Social relationships, homelessness, and substance use among emergency department patients

Abstract

Background: Emergency department (ED) patients commonly experience both substance use and homelessness, and social relationships impact each in varied ways not fully captured by existing quantitative research. This qualitative study examines how social relationships can precipitate or ameliorate homelessness and the connection (if any) between substance use and social relationships among ED patients experiencing homelessness. Methods: As part of a broader study to develop ED-based homelessness prevention interventions, we conducted in-depth interviews with 25 ED patients who used alcohol or drugs and had recently become homeless. We asked patients about the relationship between their substance use and homelessness. Interviews were recorded, transcribed, and coded line-by-line by investigators. Final codes formed the basis for thematic analysis through consensus discussions. Results: Social relationships emerged as focal points for understanding the four major themes related to the intersection of homelessness and substance use: (1) Substance use can create strain in relationships; (2) Help is there until it’s not; (3) Social relationships can create challenges contributing to substance use; and (4) Reciprocal relationship of substance use and isolation. Sub-themes were also identified and described. Conclusions: The association between substance use and homelessness is multifaceted and social relationships are a complex factor linking the two. Social relationships are often critical for homelessness prevention, but they are impacted by and reciprocally affect substance use. ED-based substance use interventions should consider the high prevalence of homelessness and the impact of social relationships on the interaction between homelessness and substance use.

Keywords:

• Substance use
• homelessness
• emergency department
• social relationships

Author contributions

KMD, DS, and DKP conceived of the study and developed the interview guide. LG and RPM additionally contributed to study content and design. DGC and KMD conducted the interviews. DGC, ZR, and KMD coded the interviews. AJ and DKP conducted additional thematic analysis. AJ drafted the manuscript with DKP and KMD. All authors provided critical feedback and approved the final version.

Additional information

Funding

Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health [K23DA039179, PI Doran], the United Hospital Fund (PI Doran), and the Doris Duke Charitable Trust—NYULMC (PI Doran). Funding for Amanda Jurewicz’s participation with this project was provided by the SARET program [NIH/NIDA grant R25DA022461] and NYU Grossman School of Medicine. The funding organization(s) had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.