Extending the estrangement model to examine factors associated with alcohol/drug addiction

Background/Purpose

The conceptual framework of Societal Estrangement among homeless individuals has been applied to understand challenges of homeless youth and young adults. It includes four domains: disaffiliation, human capital, identification with homeless culture, and psychological dysfunction. Homeless young people who use high levels of substances demonstrate difficulty in establishing adult social connections and often become socially estranged. Despite the relationship between social estrangement and substance abuse, few studies have applied the social estrangement model to homeless youths' substance abuse behaviors. Thus, this study examined domains of estrangement to predict alcohol and drug addiction among homeless young adults.

Methods

Homeless young adults were recruited using comparable research methods and measurement instruments across three U.S. cities: Los Angeles, CA (n=50), Austin, TX (n=50) and St. Louis, MO (n=46). Participants were recruited from multi-service non-profit agencies providing comprehensive care to homeless/runaway youth. Agency staff facilitated introductions; semi-structured retrospective interviews and self-report questionnaires of standardized measures were conducted. Participants averaged 20 years of age, were predominately male (67.8%), Black/not Latino (39.0%) or White/not Latino (30.1%) and lived on the streets/in temporary shelters (44.5%).

The Mini International Neuropsychiatry Interview was used to determine level of addiction to alcohol and various drugs. Estrangement variables included: disaffiliation (living on the streets, arrest history, victimization), human capital (panhandling, employment), homeless culture (length of time on the street, using multiple substances, carry weapon), and psychological dysfunction (PTSD, depression).

Chi-square and t-tests determined differences between those alcohol-addicted or not and drug-addicted or not. Logistic regression models examined the four domains of societal estrangement to predict alcohol and drug addiction separately.

Results

The logistic regression model predicting alcohol addiction indicated that youth who used greater numbers of substances (OR=1.7) and who met criteria for PTSD (OR=7.5) were more likely to be addicted to alcohol (F[df=17]=47.1, p<.001).

For the logistic regression model predicting drug addiction, being arrested for status offenses (OR=11.7) or vandalism (OR=51.8) or using a large number of substances (OR=2.0) significantly increased the likelihood of drug addiction (F[df=16]=55.4, p<.001).

Discussion/Conclusions

Findings demonstrated that youth who are deeply ingrained in homeless culture (and experimenting with a variety of drugs) may be the most at risk for developing addiction to alcohol and/or drugs. However, distinct domains of estrangement affected alcohol and drug addiction beyond this common factor. Alcohol-addicted youth may represent a group struggling with higher levels of psychological dysfunction, particularly symptoms from past trauma experiences. In contrast, drug-addicted youth may be entrenched in a more delinquent lifestyle, representing their general disaffiliation with mainstream society. As socially estranged youth were more likely to develop substance-use disorders, findings suggests that youth most in need of services may not be receiving them. Outreach efforts that target substance-abuse screening or referral for intervention are likely to have value in bringing services to estranged youth who do not independently seek shelter or drop-in services. Involving service-engaged homeless youth directly as peer mentors, counselors and educators may encourage less-engaged street youth to seek needed services and address issues that have led to estrangement from societal supports.