Presentation given by Joe Doherty, Iain Atherton and Maria Stuttaford, University of St Andrews, Scotland at a FEANTSA Research Conference on "Rethinking Homelessness Policies", Lisbon, Portugal, 2007

1. Centre for Housing Research
University of St Andrews
Housing status, social support
networks and substance misuse
Dr Iain Atherton
Dr Maria Stuttaford
Professor Joe Doherty

2. Overview
• Research question
• Methods
• Results
• policy implications

3. Housing ready vs Housing First
• Housing Ready
1.Substance misusing/mental health
2.Once stabilised, then house
• Housing First (Tsemberis et al, 2004)
1.Housing
2.Services available - no compulsion

4. Outcomes of Housing First
• Outcomes
– Higher service use
– Stability of accommodation
– Declining drug use for those with co-
morbidities
– Greater service engagement (though
proportions substance misusing largely
unchanged)

5. What’s missing?
Stable housing Substance use
Social networks

6. Social networks
• Positives
– Friendship
– Practical support
• Negatives
1. Initiation of substance misusing
2. Perpetration of substance misusing
3. Prevention of exit from substance misusing

7. Methods
• Small scale longitudinal qualitative study –
– 11 participants
– 22 in-depth interviews
– recruitment through service providers/drop in
centres
– Interviews attempted every 4-5 weeks
– Participatory observation of hostels/service
providers

9. Findings:
(1) Initiation of substance use

10. Interviewee
• Alix
• Age – early 30s
• Housing status
– Currently in stable accommodation on
methadone
– Previously homeless and using heroin

11. [I started using heroin] cause I’d let one of my
friends stay with me… because they’d nowhere
else to stay …and I’d never seen it before in my
life…didn’t ever want…to…be anywhere near it,
but because, well I let my friend stay, they
brought it into my house and then it was like, just
try this, so I tried it and then… you end up with a
habit …so that’s how I ended up using.

12. [I started using heroin] cause I’d let one of my
friends stay with me… because they’d nowhere
else to stay …and I’d never seen it before in my
life…didn’t ever want…to…be anywhere near it,
but because, well I let my friend stay, they
brought it into my house and then it was like, just
try this, so I tried it and then… you end up with a
habit …so that’s how I ended up using.

13. Findings:
(2) Perpetuation of substance
using

14. Interviewee
• Matt
• Age – late 20s
• Housing status
– Homeless (living with friends)
• Substance misusing – regularly using
heroin

15. Right, well, I stay with a friend just noo… em…I
get up in the morning, well I get wakened up in
the morning with my friend, and he’s got a…
handing me a needle wi’ kit in it, ken, for ma’…
breakfast really…

16. Right, well, I stay with a friend just noo… em…I
get up in the morning, well I get wakened up in
the morning with my friend, and he’s got a…
handing me a needle wi’ kit in it, ken, for ma’…
breakfast really…

17. Interviewee
• David
• Age – mid-30s
• Housing status
– Hostel
• Substance misuse
– Currently not using heroin after years of use

18. [I share a flat] up the stair, with two other people.
And one, two in fact are drug users. With me
trying to come off drugs…it’s in my face all the
time, ken what I mean…basically. Ninety
percent of people in here use. They either do
drugs or drink, one of the two…don’t think there
is a straight person in here.

19. [I share a flat] up the stair, with two other people.
And one, two in fact are drug users. With me
trying to come off drugs…it’s in my face all the
time, ken what I mean…basically. Ninety
percent of people in here use. They either do
drugs or drink, one of the two…don’t think there
is a straight person in here.

20. Notes from an interview
• Elspeth
• Service Provider

21. Geography figures prominently at one point in
our conversation. Without any prompting, [The
service provider] suddenly claims that nobody
will cease substance misuse whilst continuing to
live in their home town, especially in the [ex
mining community] area.
“…its too hard remaining in the same community
[to stop drug using]”

22. Geography figures prominently at one point in
our conversation. Without any prompting, [The
service provider] suddenly claims that nobody
will cease substance misuse whilst continuing to
live in their home town, especially in the [ex
mining community] area.
“…its too hard remaining in the same community
[to stop drug using]”

23. (3) Prevention of exit

24. Elspeth the service provider-
Such a strategy [relocating] is not always
successful; she quotes an example where the
individuals concerned linked into new local drug
networks. Similarly, relocating is difficult where
a person cannot access drugs, something that
would enforce immediate stopping; a step that
would be problematic and is often counseled
against.

25. Elspeth the service provider-
Such a strategy [relocating] is not always
successful; she quotes an example where the
individuals concerned linked into new local drug
networks. Similarly, relocating is difficult where
a person cannot access drugs, something that
would enforce immediate stopping; a step that
would be problematic and is often counseled
against.

26. David-
[my treatment officer] gives me a weekly bus
pass…to get me out of here, because I’ve told
them what its like here. To get me out so I’m not
in a position to get drugs, you know what I
mean.

27. David-
[my treatment officer] gives me a weekly bus
pass… to get me out of here, because I’ve told
them what its like here. To get me out so I’m not
in a position to get drugs, you know what I
mean.

28. Interviewee
• Paul
• Age – mid-30s
• Housing status
– Recently made homeless – now in hostel
• Substance misusing
– Drug free for two months

29. Iain- …would you have been able to get away from
drugs without making that move?
Paul- Nuh. [said without any hesitation and quite
assertively]…
Iain- What would have happened if you hadn’t been
evicted but you still got all this support?
Paul- …I reckon I would have still been the same,
because I don’t think I’ve got the strength to say to my
mates, beat it, your no coming back here, ken sort of
like… I don’t know why because they are my mates but
at the end of the day they’re, they’re no ma mates if you
know what I mean, ken because basically they’re using
ma house as somewhere to have a jag…I don’t think I’d
be able to do it maself…but with the support that I’ve
got…been able to move, get a change of life, you know.

30. Iain- …would you have been able to get away from
drugs without making that move?
Paul- Nuh. [said without any hesitation and quite
assertively]…
Iain- What would have happened if you hadn’t been
evicted but you still got all this support?
Paul- …I reckon I would have still been the same,
because I don’t think I’ve got the strength to say to my
mates, beat it, your no coming back here, ken sort of
like… I don’t know why because they are my mates but
at the end of the day they’re, they’re no ma mates if you
know what I mean, ken because basically they’re using
ma house as somewhere to have a jag… I don’t think I’d
be able to do it maself…but with the support that I’ve
got…been able to move, get a change of life, you know.

31. Policy
• Prevent homelessness
• Assisting with daily geographic mobility
• Geographically sensitive housing
programmes
– Caution with hostel use (Wright et al. 2005)
– Location of re-housing
• Relocation?

32. Conclusion
Housing First might have more effect if
linked to helping people to rebuild their
social networks