First Alcohol Experiences Among Individuals with the Lived Experience of Chronic Homelessness and Severe Alcohol Use Problems

Background and purpose: Alcohol has been cited as one of the most pervasive health problems in homeless populations. While homelessness and substance use have long been studied as intertwined conditions, the relationship is complex and not well understood. One well-established finding in the substance use literature is that early onset of alcohol use is associated with subsequent alcohol use disorders and related problems, including lifetime prevalence. . What is less well understood is what relationship early drinking onset has with the risk of developing subsequent alcohol problems and/or homelessness. Few studies have explored first drinking experiences amongst individuals with current alcohol related problems and lived experience of homelessness. Given that this time point appears to be critical in the development of subsequent alcohol use problems, a better understanding of the elements inherent in these early recalled drinking experiences provides insights into factors that lead to these conditions.

This study explores the qualitative nature of first alcohol memories as recalled by individuals with the lived experience of homelessness and severe alcohol use problems.

Methods: Qualitative data were collected via one on one, semi-structured interviews with N=39 individuals with lived experience of homelessness and severe alcohol use problems. Participants were asked to recall their first alcohol experience and the age at which it occurred. These questions were embedded in a larger list of open-ended questions exploring individuals’ general experience of homelessness, the role of alcohol in their lives, treatment enhancement, as well as their experience of moving to supportive housing from the streets. Data were coded using a constant comparative process consistent with grounded theory methodology.

Findings:Consistent with findings associating early drinking initiation with subsequent alcohol related problems, our data reveal that participants reported a mean age of 12.2 years (SD=4.9) as their first alcohol experience. Qualitative data were categorized into three temporal points: Precursors to drinking (Before), Drinking Initiation (During), and Feelings/Reactions after the first drinking experience (After), with each category revealing predominant themes within each temporal category: 1) Contextual factors/precursors to drinking: family history of drinking/alcohol dependence, foster homes or adoptive family, moving around a lot, traumatic event in early childhood; 2) Drinking initiation: Acting out of boredom, haphazard initiation (e.g., stumbling across beer), easy access (e.g., parents liquor cabinet), peer pressure/peer acceptance, drinking as family culture/connection; perceived non caring by parents; 3) Feelings/reactions to first alcohol experience: Being consumed by alcohol, alcohol “taking its hold,” being an alcoholic from day one, a reported spiritual connection with alcohol from first experience.

Conclusion and Implications: This study provides a rich thematic description of first alcohol memories as recalled by individuals with lived experience of homelessness and severe alcohol problems. Given the prevalence of alcohol use problems amongst homeless individuals, better understanding of these early alcohol experiences may help elucidate factors that contribute to, maintain, and/or precipitate both alcohol use and homelessness and provide substance use researchers with more tools to develop effective prevention strategies.