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

• Published in: The American journal of drug and alcohol abuse 2018-01, Vol.44 (2), p.252-262
• Main Authors: Upshur, Carole C., Jenkins, Darlene, Weinreb, Linda, Gelberg, Lillian, Orvek, Elizabeth Aaker
• Format: Article
• Language: English
• Subjects: Adult; Alcohol; Alcohol use; Alternative medicine; Barriers; Clinics; Drug abuse; Drug use; Female; Females; Health problems; Health Services Accessibility; High risk; Homeless people; homelessness; Humans; Ill-Housed Persons - psychology; Medical treatment; Mental disorders; Mental health; Mental health care; Mental health services; Middle Aged; Motivation; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Primary care; Primary Health Care; services; Substance abuse treatment; substance disorders; Substance use disorder; Substance-Related Disorders - psychology; Support groups; Willingness; Women; Womens health
• ISSN: 0095-2990; 1097-9891
• DOI: 10.1080/00952990.2017.1357183

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.