Substance use and predictors of substance dependence in homeless women

To examine lifetime and current prevalence rates of substance use disorders and the demographic and clinical correlates of current drug dependence in a sample of homeless women.

A cross-sectional study of 196 homeless women in three Canadian cities was done. Each subject was assessed using structured clinical interviews. A multivariate regression model was applied to determine predictors of substance use.

The mean age of the sample was 35.3 years, 54.4% identified as Aboriginal, 46.4% lived on the street Crack cocaine (58%) was the most common substance used, followed by alcohol (53%), cannabis (41%), and heroin (30%). Overall, 82.4% of the sample had at least one type of current substance use disorder, of which 70.5% had drug dependence and 37.8% had alcohol dependence. 58.3% had concurrent substance use and mental health disorders. 76.7% of those individuals with current alcohol dependence had concurrent drug dependence. Only 24.6% of those who had recovered from alcohol dependence had no current substance use disorder. Multivariate analyses showed that younger age, living on the street, engaging in sex work, and having ever attempted suicide were associated with current drug dependence.

Prevalence rates for alcohol and especially drug dependence were exceptionally high in this sample. Innovative programs need to be developed which are accessible and tailored to meet the needs of this specific population, accounting for high problem severity, polysubstance dependence, and high rates of psychiatric comorbidity.