Content Analysis of Advantages and Disadvantages of Drinking Among Individuals With the Lived Experience of Homelessness and Alcohol Use Disorders

ABSTRACT

Background: Alcohol use disorders (AUDs) are more prevalent among people who are homeless than in the general population. Thus, homeless individuals experience disproportionately high levels of alcohol-related problems and associated publicly funded criminal justice and healthcare system utilization. Available treatment services, however, are not effective at engaging and treating this population. To better tailor treatment services to their needs, it is imperative we understand this population's perceptions of their alcohol use. Objectives: The aim of this study was to provide description and relative rankings of the advantages and disadvantages of alcohol use from this population's perspectives. Methods: Participants were 44 individuals with lived experiences of AUDs and homelessness who received services at community-based agencies in Seattle, Washington. Open-ended prompts were used in interviews conducted in 2013–2014 to assess the perceived role of alcohol in participants’ lives, including participants’ perceptions of the advantages and disadvantages of their current drinking, and a conventional content analysis was conducted. Results: The most frequently mentioned advantages of drinking included positively and negatively reinforcing psychological reasons, perceived control over drinking, and social benefits. Physical effects, concerns about dependence on alcohol, and health problems were the most commonly mentioned disadvantages. Conclusions/importance: By documenting the perceived advantages and disadvantages of drinking among people with the lived experience of homelessness and AUDs, this study supplies information providers may use to better tailor treatment services to this multimorbid, high service-utilizing population's needs and interests.

KEYWORDS:

• Advantages and disadvantages of alcohol use
• homelessness
• alcohol use
• qualitative analysis
• content analysis

Acknowledgments

This research was supported by grants from the National Institute on Alcohol Abuse and Alcoholism to Susan E. Collins (R34AA022077) and Seema L. Clifasefi (K01AA021147). The authors thank Gail Hoffman and Nicole Torres for their help managing the study data.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Glossary

•	Homelessness: As defined in the McKinney-Vento Homeless Assistance Act, homelessness is lacking a fixed, regular and adequate nighttime residence; having a primary nighttime dwelling that is not a regular sleeping accommodation; living in a supervised shelter or transitional housing; exiting an institution that served as temporary residence when the individual had previously resided in a shelter or place not meant for human habitation; or facing imminent loss of housing when no subsequent residence is identified and insufficient resources/support networks exist.
•	Alcohol use disorders (AUDs): AUDs are conditions characterized by craving/urges, a pattern of compulsive alcohol use, the harmful consequences of repeated alcohol use, and sometimes, physiological dependence on alcohol (i.e., tolerance, withdrawal).
•	Conventional content analysis: A qualitative research method used to interpret the content of text data through a systematic classification process involving coding and identifying themes. In conventional content analysis, the researcher does not start with preconceived, theory-based notions about what kinds of codes or categories of codes will be found. Instead, the researcher allows the data to drive the codes and categories.