Substance use and labor force participation among homeless adults

Needs Assessment for a Comprehensive Reemployment Program Among Residents of a Work Rehabilitation Program for Individuals With Unstable or Lack of Housing

OBJECTIVE

Individuals in transitional housing programs often have a goal of reaching stable employment, but the unique needs and barriers for achieving this warrants further study.

METHODS

A structured interview guide was administered orally and descriptive data analysis was done for this exploratory mixed-methods study.

RESULTS

Commonly reported reemployment challenges included legal barriers and unmet transportation, housing, and financial needs. More than two-thirds of residents reported no place to live after the program regardless of if they had previous precarious housing. Emerging themes included challenges regarding sufficient time for the transition to being employed, fear of relapse, and lack of long-term goals and planning.

CONCLUSIONS

Findings suggest that residential rehabilitation programs are an important resource. While these programs tend to focus on reemployment, their services could be enhanced by assessing individual needs and allowing for variation in reemployment preparation.

Economic Stressors, Social Integration, and Drug Use among Women in an Inner City Community

This article uses data from a study of 122 adult women drug users residing in the Atlanta, Georgia metropolitan area to identify associations between economic stressors related to occupying disadvantaged statuses, institutional integration, and drug use. The data stem from targeted sampling and ethnographic mapping procedures. The findings suggest that experiencing stressors related to economic circumstance and daily subsistence increased the likelihood of drug use. Results also indicate religious involvement and kinship networks are independently and negatively associated with drug use, but fail to reduce the negative effects of economic stressors on drug use. The author suggests that institutional integration, however limited, may be a formidable deterrent to drug use. Continued identification of multi-level integration sources may inform drug treatment approaches in community programs.

The Relationship of Gender and Ethnicity to Employment Among Adults Residing in Communal-living Recovery Homes

This study examined employment and sources of income for different genders and ethnic groups residing in a substance abuse recovery homes called Oxford Houses. Men compared to women reported significantly higher mean income from employment as well as total income. African Americans compared to European Americans reported significantly more work in the past 30 days; however, the rate of pay between these two ethnic groups was not significantly different. Longer length of stay in Oxford House was related to higher incomes. Implications of these findings are discussed.

Recognizing work as a priority in preventing or ending homelessness

The literature speaks to the importance of employment in the lives of homeless individuals and shows how they can be assisted in job seeking (Long & Amendolia, 2003; Marrone, 2005; Quimby, Drake, & Becker, 2001; Rio, Russell, Dudasik, & Gravino, 1999; Rog & Holupka, 1998; Shaheen, Williams, & Dennis, 2003; Trutko, Barnow, Beck, Min, & Isbell, 1998). Some reports suggest it may be effective and worthwhile to offer employment at the earliest stages of engagement to help people who are homeless develop trust, motivation, and hope (Cook et al., 2001; Min, Wong, & Rothbard, 2004). Practitioners have historically focused on providing people with access to safe and affordable housing and supportive services, usually addressing employment later in the continuum. This practice-oriented report from the field proposes that employment should be offered as early as possible and maintains that facilitating employment is an unrecognized and underutilized practice for preventing and ending homelessness. The paper provides principles, practices, and strategies programs can use to make work a priority.

Measuring employment among substance-using offenders

Employment has been identified as an important predictor of drug abuse treatment outcome; however, employment has been measured in a variety of different ways in the drug abuse literature and typically with community samples. The present IRB-approved study used factor analysis to identify commonalities among several employment measures collected from a sample of drug court offenders who entered one of two Kentucky drug courts between March 2000 and November 2002. Measures included demographics, employment, substance use, and criminality. The factor analysis produced four employment factors: status, earnings, duration, and stability. These factors had different correlation patterns with substance use and criminality. Study limitations are noted.

Employment outcomes for hard-to-reach persons with chronic and severe substance use disorders receiving assertive community treatment

Many persons with chronic and severe substance use disorders (SUDs) enter and exit public substance dependence treatment systems with limited benefit, but continue overuse of high-cost health and human services. Less than a third holds jobs, earning income below U.S. federal poverty levels. Long-term integrated substance dependency treatment, rehabilitation, and support services will be essential to resolve substance dependence and employment problems. This single-group program evaluation reports adaptation of Assertive Community Treatment (ACT), a multi-component, team-based service model originally designed for persons with severe mental illnesses and multiple disabilities, for effectiveness with persons with severe SUDs. The ACT model delivers an integrated package of treatment, rehabilitation, and support to reduce substance misuse and increase employment. Of the 35 clients admitted 12 months prior to conclusion of this 2-year service demonstration, only one left treatment prematurely. Generally, clients modestly reduced substance misuse and increased employment. However, the evaluation design and small sample limit inferences of causation and generalizability of these promising outcomes. Persuading states to adopt expensive team-based approaches for this population will require firm evidence of favorable cost-benefit ratios.

Longitudinal Perspective: Adverse Childhood Events, Substance Use, and Labor Force Participation Among Homeless Adults

OBJECTIVES

We examined the long-term effects of adverse childhood events on adulthood substance use, social service utilization, and subsequent labor force participation.

METHODS

A county-wide probability sample of 397 homeless adults was interviewed three times in a 15-month period. By using a path model, literature-based relationships between adverse childhood events and labor force participation with the mediating effects of adulthood substance use and service use were tested.

RESULTS

Adverse childhood events were precursors to adulthood alcohol and drug use. Consistent substance use was negatively associated with long-term labor force participation and with social service utilization among homeless adults. Adverse events at childhood, however, were positively associated with service use.

CONCLUSIONS

Adverse childhood events may contribute to negative adulthood consequences, including consistent substance use and reduced labor force participation. Agencies that are involved in halting the abuse or neglect also should participate in more preventive interventions. Job-related assistance is particularly important to facilitate employment and labor force participation among homeless adults.

Impacts of federal ephedrine and pseudoephedrine regulations on methamphetamine-related hospital admissions

AIMS

To determine whether the federal regulation of ephedrine and pseudoephedrine, precursors used in illicit methamphetamine production, reduced methamphetamine-related acute care hospital admissions.

DESIGN

ARIMA-intervention time-series analysis.

SETTING

California (1983-2000), Arizona and Nevada (1991-2000), USA.

MEASUREMENTS

Monthly counts of methamphetamine-related acute care hospital admissions.

INTERVENTIONS

Bulk powder ephedrine and pseudoephedrine: regulated November 1989. Products containing ephedrine as the single active medicinal ingredient: regulated August 1995. Products containing pseudoephedrine: regulated October 1997. Large-scale producers used ephedrine and pseudoephedrine in these forms. Ephedrine combined with other active medicinal ingredients (e.g. various cold medicines), used mainly by small-scale producers: regulated October 1996.

FINDINGS

In California, the bulk powder regulation stopped a 7-year rise in admissions (1983-89) and reduced them by 35% (P < 0.01). The single ingredient ephedrine regulation stopped a 4-year rise (1992-95) in California, Arizona and Nevada, with 48% (P < 0.01), 71% (P < 0.01) and 52% (P < 0.01) reductions, respectively. The pseudoephedrine products regulation stopped a 2-year rise (1996-97) in California, Arizona and Nevada, with 38% (P < 0.01), 41% (P < 0.05) and 61% (P < 0.01) reductions, respectively. Admissions rose at the end of the study period but were still well below peak 1990s levels. The regulation of ephedrine combined with other active medicinal ingredients had no significant impact in any of the three states.

CONCLUSIONS

Regulations targeting precursors used by large-scale producers reduced admissions substantially during the study period. However, the regulation of precursors used primarily by small-scale producers had little, if any, effect.