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Article Excerpt
People typically regard Jamie as being "on the streets" but to him living in a bushland squat means he is "not quite homeless". In his words, he is "homeless but not roofless". Jamie is 17 and has been living on the streets on or off since he was 12. His parents were abusive and Jamie has lived in foster care or with his grandmother for most of his life. After he left home, a friend taught him how to live by stealing cars, "doing burgs," and holding people up at knifepoint. He got into trouble over drugs with bikies when he was 12--he says he didn't realize what he "was playing with". He started smoking marijuana at 11 and has used heroin a few times (his parents' drug of choice), ecstasy once, and also coke, speed and acid among other drugs. Speed is the only drug he has used at problematic levels.
"Oh, speed was ongoing. Speed, as soon as I experimented [with] it, I loved it, I wanted more and more, couldn't give it up, just wanted it. That bad, it destroyed quite a few of my relationships ... it's like you're in heaven mate.., ever since we were young I've been a violent person and ah, I snap quite easily, so it wasn't good stuff for me ... "
He says "at that time it was either take drugs or kill myself". Jamie did hang himself a week before his first interview but was cut down by a friend. Over the last two years he has "woken up" and realizes that other people do care. He has given up crime and has a new girlfriend. He says looking after her makes him look after himself. He has also given up regular drug use apart from alcohol and marijuana which he believes help to control his anger. Occasionally, he will use other drugs recreationally. Now, he keeps himself safe by avoiding repeated use of any drug he particularly enjoys:
"I believe if I like a drug, not to touch it again because I will not stop. I've got a strong will power and if I want something I'll get it."
Jamie says that you need the will to survive. He'd like to believe he has that will but is not sure.
Estimates of drug use among homeless young people vary across studies but there is evidence of relatively high rates in this population compared to their home-based peers (Australian Institute of Health and Welfare (AIHW), 2002; Bailey et al., 1998; Blue Moon Research and Planning (BMR), 2000; Department of Human Services, 1998; Downing-Orr, 1996; Klee & Reid, 1998; Kral et al., 1997; Miller & Draper, 2001; Ringwalt et al., 1998; Rosenthal et al., 2004; Smart et al., 1994; Unger et al., 1998).
Debate exists in the research literature about the causal relation, if any, between drug use and homelessness. Some consider drug use as precipitating homelessness (Greenblatt & Robertson, 1993; Noble, 1999). Others focus on drug use as a response to crisis and the ensuing instability associated with homelessness (Ayerst, 1999). Drug use is commonly perceived to be exacerbated through young people's contact with street-based or service-based homeless subcultures where drugs are more accessible. It is assumed that in these contexts newly homeless young people are highly vulnerable and likely to commence or increase their drug use in association with homeless peers (Whitbeck & Hoyt, 1999). In discussing these findings, researchers and policy makers alike often presume that homelessness is ongoing, the influence of homeless peers is wholly negative and the possibility of avoiding long term problematic drug use is slight.
While there is research to indicate that drug use can be either a cause or a consequence of homelessness (Mallett et al., 2004 in press), there is little evidence about changes in drug use over time once young people become homeless. The following article addresses this issue. We report on the factors identified by young people as impacting on their drug use and the common developments in their lives that attended changes in that use. Our focus is on motivation and surrounding circumstances rather than technique.
Addiction and dependence
The widely adopted medical model of drug use is based on the concept of addiction as a disease requiring professional intervention. It implies "once an addict always an addict", a stance that informs 12-step recovery programs. This position was challenged in the 1980s by researchers such as Zinberg (1984) and Biernacki (1986) who dubbed it a myth. The importance of social context, in Zinberg's terms "set" and "setting" (Zinberg, 1984), to meanings and patterns of use has led to a greater focus on broader structural factors (Granfield & Cloud, 1999; Moore, 2002; Waldorf, Reinarman & Murphy, 1991). These approaches conceive of problematic drug and alcohol use as "dependence"--either as a change in state or a variation along a continuum (Moore, 1992)--rather than merely physical addiction.
Dependence has been variously defined. Burrows (1994) highlights a lack of control over usage and the emergence of physiological or psychological dependency. In contrast the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis of dependency emphasizes ongoing use (Coffey et al., 2002) among other criteria. Over time the focus of these definitions has changed away from the physiological (e.g. withdrawal) to the social (e.g. persistent desire or the existence of social consequences [Coffey et al., 2002]).
The shift from a notion of addiction to one of dependence has focused attention on social and cultural factors in the establishment, maintenance and cessation of drug use (Moore, 1992). However, as Moore has observed, the idea of dependence does not necessarily acknowledge that cultural, social, and economic factors can actually constitute and underpin, rather than merely influence, drug use. The idea of dependence can focus too heavily on individual deficiencies or proclivities, thereby overlooking the interaction between the broader context and the individual (Duckert, 1993).
Giving up
In recent years, more attention has been paid to those who cease problematic drug use without professional assistance or the aid of self-help groups. This is variously referred to as natural recovery, spontaneous recovery, remission, maturing out (Winick, 1962), autoremission, self-generated change (McCartney, 1996), or simply cessation (Waldorf, Reinarman & Murphy, 1991). However, there is still relatively scant attention being paid to those who give up unassisted, despite the fact that change without intervention is widespread (Biernacki, 1986; Cunningham, 1999). Certainly, there has been no investigation of cessation or modification of problematic use among homeless young people.
Among those researchers who reject the medical model of addiction, there is agreement that multiple pathways out of problematic levels or patterns of use exist, other than through treatment (Blomqvist, 1996; Cunningham, 2000; Koski-Jannes & Turner, 1999; Sobell, Ellingstad & Sobell, 2000; Waldorf & Biernacki, 1981). Such pathways involve complex interactions between the individual and the world they inhabit.
For many, ceasing problematic drug use involves a cognitive evaluation of the pros and cons of continuing use, however others seem to simply drift out of using (Biernacki, 1986; Waldorf & Biernacki, 1981; Waldorf, Reinarman & Murphy, 1991). Those who actively quit and those whose use simply tapers off often report that they want to stop using because they no longer enjoy that particular drug (McCartney, 1996; Waldorf, Reinarman & Murphy, 1991).
Although some studies have shown that most drug use tapers off by the early 30's (Chen & Kandel, 1995), the relation between individual decision-making and social/environmental factors is unclear (McCartney, 1996). Commonly identified social/environmental factors include health, legal, financial and relationship issues, meaningful work, and family/peer support (Bammer & Weekes, 1994; Biernacki, 1986; Blomqvist, 1996; Brady 1993; Cunningham, Koski-Jannes & Toneatto, 1999; Koski-Jannes & Turner, 1999; Sobell, Ellingstad & Sobell, 2000; Waldorf & Biernacki, 1981; Waldorf, Reinarman & Murphy, 1991).
Dealing with problematic drug use can prove challenging under the best of circumstances but there are additional hurdles for those who are homeless. Some imply that it is unstable housing (Henkel, 1999) that is a critical risk factor; others emphasize the positive aspects of good social relationships (Bammer & Weekes, 1994; Granfield & Cloud, 1999), and financial and employment security (Raynor, 2003). In this study we consider young people's accounts of giving up their self-reported problematic drug use. We identify those social/environmental and personal factors that young people highlight as pivotal to their reduction in drug use.
Method
This article is based on 40 semi-structured, qualitative interviews undertaken in Melbourne, Australia as a component of Project i, a five-year study of homeless young people in Melbourne and Los Angeles, California. (1) In Melbourne, 674 young people, aged between 12 and 20, were recruited from youth and homeless services across metropolitan Melbourne between December 2000 and August 2002. Of these, 165 newly homeless young people were recruited to participate in the two year longitudinal component of the study. (2)
Newly homeless were defined as those who had been out of home from two days to six months at the time of their baseline interview. This group included young people without any accommodation, those in emergency accommodation, temporary accommodation, and supported accommodation.
In-depth, semi-structured interviews were undertaken with a subgroup (n=40) of those participating in the longitudinal study. These interviews were conducted 18 months after young people had completed their initial baseline interviews. The primary principles of selection for participation in the in-depth interviews were gender, age, and level of service use. The sample was selected by generating eight groups of newly homeless young people from a cross-tabulation of age, gender, and service use (high and low).
Age was defined by median split (12-16 years and 17-20 years). For each participant, a measure of number of services used was created by summing responses to 18 service use questions on the initial baseline survey. High/low service use was defined by median split (0-2 and 3-9 services used). Five participants from each group were then randomly selected to undertake the interviews.
Following institutional ethics approval, interviews lasting between 1 and 1 1/2 hours were undertaken by trained interviewers between November 2002 and August 2003. Interviews were conducted at the referral agency or at the research center. Informed consent was obtained and the interviews were tape recorded and later transcribed. All young people received $40 (local currency) compensation for their participation.
During the interviews young people were asked about their experiences since they first left home, the places they had lived, the people that support them, their drug use, sex life,...
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