Social context of homeless men's substance use

Purpose: Homeless men may be at particular risk for the negative effects of substance use. This cross-sectional study investigates individual and social risk factors for substance use in this vulnerable population. Data & Methods: Participants were a representative probability sample of 305 heterosexually active homeless men interviewed from meal programs in the Skid Row region of LA. Interviews assessed individual, personal network, and substance use characteristics. Logistic regression examined individual and network-level predictors of the most prevalent substances. Results: In the past 6 months, the 3 most prevalent substances were marijuana (56%), crack (40%), and alcohol to intoxication (38%). Mental health status was associated with substance use, with depression more likely among binge drinkers (OR=1.97; 95% CI=1.04, 3.75) and PTSD more common among those who used crack (OR=3.26; 95% CI=1.62, 6.58). Riskier networks (comprised of a larger proportion of drug users) were associated with marijuana use (OR=8.00; 95% CI=2.44, 26.17), and normative social ties (family or school/work) were associated with a decreased likelihood of crack use (OR=0.04; 95% CI=0.00, 0.52; OR=0.05; 95% CI=0.00, 0.49, respectively). Conclusion and recommendations: Mental health problems and riskier personal networks are associated with homeless men's substance use. These findings underscore the importance of interventions that focus on: mental health, mitigating the drug-using norms of personal networks, and helping men to maintain contact with normative, low-risk alters. Mental health care and peer-based, network interventions to reduce substance use should be a priority for homeless men.