Homeless Women With Children:The Role of Alcohol and Other Drug Abuse

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For some women with children, alcohol and other drug use may be an important risk factor for homelessness be- cause it may interfere with a woman’s capacity to compete for scarce resources such as housing, employment, or ser- vices. The impact of various policy decisions on homeless women, their dependent children, and the family unit is considered, including women’s right to privacy, crim- inalization of drug use, and scarcity of appropriate treat- ment programs for homeless women.

Homeless families are a heterogeneous population, and the causes of family homelessness are multiple and in- teractive (McChesney, in press; Weitzman, Knickman, & Shinn, 1990; Wood, Schlossman, Hayashi, & Valdez, 1989). The most accurate and comprehensive depiction of homeless women with children and the risk factors for their homelessness is essential for the design of adequate programs and services to prevent or alleviate homelessness in this population.

Often, descriptions of the individual characteristics of homeless persons, such as alcohol- or other drug-related problems, have been inappropriately interpreted as ex- planations of their homelessness. On one hand, such sim- plistic explanations tend to ignore or minimize structural or environmental factors that influence the extent and course ofhomelessness (Hopper, 1990). Principal among these are the crisis in affordable housing, reduced social welfare benefits, and increasing poverty among single women with children in the United States.

On the other hand, the experience of homelessness is not a random event that is independent of individual characteristics or experiences. In the context of poverty and high housing costs (Dolbeare, 1989), serious personal and family problems such as alcohol and other drug abuse can make an individual less able to compete for scarce resources such as low-cost housing or employment (Hop- per, 1990; Wood et al., 1989). In the words of one re- searcher, serious alcohol or other drug abuse represents an additional “burden of vulnerability” for homeless and other poor people (Fischer, 1989). Thus, although alcohol or other drug abuse should not be construed as the ex- planation of family homelessness (Weitzman et al., 1990), it may serve as an important contributing risk factor for some women with children.

Alcohol and other drug use among contemporary homeless adults is increasingly identified as a serious

Alcohol Research Group, Institute of Epidemiology and Behavioral Medicine, Medical Research Institute of San Francisco, Berkeley, CA

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problem that is more prevalent among the homeless than among the general population (Fischer, 1989; Garrett, 1989; Milburn, 1988). However, almost nothing is known about the direct contribution of alcohol and other drug abuse to homelessness among women with dependent children. In this article, I explore critical ways in which alcohol and other drug use can aggravate, precipitate, or prolong homeless episodes among homeless women with dependent children. Epidemiologic data on the impact of alcohol and other drug use on women and their chil- dren, and on the stability of the family unit, are discussed briefly. Policy considerations are introduced, including available treatment and policy options. Because the lit- erature is limited, substantive findings will be integrated into a conceptual inquiry into the ways in which alcohol and other drug abuse affects homeless women with chil- dren.

Alcohol and Other Drug Use Among Homeless Women With Children Alcohol-related problems have been prominently re- ported in studies of homeless persons in past decades, and the contemporary generation of homeless adults is distinguished by reports of high rates of illicit drug use, as well (Garrett, 1989). A review of the empirical literature suggests that alcohol and other drug problems are more prevalent among the homeless population than among the general population, with estimates of alcohol problems ranging from 12% to 68%, and estimates of other drug problems ranging from 1% to 48% (Fischer, 1989). In general, alcohol and other drug problems are reportedly less prevalent among homeless women than among homeless men (Fischer).

Homeless women with dependent children seem to be a distinctive subpopulation among homeless adults, with lower rates of substance use and related problems than have been reported for homeless men or for homeless women without children (Burr & Cohen, 1989; Johnson

Preparation of this article was supported by National Institute of Mental Health Grant RO1 MH46104.

The author is grateful to Elizabeth A. Smith, Herb Westerfelt, Scott O. Swain, and anonymous reviewers for comments on earlier drafts of this article.

Correspondence concerning this article should be addressed to Marjorie J. Robertson, Alcohol Research Group, Institute for Epide- miology and Behavioral Medicine, 2000 Hearst Avenue, Suite 300, Berkeley, CA 94709.

Vol. 46, No. 11, 1198-1204

& Krueger, 1989; Robertson, in press-a). Estimating the prevalence of alcohol and other drug abuse in this special population is difficult, however. The task of estimation is hampered by the paucity of empirical work on homeless families. Also, because of major methodological limita- tions common to studies of homeless populations, most current findings on homeless women with children are neither comparable with one another nor representative of the population as a whole. Studies of homeless families vary significantly by focus, design, measurement, and def- initions of homelessness and family unit. These variations prohibit meaningful generaliTation or comparisons across studies. For example, studies of homeless families tend to be based exclusively on families in shelters, leaving uncertain how these homeless families differ from those that are not in shelters (Solarz, in press). Virtually all of the studies are cross-sectional, overrepresenting persons who have been homeless longer and likely overrepresent- ing the prevalence of alcohol- and other drug-related problems, inasmuch as these problems are more likely to be associated with longer term homelessness. Moreover, the lack of rigorous sampling methods often prevents generalization beyond the homeless family members in- terviewed.

With regard to instrumentation, most studies of homeless families are not designed as epidemiologic studies of substance abuse. Because studies of homeless families tend not to focus on alcohol and drug use, sparse findings must be gleaned from studies of homeless families that have been designed with some other focus, such as physical or mental health. This is a common strategy for examining alcohol and other drug use among homeless persons generally (Fischer, 1989). Furthermore, if alcohol and other drug use are assessed at all, standardized in- strumentation or specific criteria for alcohol or drug abuse are often lacking. Prevalence rates cannot be compared across studies because rates vary as a function of instru- mentation and whether one uses lifetime or current rates, clinical or descriptive definitions of abuse, or treatment histories (Fischer). Also, information about use of a spe- cific drug is seldom reported, and alcohol and other drug indicators are often aggregated into a single rate of sub- stance use, abyse, or t reatment (Robertson, in press-b).

Although these methodological issues constrain our ability to generalize across samples to the larger popu- lation, the available literature suggests a high prevalence of alcohol and other drug use and related problems among homeless women with children compared with other poor women with children. For example, in a case-control study of poor, female-headed families in Boston, higher alcohol and other drug problems were reported for homeless mothers compared with poor-but-housed mothers (16% compared with 6%, respectively, on the basis of structured psychiatric interviews and applying Diagnostic and Statistical Manual of Mental Disorders, 3rd edition criteria (Bassuk & Rosenberg, 1988). Simi- larly, in New York City, more homeless parents (i.e., those requesting access to city shelters) reported recent, personal substance-abuse problems than did housed parents re-

ceiving public assistance (4.8% vs. 1.1%, respectively; Knickman & Weitzman, 1989; Weitzman, Shinn, & Knickman, 1989). In the same study, detoxification treatment for alcohol or drugs was a significant predictor of homelessness in a multivariate model. In Los Angeles, homeless mothers reported more alcohol or other drug use than did poor, housed mothers (43% vs. 30%; Wood, Valdez, Hayashi, & Shen, 1990). The difference in drug use s temmed mainly from a higher prevalence and more frequent use of cocaine, including crack, among homeless mothers (25.3% of homeless mothers used cocaine com- pared with 16.8% of housed mothers, and cocaine was frequently used by 8.7% of homeless mothers compared with 3.1% of housed mothers; personal communication, Hayashi, January 18, 1990; Wood et al., 1989).

In sum, there is insufficient empirical evidence on which to base a reliable prevalence estimate for alcohol and other drug abuse among homeless women with chil- dren. More germane than specific prevalence rates, how- ever, are the patterned findings that suggest that homeless women with children consume less alcohol and other drugs than do either homeless men or homeless women without children (Robertson, in press-b). However, homeless women with children have higher rates of al- cohol and other drug use than do other poor women with children.