The Individual and Beyond: A Socio-Rational Choice Model of Service Participation Among Homeless Adults with Substance Abuse Problems

Abstract

While substance user service programs can help homeless adults solve their substance use and housing problems, relatively few needy individuals use and complete these programs. The lack of participation is poorly explained by typical empirical studies, most of which consider the role in service participation of various personal traits and client problems. The current article instead seeks to explain service participation through the application of an alternative, “socio-rational choice” model. This model has three premises:

• Clients weigh the costs and benefits of participating in services against alternative uses of their time and resources.

• The clients’ weighing procedures reflect their personal situations and perceptions of the treatment environment.

• The perceptions of their personal situations and perceptions of the treatment environment are affected by the manner in which clients react to representatives of service systems, members of their social network including both housed and homeless persons, and other individuals.

Secondary evidence supports many of the model's hypotheses and generally suggests that homeless clients may be heavily affected by their experiences with individuals and systems with which they come into contact.

• Service participation
• Homelessness
• Substance user treatment
• Rational choice models
• Sociological models of service participation
• Health service utilization
• Disaffiliation
• Domiciled

Notes

Relatively few works examine the availability of services (Booth et al., [2000]; Fortney et al., [1995]; George and Tucker, [1996]) or the role of organizational factors (McCaughrin and Price, [1992]).

Another common criticism (Becker and Maiman, [1975]) is that traditional studies focus on social problems and demographic traits that are relatively enduring, not easy to change, and thus do not help to suggest how to improve service use.

One traditional view argues that the strongest predictors of health use across studies are barriers to action, that is, perceptions that services are inconvenient or uncomfortable. The weakest is the perceived seriousness of the disease, which is similar to the type of variables examined in research on homelessness (Becker and Rosenstock, [1984]).

See LaVeist ([1994]) for a critique of the way in which race is conceptualized in many health research studies.

This may reflect that indices tapping belief statements, which are the only conceivable way of proceeding, fail to measure what might be only semiconscious motivations and the decision-making process that they involve.

North and Smith ([1992]) found that although homeless men and women in their study listed lack of insurance as a barrier to care, there was no relationship between actually having insurance and receipt of mental health or substance-user tratment. Only small percentages of North and Smith's sample of 900 homeless individuals cited factors such as not knowing where to go for treatment (4%), lack of transportation (9%), lack of time (6%), and having to wait too long to see a doctor (3%), as reasons for not receiving treatment. Scholossstein et al. ([1991]) similarly note that no sample members in their study of homeless women who were referred to services mentioned inability to pay or lack of access as a barrier.

All this implies that it is theoretically possible to increase service participation by organizing services in a helpful way. However, this may not be simple. For example, the limits to availability may depend on large, politically-based and difficult-to-alter decisions concerning how to set up a network of substance use services.

Additional information

Notes on contributors

Michael R. Sosin

Michael R. Sosin, Ph.D., is Emily Klein Gidwitz Professor at The School of Social Service Administration, The University of Chicago. He is affiliated with many research institutes and also edits Social Service Review. His research generally concerns the interactions between social institutions and the poor. He currently is studying substance abuse managed care, service integration programs for adults with substance use problems, and the role of religion in nonprofit organizations.

Susan F. Grossman

Susan F. Grossman, Ph.D., is an assistant professor of social work at Loyola University Chicago School of Social Work. Prior to coming to Loyola, Dr. Grossman was the director of research for a federally funded national program evaluation of gang youth, and project coordinator for a NIAAA demonstration project evaluating interventions for homeless persons with substance-use problems. She has been involved in conducting research and writing articles related to services for such disenfranchised populations as victims of domestic violence and homeless individuals with mental health and substance use problems.