Homeless women’s service use, barriers, and motivation for participating in substance use treatment

ABSTRACT

Background: Homeless women are at high risk for substance use disorder (SUD), and are a growing proportion of the homeless population. However, homeless women experience barriers to engaging in substance use services. Objectives: Among homeless women with SUD, to explore service use, motivation to change, service barriers, and willingness to have substance use and mental health problems addressed in primary health care. Methods: Women with SUD were sampled from 11 Health Care for the Homeless (HCH) primary care clinics in 9 states, yielding 241 with either an alcohol or drug use disorder who then completed questions about SUD services. Results: Over 60% of women with dual alcohol and drug use disorders used some type of SUD service in the past year, while 52% with a drug only disorder, and 44% with an alcohol only disorder used services. The most mentioned barrier to service use was depression, but cost, wait time, where to find treatment, and facilities located too far away, were also frequently noted. A large proportion across all groups indicated high motivation for treatment and willingness to discuss their SUD in a primary care setting. Conclusion: There are continued barriers to SUD service use for homeless women despite high motivation for treatment, and willingness to be asked about SUD and mental health problems in primary care. HCH primary care sites should more systematically ask about SUD and mental health issues and address women’s expressed need for support groups and alternative therapies to more holistically address their SUD needs.

KEYWORDS:

• Women
• homelessness
• substance disorders
• services
• barriers

Acknowledgments

This work was supported by the National Institute of Alcohol Abuse and Alcoholism, Grant # R21AA020871. The research methods, results, and conclusions are solely the responsibility of the authors and not the funding source. The authors wish to thank the work of Research Associates from both the National Health Care for the Homeless Council (Claudia Davidson, MPH and Molly Meinbresse, MPH) and the Department of Family Medicine and Community Health at the University of Massachusetts Medical School (Elizabeth Lawson, BA and Kate Sullivan, BA) for their coordination and data management work. We also wish to thank the leadership, data collection staff and volunteers, and the patients, from the 11 participating HCH sites for contributing to the conceptualization, and implementation of the study, and for meeting all data collection goals. These sites were: Mercy Care, Atlanta Georgia; Care Alliance, Cleveland OH; Health Care for the Homeless, Houston TX; Duffy Health Center, Hyannis, MA; JWCH Institute, Los Angeles CA; Catholic Medical Center/Health Care for the Homeless, Manchester NH; Contra Costa County Health Services, Martinez CA; Care for the Homeless, NYC; Charles Drew Health Center, Omaha NE; Maricopa County Health Care for the Homeless, Phoenix AZ; and Health Care for the Homeless/Mercy Health Center, Springfield MA.

Declaration of interest

Financial Disclosures: The authors report no relevant financial conflicts.

Funding

This work was supported by the National Institute of Alcohol Abuse and Alcoholism, Grant # R21AA020871.

Additional information

Funding

This work was supported by the National Institute of Alcohol Abuse and Alcoholism, Grant # R21AA020871.