14] [3] 3 - [7] - 3 25 [1] [9] 17 [6] - - Treatment 24Treatment Legal [83] Accom.Emergency 28 17Psychiatric [69] [59] 14 20 18 [5] [70] [44] 25 3 3 [60] [1] [1] 14 22 3 [5] [8] [1] - 36 - [13] 14 [5] Accommodation 86 [302]Training/ Employment 39 89 [135] Health Care [216]Social Support 42 89Drug/Alcohol [101] 29 [31] 27 [102] 40 [96] 56 [14] 34 34 [20] [83] 19 [83] 97 20 [7] [35] 6 [7] 36 [2] [13] 3 3 [1] [1] 31 28 [11] [10] Stable 8.8 Summary and Conclusions ■ Table 8.1 Self-Reported Service Needs by City Location 8.1 Self-Reported Table 150 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Eight ■ ■ ■ ■ ■ who isprimarilyadruguserthantoanotherhomelessperson(Fountain together (Kennedy one possibleexplanationprovided isafailure ofdrugand homelessservicestoworkeffectively homeless peopleanddrugusersfrequently encounterdifficulties accessingservices.Furthermore, service needed toprovide reduction appropriate services. harm particularly inrelation toaccommodation.Moreover, theyemphasised thatanyspecialist interviewed feltthatspecialist serviceswere themostappropriate forhomelessdrug users, to anex-userwishingsustain adrug-free lifestyle.The majorityofserviceproviders Reference wasoftenmadetosomehomelessserviceenvironments notbeingconducive limitations, suchastrainingandadequateresource allocation. users isbeenchallengedbynotonlythecomplexityoftheirneeds butalsoorganisational homeless servicesbydrugusers.Thecapacityof todealwithhomelessdrug This supportsinternationalliterature whichindicatesthatagrowing demandisbeingplacedon drug usersandhighlightedthelackofmove-onoptionsfrom emergency accommodation. accommodation, serviceproviders questionedthequalityoftheseservicesforhomeless approach andnodayservicespecificallytargeted athomelessdrugusers.Inrelation to reductionrestrictions, alienatingclients byadoptinganabstinence-orientedratherthanharm negative attitudeofsomestaff towards drugusers,lackofresources andfunding included lackofknowledgeandtrainingaround drugissues,lackofexperienceandthe adequately meettheneedsofhomelessdrugsusers.Barriersfacedbyservices The generalperception among serviceproviders wasthathomelessservicesdonot with thetarget group (Flemen,1999;Kennedy particularly challengingwhichoftenmeantthatsomehomelessagencieswere reluctant towork Similarly research carriedoutinBritainfoundthatworkingwithhomelessdruguserswas address theirdruguse. with deathbyoverdose, protecting staff andclientsafetymotivatingdrug users to simultaneously, addressing theirownpreconceptions ofhomelessdrugusers,feardealing users includedetectingandrecognising druguse,beingabletodealwithanumberofissues Many ofthechallengesfacedbyhomelessserviceproviders workingwithhomelessdrug and Pamneja,2000). not inanymannercontradictorytoserviceusersrightsoroverallethosoftheorganisation (Britton policies. Itisalsonecessarytoensure thatanydetailsincludedwithinanorganisational policyare in whichitmaybenecessarytomakejudgmentsonthebasisofknownprocedures and organisational managementapproach. Organisational policiescanonlybeoffered asaframework concerned solelywith“whatisandnotlegal”butrathershouldbepartofamore extensive Flemen (1999:31)argues that whenformulatingdrugpolicieshomelessservicesshouldnotbe premises butpoliciesaround drug-related incidentswere more flexible. and dealing.Allagenciesintervieweddidnotallowdruguseordealingonthe Few ofthehomelessservicesinterviewedhadofficial policiesonillicitdruguse,possession Kennedy accessing homelessservicesandmore likelytoberefused accesstohomelessservices. drug users,andtoalesserdegree, problematic drinkers, were more likelytohaveproblems In relation tocontactwithhomelessservices,theresults wouldindicatethatproblematic et al. Service Provision (2001:22) refers toasubstantialbodyofliterature whichhasdocumentedthat et al., 2001). Furthermore, aserviceoftenresponds verydifferently toaperson et al., 2001). et al., 2002). NACD 2005 Drug Use Among the Homeless Population in Ireland 151 Service Provision Service 1992). Chapter Eight Eight Chapter et al. 2002). Randall and Brown (2002a) argue that specialist substance misuse (2002a) argue 2002). Randall and Brown (2003:387) which noted that “while drug use and dependence of the sample was et al., et al. Just over a third of the homeless population reported contact with a drug service within contact of the homeless population reported Just over a third workers working on the streets and in hostels are better able to negotiate access to services and better able to negotiate access and in hostels are streets workers working on the suggests that the area in Best practice literature than non-specialists. programmes treatment drug users (London of services for homeless is central to the provision specialist accommodation Randall and Drugscope, 2001). Drug Policy Forum, 1999; According to service providers the quality of drug services offered to homeless drug users the quality of drug services offered to service providers According exchanges in The lack of needle and short-staffed. was often poor and under-resourced at weekends Galway and Limerick and the absence of needle exchanges in the evening and to drug service According provision. highlighted as serious gaps in service in Dublin were The main challenges drug service providers reported in working with homeless drug users reported The main challenges drug service providers to give up was trying to meet their multiple needs, engaging with those who did not want (mainly in drugs, while those working within the confines of an abstinence-oriented model Cork and Galway) found it frustrating. During the focus groups, no drug services interviewed reported having a policy on how do reported no drug services interviewed During the focus groups, deal with homeless clients. According to homeless service providers, successful ways of engaging with homeless drug successful ways to homeless service providers, According focusing on individuals’ behaviour rather than drug users, which could be built on, included also work. Service providers multi-disciplinary flexible and promoting use, remaining in resources could be developed in the following ways: increases that services recommended and settlement plan for homeless drug of care and funding; development of a continuum of a range of provision safe injecting room; users; exploration of the feasibility of a accommodation for drug users in emergency accommodation options including move-on housing; long-termaccommodation; additional transitional stable accommodation (through and half way houses. local authorities and private rented); to five broad that good practice in working with homeless drug users related Neale (2002) revealed service delivery and agency support provided, agency environment, staffing, These were: areas. aims and objectives. It is argued that generalist provision of homeless services can often ill equip people with multiple homeless services can often ill equip people of that generalist provision It is argued needs (Fountain the previous three months (36%). Contact with drop-in centres and methadone treatment and methadone centres months (36%). Contact with drop-in three the previous drug service by one-in-two of those who reported high, reported relatively services were in contact with a needle exchange injectors were of current contact. Eighty-five percent population. 17% of the total homeless months, representing three within the preceding in contact with addiction services were of respondents Houghton and Hickey (2001) found that 40% those The study findings reiterate months previously. at the time of interview and 48% in the three of Fountain high, the uptake of drug services by those in need of them was low”. Syringe exchanges are high, the uptake of drug services by those in need of them was low”. Syringe exchanges of first time attendees at the into services. Forty-eight percent in attracting drug users effective been in contact with any drug syringe exchange had never previously Quay Ireland Merchants risk behaviour the influence of syringe exchanges upon service (Cox and Lawless, 2000). However, of injectors, of equipment, the profile by local conditions of availability is likely to be affected of services (Friedman educational strategies and the user-friendliness ■ ■ ■ ■ ■ 152 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Eight ■ ■ ■ rates ofneedwere observedfordrugtreatment amongrough sleepers. personal safety(Greenwood, 1992). perceived skillortrainingtodealwiththisclientgroup, orevenconcernsregarding theirown which caninfluencegeneralpractitionersnegativeattitudesofdrugusersmaybethelack often reactive tosituationsratherthanonaroutinely health care basis(Lawless,2003).Factors to appropriate healthservicesduetotheirdrug-usingstatus.Medicalvisitsamongdrugusersare inaccessible, unacceptableandinappropriate. Similarly, druguserscanexperiencelackofaccess associated withhomelessnessmightbeduetothelimiteduseofhealthserviceswhichare often as aserviceneed amongrough sleepersare consistentwithFountain repercussions ontheir accommodation (Flemen,1999).Theabovefigures foralcoholtreatment services forfearofbeinglabelled asadruguserordisclosure ofpracticesandthepossible drug serviceuptakeamonghomeless drugusers.Individualsmaynotwanttoapproach drug 377). Fountain currently accessingtheappropriate services,otherthan needleexchanges(Fountain of current alcoholusersstatedthattheyrequired helpwiththeirsubstanceuse,butfewwere In astudyofrough sleepersin theUK,overahalfofcurrent drugusers(52%)andathird (33%) requiring drug/alcoholtreatment thanhosteldwellers orB&Boccupants(23%respectively). increasing to28%withintheDublinsample.Highernumbersofrough sleepers(29%)reported One-in-four respondents reported drugoralcoholtreatment asaserviceneed(24%), Stable accommodationwasreported astheprimaryserviceneedamongrespondents (86%). equipped tomeettheirneeds(Wright, 2002).Moore importance, isthefactthatmanyhomelessindividualsfindhealthservicesinappropriate orill- health services(Bines,1994;PleaceandQuilgars,1996;Holohan,1997;Wright, 2002).Ofgreater Evidence hasshownthathomelesspeopleexperiencedifficulties inaccessingmainstream who reported contactwith aGPwere problematic drugusers(n=99;55%). one-in-three homelessindividuals reported healthcare asaserviceneed.Halfof those Despite highlevelsofcontactwithGPs,hospitalclinics,andA&Edepartments,almost and socialsupport. care forhomelessdrugusers aswellaftercare addressing housing,retraining, employment accommodation. Someserviceproviders inCorkandDublinexpressed aneedforrespite flexible, lessstructured, take anholisticapproach andassisthomelessdruguserstoaccess providers advocatedthatmethadone maintenanceandtreatment programmes shouldbe felt needleexchangesshouldbepilotedindifferent locationsintheseareas. Service Dublin highlightedtheneedforasafeinjectingroom, whilethoseinGalwayandLimerick trained staff inorder tomeettheneedsofhomeless drugusers.Someserviceproviders in Drug serviceproviders recommended theneedforsufficient fundingandappropriately users were oftensetuptofail. thelackofaftercarenot suithomelessdrugusers.Furthermore, meantthathomelessdrug homeless peopleatriskandtheroutine andstructure oftreatment programmes oftendid and residential places,thedelaybetweeninitialassessmentanddrugtreatment put daily. Inrelation totreatment, drugservice providers feltthatthere were notenoughdetox sanctioning forfailingurinalysisandtheproblems inhavingtoattendmethadoneclinics address,treatment waitinglists,keepingappointments,harsh includedlackofpermanent providers, difficulties homelessdrugusershadinaccessing methadonemaintenance Service Provision et al. (2003) statethatadiscrepancy canexistbetweenthedruguser’s needand et al. (1997) foundthatmanyhealthproblems et al. (2003), however lower et al., 2003: NACD 2005 Drug Use Among the Homeless Population in Ireland 153 individual/personal and societal/structural factors. For many, drug use was initiated prior to drug use was initiated factors. For many, individual/personal and societal/structural of their homeless as a feature drug use emerged becoming homeless, while for the minority, of the the complexity that drug use causes homelessness reduces argue To predicament. with no intervening variables. process a cause and effect and simplifies it to merely relationship of not always a result homeless were for remaining Reasons for becoming homeless and reasons population cited a number of personal reasons the same phenomena. Members of the homeless for remaining alcohol use, drug use), while reasons for becoming homeless (e.g. family conflict, (e.g. barriers in accessing housing in Ireland to structural factors related largely homeless were sector etc.). Drug use was the the private rented regarding length of time on waiting list, difficulties also a contributing cause for becoming homeless. Alcohol was second most commonly cited reason only to the first experience of homelessness for homelessness refer of homelessness. Main reasons more were Women have altered. may therefore and factors associated with subsequent episodes experiences of homelessness. This would suggest more likely than their male counterparts to have for women which has implications for their security of that specific triggers for homelessness exist sensitive to the highlights an exploration into various intervention strategies which are and tenure women with children. needs of homeless women and homeless experiences of, homelessness, in addition to a number includes demographics, pathways into, and and alcohol use, these include drug of complex and interacting service needs. Most commonly, mental health issues, dual diagnosis, poor physical health and experience of blood-borne often chaotic and vulnerable that individuals are of multiple needs means infections. The presence their needs. Although the vast majority of to address a multi-disciplinary approach and require that they worked with people with multiple needs, service systems were reported service providers The ability and capacity of those working in a one-dimensional manner. to respond often reported of training, co-ordination resources, is challenged by the lack of appropriate with this group services and overall integrated structures. the in drug-use patterns and experiences. Alcohol remains differences population with regional the highest drug of choice among the homeless population, with older males reporting current of a higher frequency also reported rough of use. Those staying in squats and sleeping frequency representing as problematic, drinkers scored current alcohol consumption. Almost three-in-four a higher level of alcohol over half of the total homeless population. Homeless males reported of Those staying in hostels exhibited the highest proportion than female respondents. problems sleepers (52%). Nearly two-fifths of B&B drinkers (55%), followed closely by rough problematic drinking (39%). occupants exhibited problematic This is the first Irish study undertaken which examines the nature, extent and context of drug use extent and context of drug undertaken which examines the nature, This is the first Irish study a strong provides this report population. The information contained within among the homeless policies. future which to develop services and implement empirical base upon 1.complex and include both are has highlighted that the causes of homelessness This study 2. population. This heterogeneity heterogeneous an extremely are Those experiencing homelessness 3. among the homeless reported High levels of licit (including alcohol) and illicit drug use were Conclusions and Policy Implications Conclusions 9.1 Conclusions Chapter Nine Chapter 154 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Nine . Moreover, theresearch supportsthehypothesisthatextentofillicitdruguseamong 4. . Surveydatafrom thoseexperiencinghomelessness,andinformation from serviceproviders, 6. Thisresearch hashighlightedtheimportanceoflifestylefactors,i.e.appropriate housingamong 5. intravenous drugusereported amongtheDublinhomelesspopulation. frequency ofuseprescribed medicationwasreported byrespondents. There were highlevelsof a tendencytowards polydruguse(i.e.theymore thanonedrug)(excludingalcohol).Ahigh current usersofmethadonewere from theDublinhomelesssample.Homelessdrugusersalsohad mainly onopiateuse.Thiswashighlyevidentintermsofdrugsubstitutionprogrammes where all mainly confinedtotheDublinArea. Similarly, drugtreatment servicesintheDublinArea focus is themostcommonlyusedillicitdrug.Theuseofopiatesamonghomelesspopulationwas homeless populationissubstantiallyhigherthanitamongthegeneralIrishpopulation.Cannabis therefore havetorecognise thedifferent familytypes affected. possible toassumethatpsychiatric illnessordruguseisconfinedtosingleadultsandresponses would highlightimplicationsfor servicedeliveryandidentifyingappropriate interventions.Itisnot These findingsare particularlyinteresting giventheirprofile aslargely womenwith children which a psychiatricillness.Similarly, B&Boccupantsscored thehighestlevelofdrug dependency(36%). occupants exceededhosteldwellersandrough sleepersintermsofeverbeingdiagnosed with problematic druguserswere proportionally more likely, toreport psychiatric concerns.B&B sufficiently metbyexistingservices.Problematic drinkerswere significantlymore likely, and substantiate thathomelessdrugusershavenumerous complexneedsthatare notbeing treatment canbeonerous forindividualsintermsofstabilisingtheirdruguse. treatment forhepatitisC(11%) mustbeseenwithinacontextwhere accessinghepatitisC hepatitis Cstatus.Thelownumbersofproblematic druguserswhowere currently receiving risk behaviourandhealthconcernswithoverhalfofproblematic drugusersreporting apositive obvious from individualquotes. Suchactivitieshavedemonstratedtheimplicationsforindividual injecting paraphernalia.The“situationalsharing”ofequipmentandparaphernaliawas last three months),mostnotably theborrowing ofusedinjectingequipmentandthesharing practices. Homelessinjectorsexhibitedextremely highlevelsofinjectingriskbehaviour(i.e.within themselves andassuchwere more likelythanmaleinjectorstoreport communalinjecting others, eitherwiththeirpartnerorinagroup. Femaleinjectorswere lesslikelytoreport injecting more likelytoinvolvecontact withotherinjectors.Overhalfofinjectorsreported injectingwith exacerbating oneanother. Thesocialcontextofinjectingpracticesamongthehomelesswasalso terms ofriskbehaviour, druguseandhomelessnessare clearlyinterrelated, complicatingand to usewhentheybecomehomelessbuttheirpracticesandbehaviourmore ‘risky’. In Homelessness wasclearlyrelated toaworseningdrugssituation.Theissueisnotthatpeoplestart accommodation type,theirinjectingpracticestendedtooccurinprivateratherthanexposedareas. residence were B&Boccupants.Aswomenandchildren tendtocharacterisetheprofile ofthis interviewed. Itisinteresting tonotethatovertwo-thirds ofthosewhoinjectedattheirplace was increasingly commonamong homelessinjectorsandwasoftentheonlyviableoptionforthose above thoseofpersonalchoiceormotivation.Injectingdrugsinthestreets andotherpublicplaces circumstances inwhichdrug useanddruginjectingamongthehomelesstookplacewere overand drug usersandtheimpactoftheirhousingarrangementsinpatternsriskbehaviour. The Conclusions andPolicyImplications NACD 2005 Drug Use Among the Homeless Population in Ireland 155 Conclusions and Policy Implications Policy and Conclusions Chapter Nine Chapter Alcohol is the current drug of choice among the homeless population. Alcohol is the current Cannabis is the primary illicit drug of use for the homeless population. Drug use and homelessness are clearly interlinked. Drug use and homelessness are the general Drug use amongst homeless individuals occurs at much higher levels than among population. those who consume drugs in an Drug use among the homeless population ranges from and dependent users. problematic way to those who are experimental and recreational Many homeless service providers reported continual increases in the number of drug users in the number continual increases reported providers Many homeless service with the complexity of felt ill-equipped to deal Homeless service staff accessing their services. felt that they did not have homeless service providers Some by this group. the issues presented felt Some homeless service providers this client group. or expertise to deal with the resources and these myths serve to work with challenging group and a difficult were homeless drug users and such attitudes and non-deserving homeless people the idea of the deserving only to reinforce working practices. providers’ can often inform service and The existence interviewed operated a “no-drugs” policy. All accommodation providers dictated by the law covering to be largely operation of a “no-drugs policy” was reported a clear understanding of Although drug policies can demonstrate possession, use and supply. arise, in some should a problem to be followed services’ position and the necessary procedures justification for a “no drug- by services as providing instances a “no-drugs policy” was interpreted did accept homeless drug users, as long accommodation providers Some emergency user” policy. to accept active drug users. This often others refused as they complied with the policies, while this often meant that their drug use went undetected. led to drug users concealing their use and to acknowledge that among some accommodation service providers This highlights the failure extent did to a greater of their clients use drugs. Homeless drug users, a substantial proportion services. have access to daytime care as “high risk” regarded options were seek treatment to drug services. Homeless drug users who keep clients in treatment, to retain difficult that it is more reported as many drug service providers programme. a structured appointments and meet the demands of within the services and policies of the past. Although Homeless drug users cannot be managed diverse services, need for additional and more noted the both service users and service providers type of interventions which the current focusing and reviewing was also an emphasis on there highlighted the users. For example, homeless service providers made with homeless drug are and that preventative crisis provision” “limited services beyond emergency were fact that there the means for which settlement is a provide and move-on options, interventions in specific areas within the action plan on the key activities proposed in line with These expectations are possibility. will be “a shift in service delivery, homelessness for Dublin 2004-2006 in which it states that there making the services suitable” towards making people fit into the services available away from 2004: 3). (Homeless Agency, 7. to housing services, so too can homelessness act as a barrier While drug use can act as a barrier ■ ■ Based on the findings of the study, the following conclusions are warranted: the following conclusions are Based on the findings of the study, ■ ■ ■ 156 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Nine ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ priority. Services (drugandhomeless)haveultimatelyfailedtorespond tothisissueasanorganisational emerge. Services are clearlydefinedin relation toareas ofexpertiseand,assuch,gapsinservice provision development ofdrugtreatment services. There isinadequateconsiderationoftheneedsthisdrug-usingpopulationgroup inthe Homeless drugusershaveinadequateaccessto,anduseof, services. related harm. but doesnotprevent drugusersaccessingservicesandcanundermineefforts tominimisedrug- Employing policiestoexcludedrug-usingpeoplefrom homelessservicesprobably doesimpact drug-using status. Drug-using homelessindividualsare oftenexcludedfrom homelessservicesbyvirtueoftheir health issues. Drug-using homelessindividualshaveverycomplexandinterrelated needsincludingmental and practices)are highamong thehomelesspopulation. Injecting riskbehaviours(suchasneedlesharing,difficulties injecting,precarious injectingsites Homelessness isapredictor ofdrug-related riskbehaviour. Polydrug useisacharacteristicofthehomelessdrug-usingpopulation. in B&Baccommodationorsleepingrough. Drug-using homelessindividualsinhostelsusedrugsatlessdependentratesthanthosestaying in hostelorB&Baccommodation. Higher levelsofproblematic druguseisfoundamongrough sleepersthanamongthosestaying Drug useamongthosewhoare homelessvariesbyaccommodationtype. Dublin. Problematic anddependentalcoholuseisthemainissueamonghomelesspeopleoutsideof in Dublin. Problematic anddependentopiateuseisaseriousissueamongthoseexperiencinghomelessness of use. Drug useamongthoseexperiencinghomelessnesshasregional variationsbydrugtypeandlevel There isahighlevelofproblematic anddependentdrug useamongsthomelesspeople. homeless population. There isahighlevelofconsumptionandproblematic use ofalcoholamongthe Conclusions andPolicyImplications NACD 2005 Drug Use Among the Homeless Population in Ireland 157 Conclusions and Policy Implications Policy and Conclusions Chapter Nine Chapter The issue of dual diagnosis has been highlighted as creating difficulties for homeless services. difficulties The issue of dual diagnosis has been highlighted as creating for means for psychiatric care referral of the appropriate unsure are Homeless service providers is the highly medicalised such difficulties in resolving drug-using service users. Part of the problem Given the multiple needs of homeless people and homeless drug users in particular, there is there Given the multiple needs of homeless people and homeless drug users in particular, harm (ranging from to accommodation provision in relation a need for a continuum of care environments). services to drug-and-alcohol-free reduction-oriented drug services and other harm reduction low-threshold offer Some homeless services already engage with drug services and it is also important that homeless services techniques. However, drug service provision. linked into mainstream that these individuals are ensure The adoption of integrated care planning and management would help combine and co-ordinate The adoption of integrated care to meet the needs of homeless drug users. required services and interventions which are different that the partnership working between drug and homeless services to ensure It would require the Currently, the stage when it is required. service is available for the individual at appropriate to be applied to the homeless proposals management Homeless Agency has developed care Managers and the Dublin Link system. sector and supported by Care that homeless services take an inclusive other essential services. It is important exclusion from some of their services. Drug use is not to drug users rather than excluding them from approach drug users do and will access homeless services. Homeless solely an issue for drug service providers. At a local level, consideration should be given towards providing a means through which drug a means through providing towards At a local level, consideration should be given action plans and for those working in homeless services would have an input in local homeless task forces. drug on local/regional services to be represented The National Drugs Strategy Team and the Homeless Agency are beginning to work together, beginning to work together, and the Homeless Agency are The National Drugs Strategy Team would have clear links with the National Drugs to develop and establish joint strategies which also involve the local authorities and health boards. Strategy and Homeless Strategy and would to the expanded Consultative Forum of the has been appointed of the Team A representative Homeless Agency. Ireland whereby partnerships between key agencies including health, social services, education key agencies including health, social services, partnerships between whereby Ireland delivery The seen as being crucial to the success of the strategy. and criminal justice agencies are of services and on co-ordination for all drug users is dependent treatment of high-quality effective The findings of the study drug strategy. is fundamental to the success of the Government’s of drugs and homeless services and joint co-ordination issues regarding are highlight that there convey that a feature between statutory and non-statutory agencies. Results working relationships for the responsibility where regarding has been the lack of awareness of existing service responses lines of with clear strategic approach a more lies. It is important to ensure this client group individuals. and accountability for those working with drug-using homeless responsibility 2. Homelessness is the sharp end of exclusion (Seddon, 1998). Lack of stable housing can often mean ■ ■ ■ ■ ■ ■ The research findings have particular implications for policy development and areas for consideration for policy development and areas findings have particular implications The research herein. presented are 1. in problems to tackling drug an approach Drugs Strategy (2001-2008) emphasises The National 9.2 Policy Implications 9.2 Policy 158 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Nine ■ ■ ■ ■ ■ ■ ■ . Itisimportantthathomelessdruguserscan notonlyaccesstreatment, butthatthetreatment is 4. Theissueofhomelessnessamongdrugusershasimplicationsforcurrent deliveryand 3. sustaining motivation. offering supportaround meeting treatment entrycriteria, stabilising/reducing druguse and the process ofengagingindrugtreatment, bydeterminingthereadiness oftheindividual, Pre-treatment servicesfor homelesspeoplewithdrugandalcoholproblems wouldhelpwith support, aswellpracticalmeasures toencourageattendanceandengagement. accommodation types.Thismayinclude;motivationalinterventions, active,intensiveongoing takes intoaccountpathwaysinandoutofhomelessnessmobilisation across homeless A continuumofcare modelshouldensure acleartreatment route forhomelessdruguserswhich treatment ofhomelesspeopleinamulti-disciplinary, holistic,flexibleandnon-judgmentalway. effective andlinkedintoappropriate aftercare support andhousing.Itisnecessarytoapproach the injectors, suchasrough sleepers. programmes aimedatchanging normsandbehaviouramongsocialnetworksofhomelessdrug Consideration shouldbegiventothedevelopmentofpeereducationandcommunitychange enhance referral andsupportmechanismsfacilitateaccesstomainstream services. Increased coverageofdrug outreach servicestohomelessdrugsusersstayinginhostelswould part ofthesatellitesitelinkingintoabroader rangeofdrugservices. locating serviceswithinanalready familiarenvironment. Liaisonservicesshouldbeanintegral homeless agencies(fore.g.dayservices,hostels)whichwouldseektoincrease accessibilityby Consideration shouldbegiventowards theestablishmentofsatellitedrugserviceswithin as lessstructured programmes withfewerdemands. elimination ofwaitinglistsandtimeintervalsbetweenassessmententryintotreatment aswell for thisclientgroup, suchas, care-planned counselling,flexiblemethadone-prescribing options, Consideration shouldbegiventowards thedevelopmentofmore targeted treatment practices are makingatransitiontodrug-free lifestyle. homeless individualswhoare current, problematic ordependentdrugusersaswellthosewho A broad rangeofaccessible,appropriate andadequatedrug servicesshouldbetargeted at practice couldbeenhancedtoaddress themultiplicityofissueswithinthisgroup. of drugtreatment forhomelesspersonsinIreland. Thefindingssuggestthatdrugserviceand management ofdrugservices.Itisimportanttoincrease theavailability, capacityandeffectiveness and Drugscope(2002)isthatspecialistdrugworkersshouldtrainstaff inusingdrugscreening tools. and possibilitiesofspecialiseddrugworkersinservices.GoodpracticeasidentifiedbyRandall training wasprovided toallstaff inhomelessservices.Homelessservicesshouldreview therole management ofdruguseandserviceprovision. Itwouldbebeneficialifdrugawareness There isanissuearound thelevelofknowledgeamonghomelessservicesinregards to specialists wouldbewelcomed. diagnosis serviceswhichwouldintegratehomelesswithmentalhealthanddrug/alcohol focus ofmentalhealthanddrugservices(HomelessAgency, 2001:140).Thedevelopmentofdual Conclusions andPolicyImplications NACD 2005 Drug Use Among the Homeless Population in Ireland 159 , 2004:7) is foremost. , 2004:7) is foremost. Conclusions and Policy Implications Policy and Conclusions et al. Chapter Nine Chapter Homeless drug users present with a range of needs. Therefore, consideration should be given to consideration should be given a range of needs. Therefore, with Homeless drug users present sleepers, which would for homeless drug users, in particular rough care of respite the provision their difficulties. and encourage them to address life on the streets from a break provide There is a dearth of information regarding good-practice harm reduction strategies in relation to strategies in relation good-practice harm reduction is a dearth of information regarding There drugs different polydrug use. The high risk situation of polydrug use and interactions associated with further development. for in terms of potential health consequences would appear to be an area Policy makers should give consideration as to the extent to which the provision of a supervised to the extent to which the provision Policy makers should give consideration as the needs of homeless would adequately address such as a safe injecting facility, environment, street- hygienic injecting practices to occur and reduce injectors, for example by allowing more based injecting and the experience of fatal overdoses. Street-based risk-reduction strategies, which can minimise the precarious drug-using behaviour, precarious strategies, which can minimise the risk-reduction Street-based for at homeless individuals. Optimal needle exchange coverage and access need to be targeted and service level is essential. The issue of 24-hour access homeless injectors at a local, community pharmacies, (e.g. through for homeless injectors and should be addressed has particular relevance in workers and other mobile services). Sharps bins should also be strategically placed outreach of injecting equipment. the safe disposal and homeless services to ensure public areas There is a need to place greater importance on discharge practices and follow-up care following practices and follow-up care on discharge importance is a need to place greater There a more to ensure programmes) (in particular detoxification and rehabilitation drug treatment Housing needs independent living for homeless drug users. drug-free planned transition to establishing and in addition to methods of process, part of the treatment assessment is an integral support networks. maintaining aftercare harm reduction This study has conveyed the importance of a broad-based drugs issue in Ireland. and training options. Drug use accommodation, support which includes treatment, approach (i.e. the social context in which it occurs. The importance of the ‘setting’ cannot be isolated from place is seen as central drug use takes or contextual factors) in which an individual’s environmental people are homelessness prevails, where 1984). When the setting is an environment (Zinberg, among risky style of drug use than would be commonplace and more to a different predisposed Morris, 1995; Horn, 2001; Cox, 2000). In this regard, the general drug using population (Klee and (Moore groups target tailoring initiatives to the characteristics of 5. which attempt to tackle the of the extensive measures a key feature are strategies Harm reduction ■ ■ ■ ■ ■ 160 Drug Use Among the Homeless Population in Ireland NACD 2005 Chapter Nine ■ ■ ■ Traditionally, servicesforhomelesspeoplewhohavealcohol-related problems havebeen 6. in useandreducing alcohol-related harm. individual andinsuchcases,itisnecessarytoimplementstrategieswhichfocusonmoderation promoted. Aswithdruguse,abstinencemaybeunacceptableasagoalforthehomeless that atargeted alcohol-harmreduction strategyformembers ofthehomelesspopulationis include allsubstancesbothlicitandillicit.Giventheprofile ofhomelessdrugusers,itisimportant commonly referred tointhecontextofillegaldrugs.Harmreduction shouldbeunderstoodto dominated byabstinencemodelsofintervention(Butler, 2003)withharmreduction beingmore reaching them. sleepers drinkinginsidewhere theycangethelp,ratherthanoutonthestreet withnoprospect of on harmreduction. TheRoughSleepersUnitintheUK(1999)statedthatitisbettertohave space inwhichtodrinkandbeoffered supportwhenneededandreferral toservices whichfocus to useconventionalormainstream services.Awetdaycentre wouldgivestreet drinkersasafe Wet daycentres provide afirstpoint-ofreferral andcontactforthosewhoare excludedorunable Dublin thatcanoffer analternativetostreet drinkingpractices, forexample,wetdaycentres. Consideration shouldbegiventowards theestablishmentofafacilityforstreet drinkersin reduction servicestailored tomeettheirneeds. of similarinitiativestargeted atthehomelesspopulationaswelldevelopingotherharm homeless peoplemanagedbyDublinSimonCommunity. Thisresearch supportsthedevelopment promotion inrelation toalcoholuse.To thisendtheSWAHB hasfundedanalcoholdetoxunitfor The ERHA(2003)hashighlightedthehomelesspopulationasaprioritygroup intermsofhealth and aftercare servicesforthoseexperiencinghomelessness. that there isanoverarching objectiveorkeyproposals outlinedforimproving alcoholtreatment the present situationintermsofalcohol-related harmandthosewhoare mostvulnerable.Itisvital It isimportantthattheimplementationofanupdatedNationalAlcoholStrategytakesaccount Conclusions andPolicyImplications rough NACD 2005 Drug Use Among the Homeless Population in Ireland 161 Westview 33(11):2323-2351. 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Tackling HomelessnessinTallaght. Making Room:TheEconomicsofHomelessness Mountjoy Prisoners:ASociologicalandCriminologicalProfile. Occasional PaperNo.5. Rough SleepinginEdinburgh: TheHard Evidence.APilotStudyby Shelter Scotland:Edinburgh. Homelessness andDrugs:AccesstoDrugTreatment. GoodPractice Prevention IsBetterThanCure. Health andHomelessnessinLondon:AReview. Journal ofSubstanceAbuseTreatment. Health Research Board: Dublin. Access toGeneralPracticefor People SleepingRough. Health Research Board: Dublin. London: NationalHomelessAlliance. Clondalkin Partnership:Dublin. Homelessness andProblem DrugUse–Two Tallaght HomelessAdviceUnit:Dublin. DETR: UK. Occasional Paper:No.5. Crisis: London. Blanchardstown Area . USA:Harvard UniversityPress. 17 (1-2),45-66. Homelessness and Routledge: London. London: King’s The Stationery Department NACD 2005 Drug Use Among the Homeless Population in Ireland 171 References 13(5): 21-23. Royal College of Homelessness: DPAS Paper No. 18. DPAS Drug Link. Health and Social Care Health and Social Care 14:4:57-72. Sage: London. Summer 23-27. Paper Presented at Merchants Quay at Merchants Paper Presented The International Journal of Drug 88: 791 – 804. One Hundred Homeless Women: Health Homeless Women: One Hundred 19(10):1457-1467. Addiction: 191:453-457. Youth Studies Australia. Studies Australia. Youth Journal of Addictive Diseases. Addiction Cassell: London. Drug Services for Homeless People; A Good Practice Handbook. Drug Services for Homeless Homes for Street Homeless People: An Evaluation of the Rough Homeless People: Homes for Street Helping Rough Sleepers Off the Streets: A Report to the Homeless the Streets: Off Helping Rough Sleepers Coming In From the Cold: The Governments Strategy on Rough Sleeping. Coming In From British Dental Journal. Doing Qualitative Research: A Practical Handbook. A Practical Handbook. Doing Qualitative Research: 7:1:17-24. DETR: UK. The Needless Tragedy of Opiate Related Deaths. 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(1998) “Keys Rutter, of Southwark”. in the London Borough Rehabilitation of Drug and Alcohol Users London. Home Office: Ryan,(2002) M. 2002. Annual Conference Ireland M. (1993) “Development of De Le Fuente, J.R. and Grant, T.F., Saunders, J.B., Aasland, O.G., Babor, on Early Detection (AUDIT) WHO Collaborative Project Identification Test the Alcohol Use Disorders of Persons with Harmful Alcohol Consumption”. in the Cold: Drugs, Homelessness and Social Exclusion” in (1998) “Out Seddon, T. Drug Users Encouraged (2001) “Dental Health Access – Are Sheridan, J., Aggleton, M. and Carson, T. to Use Our Services?”. Programme Smith, E., North, C., and Fox, L. (1995) “Eighteen Month Follow-Up Data on a Treatment For Homeless Substance Abusing Mothers”. Silverman, D. (2000) Smith, J. (1999) “Gender and Homelessness” in Hutson, S. and Clapham, D. (Ed) Public Policies and Private Troubles. (2001) and Holohan, T. 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Journal of NACD 2005 Drug Use Among the Homeless Population in Ireland 173 1 (please specify) On Site Elsewhere d m y ) dob) (initials, gender, EL F 30041976 (tick as appropriate) (office use only) use (office (write in) Interview Location Date of Interview Start Time of Interview Finish Time of Interview Recruitment Site Consent Form Signed Interviewer Code Survey Questionnaire No. Questionnaire Participant Identifier e.g (complete as appropriate Quantitative Survey Questionnaire – Survey Questionnaire Quantitative Population Homeless Project Research Home Truths Appendix 1 Appendix 174 Drug Use Among the Homeless Population in Ireland NACD 2005 Appendix 1 Other (pleasespecify) Squat Sleeping Rough(streets/parks) Friends/Relatives With B&B Hostel/Shelter Don’t read options D03 Where isthemainplace(4nightsormore) youhavesleptinthepastweek? Don’t Know A Year orMore More than6Months A FewMonths A FewWeeks A FewDays Don’t read options D02 Howlonghaveyoubeingstayingthere? Other Squat Sleeping Rough(streets/parks) Friends/Relatives With B&B Name Hostel/Shelter Don’t read options D01 Whattypeofaccommodationare youcurrently livingin? in theresearch study. isnecessaryinorder toconveyaprofileExplain thatthisinformation ofthosewhoparticipate Section 1–Demographics (please specify) (if possible) Quantitative SurveyQuestionnaire –HomelessPopulation (Tick asAppropriate) (Tick asAppropriate) (Tick asAppropriate) (Tick 2 NACD 2005 Drug Use Among the Homeless Population in Ireland 175 3 (Tick as Appropriate) (Tick as Appropriate) Quantitative Survey Questionnaire – Homeless Population Population – Homeless Questionnaire Survey Quantitative Appendix 1 Appendix years Number of children under 18 Number of children IrelandUK EnglandUK WalesAfricaUSAOther Northern Ireland UK Scotland Other EU Asia Australia D09 Where are you from? you are D09 Where options read Don’t D08 Date of Birth day month year D07 Age D06 Gender 1. Male 2. Female D05 Clients’ Initials * D04 Do you live in this accommodation? D04 Do you live in this Read options Alone Alone with children* and Children* Parents With partner 176 Drug Use Among the Homeless Population in Ireland NACD 2005 Appendix 1 Other ethnicgroup Mixed ethnicgroup Asian Chinese Black Traveller White D10 Howwouldyoudescribeyourethnicbackground? Quantitative SurveyQuestionnaire –HomelessPopulation (Tick asAppropriate) (Tick 4 NACD 2005 Drug Use Among the Homeless Population in Ireland 177 5 Yes No Yes Quantitative Survey Questionnaire – Homeless Population Population – Homeless Questionnaire Survey Quantitative Main Place Other Places (One Response Only) (Multiple Responses Allowed) Appendix 1 Appendix Years Years Months (years) Hostel/Shelter B&B With Friends/Relatives Slept Rough Squat Housing Transitional Other (please specify) H04 Where has been the (main place/other places) you have slept over the past month? H04 Where options read Don’t H03 How old were you when you first became homeless? H03 How old were H02 In terms spell, how long have you been homeless? of your current If No (A) How many times have you been homeless? (B) In your opinion, what would be the longest period you have spent homeless? times Years Months Section 2 – Homelessness Section 2 – experience of homelessness. will ask a few questions about the individual’s State that this section experience of being homeless? H01 Is this your first Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

H05 What do you think were (the main reason/other reasons) for you first becoming homeless?

Don’t read options Main Reason Other Reasons (One Response Only) (Multiple Responses Allowed)

Family Conflict

Relationship Breakdown

Money Problems

Court Order/Notice to Quit

Told to Go by Landlord

Asked to Leave by Family

Evicted from Local Authority

Evicted from Private Rented

Pressure from Local Community

Evicted due to anti-social behaviour

Unfit Accommodation

Overcrowded Accommodation

Leaving Institution/Prison (specify)

Drug Use-Personal

Drug Use-Family

Alcohol Use-Personal Drug Use Among the Homeless Population in Ireland Alcohol Use-Family

Physical Health Problems

Mental/Psychiatric Issues-Personal

Mental/Psychiatric Issues-Family

Domestic Violence

Physical/Sexual Abuse

Other (please specify)

6 178 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

H06 What do you think are the (main reason/other reasons) for you currently remaining homeless?

Don’t read options Main Reason Other Reasons (One Response Only) (Multiple Responses Allowed)

Cannot Access Housing-Local Authority

Cannot Access Housing-Private Rented

Local Authority Will Not Re-House

Money Problems

Family Conflict

Access Denied by Residents’ Committee

Continuing Drug Use Drug Use Among the Homeless Population in Ireland

Continuing Alcohol Use

Lack of Drug Treatment

Lack of Alcohol Treatment

Psychiatric Issues

Others Alcohol/Drug Use

Personal Choice

Other (please specify)

H07 Where was your last permanent address?

If in Dublin (Area or Postcode)

Outside Dublin (Town/City)

H08 Are you currently on a local authority housing list? Yes No

If Yes

(a) Which LA Housing List(s)

(b) Date of entry onto Housing List(s) month year

month year

(c ) When did you last make contact? month year

month year 7 179 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

H09 Have you ever lived in local authority accommodation? (Tick as Appropriate)

Yes No Don’t know

If Yes

(a) Have you ever been asked to leave your housing due to anti-social behaviour?

Yes No

If Yes

(1) By whom?

(2) What type of anti-social behaviour? Drug Use Among the Homeless Population in Ireland

8 180 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

Section 3 – Alcohol and Drug Use This section will deal with the use of alcohol and drugs. Mention to the client that any information provided will be treated with confidence and only used for research purposes. Stress also that if the respondent does not want to answer a question, he/she is not compelled to but that any information provided will be very helpful.

Alcohol Use AD01 Alcohol Use

Show/Read Cards

Never Monthly 2-4/mt 2-3/wk 4+/wk or less Drug Use Among the Homeless Population in Ireland

1. How often would you have a drink containing alcohol? (number of days per week)

If never consumes alcohol (Question 1 above) go to ADO5 page 11

1 or 2 3 or 4 5 or 6 7 to 9 10 +

2. How many drinks containing alcohol do you have on a typical day when you are drinking?

Never Monthly 2-4/mt 2-3/wk 4+/wk or less

3. How often do you have more than 6 drinks on one occasion?

4. How often during the last year have you found that you were not able to stop drinking once you had started?

5. How often during the last year have you failed to do what was normally expected of you because of drinking?

6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

7. How often during the last year have you had a feeling of guilt or remorse after drinking?

8. How often during the last year have you been unable to remember what happened the night before because of drinking? 9 181 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

No Yes, but not Yes, during the in the last year last year

9. Have you or someone else been injured as a result of your drinking?

10. Has a relative or friend, or a doctor or other health worker been concerned about your drinking or suggested you cut down?

AD02 How old were you when you had your first alcoholic drink? (years)

If staying in emergency accommodation (shelters, hostels, B&Bs) answer questions AD03 and AD04

AD03 Are staff aware of your alcohol use? (Tick as Appropriate)

Yes No Don’t know

AD04 Have you ever had any difficulties in accessing accommodation as a result of your alcohol use? (Tick as Appropriate)

Yes No Don’t know

If Yes

What difficulties? Drug Use Among the Homeless Population in Ireland

10 182 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

Drug Use AD05 Have you (ever used/used in the last year/used in the last month) any of the following substances? (Tick as Appropriate)

Lifetime Use Recent Use Current Use (Ever) (Last Year) (Last Month)

Cannabis

Heroin

Other Opiates1 (specify)

Crack Drug Use Among the Homeless Population in Ireland

Cocaine Powder

Amphetamines (i.e speed)

Ecstasy

Sedatives (specify)

Tranquillisers (specify)

Anti-Depressants (specify)

Hallucinogens2

Solvents

Steroids

Other (specify)

1 Methadone, Morphine. DF118 (dihydrocodeine tartrate), Temgesic (buprenorphine), Diconal (dipipanone hydrochloride), Palfium (dextromoramide). 2 LSD, PCP, Magic Mushrooms, Ketamine.

If currently uses none of the above go to Section 4 – Health Status Page 19

11 183 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

AD06 In terms of your current use of drugs [refer to those mentioned above], what is your main route of administration and frequency of use over last four weeks? (Answer as Appropriate)

Route of Frequency of Use Administrationa in last 4 weeksb

Cannabis

Heroin

Other Opiates1 (specify)

Crack

Cocaine Powder

Amphetamines (i.e. speed)

Ecstasy

Sedatives (specify)

Tranquillisers (specify)

Anti-Depressants (specify)

Hallucinogens2

Solvents

Steroids

Drug Use Among the Homeless Population in Ireland Other (specify)

a 1. Intravenous; 2. Intramuscular; 3. Skin-Popping; 4. Smoke; 5. Ingest; 6. Sniff; 7. Don’t Know b 1. 20 days or more; 2. 10-19 days; 3. 4-9 days; 4. 1-3 days

1 Methadone, Morphine. DF118 (dihydrocodeine tartrate), Temgesic (buprenorphine), Diconal (dipipanone hydrochloride), Palfium (dextromoramide). 2 LSD, PCP, Magic Mushrooms, Ketamine.

12 184 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

AD07 What was the first drug you ever used?

AD08 What age were you when you first started using this drug? years

AD09 Did you first start using drugs…

Read options (Tick as Appropriate)

Before Becoming Homeless

After Becoming Homeless Drug Use Among the Homeless Population in Ireland

If staying in emergency accommodation (shelters, hostels, B&Bs) answer questions AD10 and AD11

AD10 Are staff aware of your drug use? (Tick as Appropriate)

Yes No Don’t know

AD11 Have you ever had any difficulties in accessing accommodation as a result of your drug use?

(Tick as Appropriate)

Yes No

If Yes

What difficulties?

13 185 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

AD12

The following questions concern information about your potential involvement with drugs during the last 12 months (i.e. recent or current use).

In the statements “drug abuse” refers to:

1. The use of prescribed drugs or over the counter drugs in excess of the directions;

2. Any non-medical drugs (including cannabis, solvents, tranquillisers, barbiturates, cocaine, stimulants, hallucinogens or opiates).

Please answer every question. If you have difficulty with a statement, then chose the response that is mostly right.

1. Have you used drugs other than those required for medical reasons? Yes (1) No (0)

2. Do you abuse more than one drug at a time? Yes (1) No (0)

3. Are you always able to stop using drugs when you want to? Yes (0) No (1)

4. Have you had “blackouts” or “flashback” as a result of drug use? Yes (1) No (0)

5. Do you ever feel bad or guilty about your drug use? Yes (1) No (0)

6. Do those close to you ever complain about your involvement with drugs? Yes (1) No (0)

7. Have you neglected your family because of your use of drugs? Yes (1) No (0)

8. Have you engaged in illegal activities in order to obtain drugs? Yes (1) No (0)

9. Have you ever experienced withdrawal symptoms (felt sick) when you stopped using drugs? Yes (1) No (0)

10. Have you had medical problems as a result of your drug use? (e.g. memory loss, hepatitis, convulsion, bleeding etc.) Yes (1) No (0) Drug Use Among the Homeless Population in Ireland Total Score

AD13

Show/Read Cards Never or Sometimes Often Always or Almost Never Nearly Always

1. Did you ever think your use of (drugs) was out of control?

2. Did the prospect of missing a smoke/snort/‘turn on’ make you very anxious or worried?

14 186 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

Not at all A little Quite a lot A great deal

3. How much did you worry about your use of (drug)?

Never or Sometimes Often Always or Almost Never Nearly Always

4 Did you wish you could stop?

Not Quite Very Impossible Difficult Difficult Difficult

5. How difficult would you find it to stop or go without (drug)? Drug Use Among the Homeless Population in Ireland

AD14 Did your pattern of drug use change as a result of being “out of home”?

15 187 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

AD15 Have you ever injected drugs? (Tick as Appropriate)

Yes No

If never injected go to Section 4 – Health Status – page 19 If ever injected ask the following:

AD16 What age were you when you first injected?

years

AD17 What was the first drug you injected?

AD18 Have you injected drugs in the last 4 weeks? (Tick as Appropriate)

Yes No

If injected in the last four weeks ask questions AD19 – 26 If client has not injected in the last 4 weeks go to Section 4 – Health Status – page 19

AD19 Do you usually inject yourself?

Read Options (Tick One) Drug Use Among the Homeless Population in Ireland Always

Sometimes

Never

AD20 What is your most common injecting site?

16 188 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

AD21 Do you have difficulty in finding an injecting site?

Read Options (Tick One)

Always

Sometimes

Never

AD22 In what place do you usually inject?

Don’t Read Options (Tick One)

Park

Street Drug Use Among the Homeless Population in Ireland Place of Residence

Home of Friends/Family

Public Toilet

Other (please specify)

AD23 In the last four weeks have you done any of the following?

Read Options (Multiple Responses Allowed)

Shared spoons/filters

Given anyone your injecting equipment

Used others’ injecting equipment

AD24 In the last four weeks how many times, have you used a needle after someone else has already used it?

Don't Read Options (Tick One)

Never

One time

Two Times

3-5 times

6-10 times

More than 10 times

Don’t Know/Unsure

Refused

17 189 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

AD25 Do you usually inject…?

Read Options (Tick One)

Alone

With Others

With Partner

AD26 Has your injecting behaviour changed since becoming homeless? Drug Use Among the Homeless Population in Ireland

18 190 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

Section 4 – Health Status

HS01 Do you currently suffer from any of the following complaints? (Tick if Yes)

1. Physical

Headache

Problems with bones and joints

Eye and Ear Complaints

Foot Problems

Skin Problems

Dental Problems Drug Use Among the Homeless Population in Ireland

2. Chronic Physical Health

Asthma

Bronchitis/Emphysema

Peptic Ulcer Disease

High Blood Pressure

Heart Disease

Rheumatic Disease

Epilepsy

Gastro-Intestinal Tract

Urinary Tract

Diabetes

Tuberculosis

Other

HS02 Have you ever received a Hepatitis B vaccination? (Tick as Appropriate)

Yes No

19 191 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

HS03 Have you ever had a Hepatitis B, C test? (Tick if Yes)

Hep. B

Hep. C

Length of Time Since Last Test? (Hep. B) Years Months

Length of Time Since Last Test? (Hep. C) Years Months

HS04 What is your current Hepatitis (B, C) Status? (Tick as Appropriate)

Don’t Read Options Hep B Hep C

Positive

Negative

Don’t Know

If Positive

(a) Are you currently receiving any treatment? (Tick as Appropriate)

Yes No

(b) If yes, what type of treatment? Drug Use Among the Homeless Population in Ireland

HS05 Have you ever had a HIV test? (Tick as Appropriate)

Yes No

Length of Time Since Last Test? Years Months

HS06 Are you aware of your current HIV status? (Tick as Appropriate)

Yes No Don’t Know

Can volunteer result– otherwise don’t question their status.

20 192 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

HS07 Do you have a current medical card?

Don’t Read Options (Tick One)

Yes, current

Yes, near expiry date

How long ago did you last renew/receive card? years months

Yes, out of date

How long ago did you last renew/receive card? years months

No, can’t get one Why? Drug Use Among the Homeless Population in Ireland No, don’t need one

Process of Applying

HS08 Only if injects

HS08 In the last three months have you experienced any of the following injecting related complaints…?

Read Options (Multiple Responses Allowed)

Abscesses/Infections

Dirty Hit (made feel sick)

Accidental Overdose

Scarring/Bruising

Difficulty Injecting

Mental/Psychiatric Health HS09 Have you ever had any concerns about your mental/psychiatric health? (Tick as Appropriate)

Yes No

If Yes

(a) What concerns?

(b) Have you ever sought help for these concerns? (Tick as Appropriate)

Yes No 21 193 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

In terms of mental health, have you ever…?

Read Options (Multiple Responses Allowed)

Undergone a Psychiatric Assessment

Been Admitted to a Psychiatric Hospital

Been Diagnosed with a Psychiatric Illness

If Diagnosed

(a) Are you currently receiving any treatment for your psychiatric illness?

Yes No

If Receiving Treatment

(b) What type of treatment?

Read Options (Multiple Responses)

Counselling

Prescribed Medication

Community Psychiatric Services

Other Drug Use Among the Homeless Population in Ireland

22 194 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

Section 5 – Income

IN01 Which of the following sources of income do you have?

Read Options (Multiple Responses Allowed)

Regular Employment

Odd Jobs/Occasional Labour (specify)

Government Benefits/ Payments

Relatives/Partner/Friends

Begging Drug Use Among the Homeless Population in Ireland

Criminal Activities

Other (please specify)

IN02 Where do you get most of your money from?

Refer to Options Selected (Main Response)

Regular Employment

Odd Jobs/Occasional Labour

Government Benefits/Payments

Relatives/Partner/Friends

Begging

Criminal Activities

Other (please specify)

23 195 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

Section 6 – Contact with Services

CS01 Have you been in contact with any of the following homeless services within the last month?

Read and/or Show Card (Multiple Responses)

Emergency Accommodation (Hostels, B&B)

Street Outreach Services

Drop-in Centres

Homeless Advice Centres

Food Services

Settlement

Transitional Housing

Day Programmes

Multi-Disciplinary Team

Homeless Persons Unit (James St., Wellington Quay)

Other (specify)

CS02 In your opinion, what attracts you to particular homeless services? Drug Use Among the Homeless Population in Ireland

CS03 Have you ever experienced any difficulties in accessing homeless services?

Yes No

If Yes

What difficulties?

24 196 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

CS04 Have you ever been refused access to homeless services?

Yes No

If Yes

For what reasons?

CS05 How do you think homeless services could be improved? Drug Use Among the Homeless Population in Ireland

CS06 Has other people’s alcohol use ever affected you accessing accommodation?

Yes No

If Yes

In what way?

CS07 Has other people’s drug use ever affected you accessing accommodation?

Yes No

If Yes

In what way?

QUESTIONS CS08-CS12 ONLY APPLICABLE IF SCORED 3 OR HIGHER ON PAGE 12 IF SCORED 0 TO 2 PLEASE GO TO CS13 PAGE 20 25 197 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

CS08 Have you been in contact with any of the following drug services within the last month?

Read and/or Show Card (Multiple Responses Allowed)

Syringe Exchange

Drop-in Centres

Methadone Maintenance

In-patient Detox

Out-patient Detox

Counselling

Outreach

Community Addiction Teams

Residential Drug-Free Prog.

Narcotics Anonymous

Other (specify)

CS09 Have you ever experienced any difficulties in accessing drugs services in general?

Yes No

If Yes

What difficulties? Drug Use Among the Homeless Population in Ireland

CS10 Have you ever experienced any of difficulties in accessing methadone treatment programmes?

Yes No

If Yes

What difficulties?

26 198 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

CS11 How do you think drug services could be improved upon to cater for the homeless?

CS12 What kind of drug services would you like to see exist? Drug Use Among the Homeless Population in Ireland

CS13 Have you had contact with any of the following services/personnel within the last month?

Read Options (Multiple Responses Allowed)

GP Services

General Hospital Clinics

Accident and Emergency Services

Psychiatric Clinic

Community Psychiatric Nurse

Multi-Disciplinary Team

Community Welfare Officers (H.P.U)

Social Worker

Local Authority Office

Gardaí

27 199 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

Section 7 – Assessment of Current Needs

CS14 What would you regard as your main service needs at the moment?

Read Options (Multiple Responses Allowed)

Stable Accommodation

Emergency Accommodation

Counselling/Treatment – Drug or Alcohol

Counselling/Treatment – Mental Health

Employment/Training

Health Care

Legal Services

Support Services/Social Support

Other (please specify)

CS15 In your opinion what do you think is preventing you from accessing these services?

Repeat services provided by respondent Drug Use Among the Homeless Population in Ireland

28 200 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

Section 8 – Background Information

Finally, I would like to ask you a few more questions about yourself:

BI01 What is your highest level of education?

(Tick as Appropriate)

Primary Education or Less

Lower Second Level Education (incl. group/inter/junior cert/GCSEs)

Upper Second Level Education (incl. leaving cert/A levels) Drug Use Among the Homeless Population in Ireland Higher Education (Third Level – Diploma/Degree)

Other (please specify)

BI02 What is your current employment status?

(Tick as Appropriate)

In Part-Time Employment

In Full-Time Employment

FÁS/Training Course

Unemployed*

Unavailable for Work/Disability Allowance

Childcare/Childrearing

Student

Other (specify)

*How long have you been unemployed? Years Months

BI03 Have you ever spent any time in prison?

Yes No

29 201 Appendix 1 Quantitative Survey Questionnaire – Homeless Population NACD 2005

BI04 What is your current legal status at the moment?

(Tick if Yes)

No Legal Trouble

Contact with Probation/Community Services

On Bail Awaiting Trial/Sentencing

Outstanding Warrants

Outstanding Fines

Other (specify)

Thank interviewee for participating in the research.

Signatures to Confirm that Payment (15 Euro) was Provided upon Completion of Interview.

Initials of Interviewee Date

Signature of Fieldworker Date

Any additional information fieldworker may think pertinent

(Record any observations, thoughts, impressions or questions arising from interview) Drug Use Among the Homeless Population in Ireland

30 202 NACD 2005 Drug Use Among the Homeless Population in Ireland 203 7. Level of contact you would have with homeless persons 6. within the organisation role Your 5. persons contact with homeless No. of people who have direct 3. No. of clients per week on average 4. No. of people who work in the organisation 2. within the organisation provided Range of services Part One - Organisational Details Part One - Organisational 1. etc.) hostel in, food centre, (i.e drop service provider of homeless Type Qualitative Interview Guide – Qualitative (Homeless) Service Providers Appendix 2 Appendix Guide – Interview Qualitative (Drug/Homeless) Providers Service 204 Drug Use Among the Homeless Population in Ireland NACD 2005 Appendix 2 .Whatwouldyousayare theparticularchallengesinworkingwithhomelessindividualswhoare 1. Part Three –RespondingtoDrugUseamongtheHomeless Describethedegree ofknowledgeandtrainingwhichexistsamongtheserviceworkersregarding 7. Inyouropinion,whatisthenature oftherelationship betweendruguseandhomelessness? 6. To whatextentdoesthedrug-usingstatusofclientsinfluence servicedelivery? 5. Howdohomelessdrugusersdiffer from other homeless peoplewhouseyourservice? 4. Whatdrugsdotheyuse? 3. Describetheproportion ofyourclientswhoare usersofillicitdrugs. 2. Describetheproportion ofyourclientswhoare alcoholusers. 1. Part Two –Profile ofServiceUsers:Characteristics&Circumstances .Anydifficulties inworkingwithotherorganisations. [Elaboration:professional/organisational 7. Inyouropinion,what wouldyouseeasthemainbarrierstowards cateringfortheneedsofthis 6. Inwhatareas doyouthinkservicescouldbeimproved tocaterforthemultipleneedsofhomeless? 5 Whatisthenature oftherelationship youwouldhavewithdrugserviceproviders? 4. Whatare theweaknessesinlocalserviceprovision forhomeless/homelessdrugusers? 3. Whatare thestrengths inlocalserviceprovision forhomeless/homelessdrugusers? 2. Whatservices,ifany, are provided locallyforhomelessdrugusers? 1. Part Four–ServiceNeedsofHomelessPeople Describeanyareas ofgoodpracticewhichyourorganisation currently operates,orhasoperated 10. Describeanyparticularproblems yourorganisation hasexperiencedregarding serviceprovision 9. Whatrecords doyoukeepofincidentswithdrug-related issues? 8. Underwhatcircumstances wouldhomelessdrugusersbeexcludedfrom yourservice? 7. Describetherangeandlevelofsanctionswhichyoucurrently employ 6. Howdoesyourorganisation respond tovariousdrug-related issues[Elaborate: druguseonthe 5. Describethepoliciesyourorganisation hasinrelation todrugissues. 4. Doesyourorganisation operateanypolicieswithregards toalcohol/drug use? 3. Whatsupport/servicesdoyouoffer tohomelessdrugusers? 2. drug users? drug use. barriers, different obligations, longerdurationofmulti-agencywork]? client group? in thepast,tocaterforneedsofhomelessdrugusers. for homelessdrugusers. premises, drugpossession/dealing etc]? Qualitative InterviewGuide–ServiceProviders (Drugs/Homeless) NACD 2005 Drug Use Among the Homeless Population in Ireland 205 Qualitative Interview Guide – Service Providers (Drugs/Homeless) Providers – Service Guide Interview Qualitative Appendix 2 Appendix 7. Level of contact you would have with drug users 6. within the organisation role Your 4. No. of people who work in the organisation 5. contact with drug users No. of people who have direct 3. No. of clients per week on average 1. service etc.) residential (i.e needle exchange, methadone programme, service provider of drug Type 2. within the organisation provided Range of services Part One – Organisational Details Part One – Organisational Qualitative Interview Guide – Qualitative (Drugs) Service Providers 206 Drug Use Among the Homeless Population in Ireland NACD 2005 Appendix 2 .To whatextentdoyoufeeldrugserviceswithinthelocalitymeetneedsofuserswhoare 2. Whatisthenature of therelationship youwouldhavewithhomelessserviceproviders? 1. Part Four–ServiceNeedsof“Out-of-Home”DrugUsers Howdoesyourorganisation respond totheissueofhomelessnessamongclientswithineveryday 1. Part Three –Providing Servicesto“Out-of-Home”DrugUsers Howdohomelessdrugusersdiffer from otherdrugusersintermsoftheirneedsand 2. Whatproportion ofyourclientsishomeless? 1. Part Two –Profile ofServiceUsers:CharacteristicsandCircumstances .Howcoulddrugserviceprovision ingeneralbeimproved tocaterfortheneedsofhomeless 4. Are there anyparticulargapsinserviceprovision whichyoufeelwould bebeneficialinhelpingyou 3. Inyouropinion,towhatextentdoesaclient’s homelessstatusimpactontheiraccessto,and 5. Whatare theweaknessesofyourserviceindealingwithhomelesspeople? 4. Whatare thestrengths ofyourservice indealingwithhomelesspeople? 3. Doyouhaveanyservicesthatspecificallytarget homelessdrugusers? 2. Describethedegree ofknowledgeandtrainingwhichexistsamongtheserviceworkersregarding 4. To whatextentdoesthehomelessnessstatusofclientsinfluenceservicedeliverytoclients? 3. homeless? service practices? characteristics? drug users? to meettheneedsofhomelessdrugusers? retention in,drugtreatment? homelessness andrelated issues? Qualitative InterviewGuide–ServiceProviders (Drugs/Homeless) NACD 2005 Drug Use Among the Homeless Population in Ireland 207 208 Drug Use Among the Homeless Population in Ireland NACD 2005