Approach To Homelessness

A PUBLICATION OF THE HCH CLINICIANS’ NETWORK

HEALING HANDS
Vol. 7, No. 5
I

October 2003

A BIMONTHLY PUBLIC ATION

A Comprehensive Approach to Substance Abuse and Homelessness
For many individuals, substance abuse and homelessness are inextricably intertwined. Indeed, substance use is often both a precipitating factor and a consequence of being homeless. 1 Further, individuals who are homeless rarely have substance use disorders alone—many have serious mental illnesses, acute and chronic physical health problems, and histories of trauma. They require safe and appropriate housing, multiple interventions, and client-centered care, as the following series of articles attest.

R

address their tangible needs for housing, income,…show more content…
Indeed, a lot of what happens under the rubric of harm reduction for homeless people with substance use disorders involves meeting their immediate subsistence needs. “When they are rested, fed, and cleaned up, they are in better shape to make decisions about their life,” McCague says. This approach is backed by research, which indicates that people are more likely to accept treatment once their basic needs have been met.12 A safety-first approach is critical for homeless adolescents, according to Eliza Gibson, LCSW, Manager of Mental Health and Substance Abuse Services for Larkin Street Youth Services in San Francisco. “I’d much rather have a kid who is high on heroin sleeping in the shelter than in the park,” she says. When an adolescent is safe and the staff has earned his or her trust, together they can begin to work on some of the larger issues that underlie substance abuse. The skills of motivational interviewing can move an adolescent in the direction of change, Gibson says. Proponents of both harm reduction and abstinence are alike in their respect for the individual and the choices he or she makes. “They [clients] have to make the decision whether or not to use,” notes David Eisen, MSW, a licensed acupuncturist and doctor of oriental medicine who is Director of the abstinence-based Portland Alternative Health Center in Portland, Oregon. “All we can do is offer them…show more content…
After a week he returned to detox. Mr. Sanchez admitted he Primary care providers who work with homeless people treat medhad tested positive for HIV in prison 10 years earlier and confided ical problems directly related to that he had recovered from numerous bouts of PCP. Primar y care substance abuse, such as was arranged at St. Vincent’s Depar tment of Community Medicine’s Because most homeless women HIV/AIDS and hepatitis C. Ryan White Clinic. Mr. Sanchez stayed on respite at BRC for 1 1/2 have been victims of violence, However, Horn points out that months. He was placed in housing by the Depar tment of AIDS their substance abuse may be because many homeless people Ser vices while waiting for a bed in a long-term substance abuse viewed as an “adaptive and reasonlack regular medical care, he and able response to serious trauma,” treatment center. “BRC’s done a great job for me,” Mr. Sanchez says. physician Mira Batra, MD, often Dr. Weinreb says. Behaviors that uncover medical problems—rang“My intention was always to get high. Right now, I don’t have a providers view as “resistant” can ing from urinary tract infections desire to get high. Now I want to get my health stable, my recover y, often be reframed as an effective to cancer—that have not been and maybe, just enjoy what little life I do have with my family.” coping stategy. “We have to attended to or diagnosed. Many understand women’s behavior and * Mr. Sanchez has given written permission for his name and his