Environmental and psychosocial influences on substance abuse among homeless adults

Within the population of homeless people, there are substantial variations in severity and histories of homelessness, housing quality, and seriousness of co-occurring psychosocial problems. Finding variations in direct and indirect influences of salient psychosocial and situational variables on problem substance use among homeless people is important in designing evidence-based, effective, and relevant interventions for this special population. A stress-coping paradigm in conjunction with situational items specialized for homeless people explored predictive relationships among psychosocial variables of self-esteem, social support, positive and negative coping, and emotional distress, situational variables of severity of homelessness history and quality of recent housing, and outcomes of alcohol use, injection drug use (IDU), and non-IDU in a sample of homeless adults in Los Angeles County (N = 664). Lower self-esteem predicted greater emotional distress, lower positive coping, greater negative coping, and more alcohol use. Social support predicted less emotional distress, and more positive coping. Even within this sample of people who were all categorized as homeless, greater severity of homelessness was negatively associated with positive coping, predicted more emotional distress, and impacted both Alcohol Use and IDU, highlighting the well-known problem of substance abuse among the chronically homeless. Furthermore, residing in the poorest quality housing directly predicted more alcohol use and more IDU. Substance abuse interventions among the homeless should have a dual focus that includes attention to psychological issues and negative coping patterns while also addressing situational, environmental factors including encouraging provision of adequate and permanent supportive housing and financial supports.