Alcohol and other drug use, and homelessness

Homelessness in Australia has been steadily rising in recent years with reports showing that roughly 105,237, or 1 in 200 Australians are currently homeless on any given night.¹ This is a 4.6% increase on the 2011 census data²

What is homelessness?

Many people think of homelessness as referring to those who don’t have a roof over their heads, or are ‘sleeping rough’. But the issue is much more complex. While people living on the streets is perhaps the most common visual form of homelessness, the Australian Bureau of Statistics³ defines a homeless person as someone who ‘does not have suitable, long term accommodation options’.

This broader definition encompasses a much higher percentage of the population and includes people residing in temporary or emergency accommodation, refuges and boarding houses, as well as people sleeping on couches and in cars.⁴

The contributing factors

As with many other social issues, there is no one definitive factor that leads to a person becoming homeless. But data regularly demonstrates a strong link between homelessness and other social vulnerability factors, such as:

• domestic and family violence
• financial hardship
• economic and social exclusion and isolation
• housing affordability and availability
• unemployment
• chronic health including mental health issues
• alcohol and other drug-related issues.¹

The co-existence of these factors often leads to individuals having to deal with a range of complex and persistent challenges. The complexity of these challenges means that we need to take a multi-pronged approach to solving them.⁵

The evidence

Data from the evaluation of the Kings Cross Medically Supervised Injecting Centre (MSIC) supports this, with roughly 30% of people who use the facility reporting unstable accommodation – highlighting the over-representation of homelessness in the injecting drug using population in NSW.⁶ This has been further shown in a 2014 survey of 1,500 homeless people, which indicated 57% of this population consumed alcohol at risky levels, 39% had used illicit drugs and 7% had injected drugs.⁷

Similarly, a four-year study conducted by the Australian Institute of Health and Welfare (AIHW) between 2011-2014 found there were significant crossovers in people using AOD-related health services and those using homelessness services. This study also found that 77% of this population were experiencing other vulnerabilities. This includes domestic violence, being underage, being over 66-years-of-age, or experiencing mental illness, fifty-one percent of homeless people in this study also presented with a mental health issue.⁵

While AOD use has been shown to contribute to homelessness, the reverse is also true. And in fact, that the longer a person is homeless, the more likely they are to use drugs or consume alcohol at risky levels.⁷

More research needed

Many of these reports push for more rigorous collection of data within the homeless population, as much of the current insight into the issues present in this population is based on small-scale studies of predominately rough-sleeping homeless people. More rigorous data collection will help to establish the influence that social vulnerabilities such as substance use and homelessness have on each other, and the persistent nature of poverty more generally.⁷

Opportunity to enhance primary prevention

While it’s important to understand the connections between social vulnerabilities from a treatment angle, as the above reports have, it may also be valuable to look at the possible links between risk factors that lead to the development of these vulnerabilities as this work could enhance the impact of primary prevention programs and mitigate the development of co-existing social vulnerabilities in individuals.

Social risk factors, primary prevention and AOD use

Preliminary research has begun to investigate the impact of significant social risk factors (such as social isolation and social exclusion) on the brain function of otherwise healthy people. Findings indicate that an area of the brain called the Insula is impacted by exposure to these social risk factors.

This, together with the fact that the Insula has previously been identified as playing a key role in the development and progression of substance dependence,⁸ has important potential in the area of primary prevention, as an individual’s capacity for social integration and rational decision-making are key factors protecting against AOD use, social exclusions and homelessness.⁸

In short, primary prevention programs that focus on socialisation, resilience, and the development of empathy, particularly in young people, appears increasingly likely to be beneficial in mitigating a range of social vulnerabilities, including alcohol and other drug-related issues.