Structural and personal factors related to access to housing and housing stability among urban drug users in Hartford, Connecticut.

Early researchers studying the causes of homelessness often focused on individual pathologies, such as chronic substance abuse or mental illness (Lamb, 1984; Baum & Burnes, 1993), e.g. the risky person model (Aidala, 2006). Others have argued that structural factors, most often conceptualized as socioeconomic changes in the inner-city, are the causes of the increase in homelessness over the past two decades (Harrington, 1984; Blau, 1992). More recent research has argued that both personal and structural factors must be considered. Substance abuse and mental illness do not cause homelessness but make individuals with these disorders more vulnerable to becoming homeless in increasingly competitive housing markets (Burt, 1992; Cohen & Thompson, 1992; Koegel & Burnam, 1992; Shinn, 1992; Koegel, Melamid & Burnam, 1995; Booth, Sullivan, Koegel & Burnam, 2002). Structural factors determine why pervasive homelessness exists in this historical time, while individual factors explain who is least able to compete for scarce affordable housing (Burt, 1992; Cohen & Thompson, 1992; Koegel & Burnam, 1992; Shinn, 1992; Koegel, Melamid, et al., 1995; Booth, Sullivan, et al., 2002).

Drug use as cause or consequence is another frequently argued question. Research has shown that substance use problems afflict anywhere from 28 to 67% of homeless individuals (Fischer & Breakey, 1991; Lehman & Cordrey, 1993; Stahler, Shipley, Bartelt, Wescott, Griffith & Shandler, 1993; Dennis, Bray & Iachan, 1998; Royse, Leukefeld, Logan, Dennis, Weschberg, Hoffman, et al., 2000) and that substance abuse increases individuals' vulnerability to homelessness (Spinner & Leaf, 1992; Winkleby, Rockhill, Jatulis & Fortman, 1992; Johnson, Freels, Parsons & Vangeest, 1997). In contrast, other researchers have argued that drug abuse is more likely to be a consequence of homelessness, as drugs are used to cope with the stresses of homelessness. Johnson and colleagues (1997) found support for both positions and argue that a multidirectional model is more appropriate. In their study, drug use was associated with first homeless episode. Also, prior homeless experiences were found to be predictive of first symptoms of drug abuse. Other research has compared the personal characteristics of drug using with non-drug using homeless (Galaif, Nyamathi & Stein, 1999; Booth, Sullivan, et al., 2002). Homeless individuals with a lifetime or recent diagnosis of substance dependence reported more severe homeless history, more childhood/adolescent vulnerabilities for homelessness, repeated homelessness, indications of poorer quality recent shelter (more days outdoors, fewer nights in places meant for sleeping, more victimization) (Booth, Sullivan, et al., 2002), and less positive social support (Galaif, Nyamathi, et al., 1999).

However, little research has examined the criminalization of drug use and housing policy as potential structural factors that may contribute to the association between substance abuse and homelessness. Many federal policies and laws criminalizing drug use may limit drug users' access to housing, housing subsidies, welfare benefits, and employment. The federal "One Strike and You're Out" law (P.L. 104-120, Sec.9), passed in 1996, allows federal housing authorities to consider drug and alcohol abuse and convictions by people and their family members when making decisions to evict them from or deny them access to federally subsidized housing, although states may opt out of this law. Other policies which have impacted drug users' access to housing include the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, in particular the elimination of the SSI Addiction Disability and a ban on receiving welfare benefits for convicted drug offenders (Anderson, Shannon, Schyb, Goldstein, et al., 2002; Crane, Quirk & van der Straten, 2002; Baumohl, Speiglman, Swartz & Stahl, 2003; Drug Policy Alliance, 2003; Hunt & Baumohl, 2003a; Hunt & Baumohl, 2003b; Norris, Scott, Speiglman & Green, 2003).

Connecticut's prison population has doubled in the last ten years, at a cost of over $513 million per year (Connecticut Department of Correction, 2002). Drug offenders account for a large percentage of this growth (Connecticut General Assembly, 2001), which has had a disproportionate effect on the state's African American population. While African American men comprise less than three percent of Connecticut's population, they account for 47 % of the state's inmates in prisons, jails and halfway houses (Scarponi, 2001). Connecticut has been active in recent years on a range of drug reform efforts, however, including sentencing reform for non-violent drug offenses, an opt-out of the federal welfare ban, data gathering to combat racial profiling, and restoration of voting rights to ex-felons (Drug Policy Alliance, 2003). In addition to these drug reform efforts, Connecticut has funded several supportive housing projects which provide affordable, service enriched rental housing for homeless and at-risk populations, many of whom are coping with mental illness, histories of substance addiction, and/or human immunodeficiency virus/acquired immune deficiency syndrom (HIV/AIDS) (Andersen, University of Pennsylvania Health System, Sherwood, 2002).

Both personal characteristics and structural factors also determine access to more stable housing. Social policies differentially affect various vulnerable populations, which in turn may affect their housing. A number of studies have shown that substance users are significantly less likely to exit homelessness (Zlotnick, Tam & Robertson, 2003) or access social services (Nyamathi, Leake, Keenan & Gelberg, 2000; Nwakeze, Magura, Rosenblum & Joseph, 2003) although the reasons for this have not been systematically studied. In particular, the processes by which a history of arrest impacts access to housing and social services have not been studied. Eligibility requirements or priorities of various local, state and federal housing programs often facilitate access to housing for some (e.g.. women with dependent children, or those with mental illness or HIV diagnoses) while excluding others (e.g. those with criminal records)(Royse, Leukefeld, et al., 2000; Sullivan, Burnam, Koegel & Hollenberg, 2000; Montoya, Atkinson & Struse, 2001; Anderson, Shannon, et al., 2002; Crane, Quirk, et al., 2002).

This article will examine the processes that lead to housing instability among active users of heroin and cocaine using in-depth interviews with housed and homeless drug users. We define housing instability as lack of access to housing, housing loss/evictions, and frequent moves. In particular, we will look at how arrest, previous evictions, lack of welfare benefits or employment, lack of housing subsidies, and disruption of family and social support networks lead to homelessness and housing instability among active drug users. We will also look at structural factors (e.g. the criminalization of drug use, federal housing policies) that create a context of stigmatization that limit drug users' housing and employment options. Finally, we will explore the types of social and financial support provided by institutions or individuals within drug users' personal network that have helped them to access stable housing. Qualitative research is particularly suited to illuminating these processes as drug users describe the events that led to their loss of housing, difficulties in exiting homelessness and strategies used to maintain stable housing.

Methods