Get access

Does experiencing homelessness affect women's motivation to change alcohol or drug use?

Authors

  • Carole C. Upshur EdD,

    Corresponding author
    1. Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts
    • Address correspondence to Dr. Upshur, Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Ave. North, Worcester, MA 01655. E-mail: carole.upshur@umassmed.edu.

    Search for more papers by this author
  • Linda Weinreb MD,

    1. Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts
    Search for more papers by this author
  • Debbie M. Cheng ScD,

    1. Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
    2. Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, Massachusetts
    3. Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts
    Search for more papers by this author
  • Theresa W. Kim MD,

    1. Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, Massachusetts
    2. Boston Health Care for the Homeless Program, Boston, Massachusetts
    Search for more papers by this author
  • Jeffrey H. Samet MD, MPH,

    1. Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, Massachusetts
    2. Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
    Search for more papers by this author
  • Richard Saitz MD, MPH

    1. Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, Massachusetts
    2. Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
    Search for more papers by this author

Abstract

Background and Objectives

Homeless women are at high risk of drug and alcohol dependence and may receive less opportunity for treatment. Our objective was to examine the association between experiencing homelessness and motivation to change drug or alcohol use.

Methods

Women (n = 154) participants in a study of substance dependence at an urban medical center (69 with some homeless days in the last 90 days; 85 continuously housed at baseline) completed six items rating motivation to change alcohol or drug use (ie, importance, readiness, and confidence) at baseline and in 3-, 6-, and 12-month follow-up interviews. Unadjusted and longitudinal analyses controlling for covariates (eg, demographics, insurance status, substance use consequences, mental health status, and participation in treatment) were conducted.

Results

There were no significant differences between women experiencing homeless days versus continuously housed women in the odds of reporting high motivation to change alcohol or drug use, either in unadjusted baseline analyses or longitudinal analyses adjusted for covariates. Covariates that were significantly associated with high importance, readiness or confidence to change behavior were higher life time consequences of substance use, and participation in 12-step programs.

Discussion and Conclusions

The findings suggest that clinicians should not make assumptions that homeless women have low motivation to change their substance use.

Scientific Significance and Future Directions

The same opportunities for addiction treatment should be offered to homeless as to housed women. (Am J Addict 2014;23:76–83)

Ancillary