Alcohol and homelessness
James Morris, The AERC Alcohol Academy
JSNA and Homelessness event
16th June 2010
The Academy
 A social enterprise that:
 Aims to ‘promote excellence in local
alcohol harm reduction’
 Workshops, networking, best practice
sharing for strategic leads
 Consultation and policy advocacy
 Training for practitioners and front line
staff
Promoting excellence in
local alcohol harm reduction
Alcohol and homelessness
 Homeless Link (HL) 2009 SNAP survey found
alcohol problems within:
 39% of clients in an ‘average’ homelessness
project
 56% in day centres 54% in Direct Access
hostels
 Leicester Homeless project found 45% of
deaths has alcohol implicated as a cause
 4% of those in alcohol treatment were NFA, a
further 11% had housing problems (NATMS 2010)
Promoting excellence in
local alcohol harm reduction
A 2003 survey of homeless in London
 Results from a Survey of Homeless People in
London (NAC 2001) found of 389 people:
 25% were dependant on alcohol
 63% said drug or alcohol use was one of
the reasons they first became homeless
 Overall, drug and alcohol use and
dependency increased the longer the
respondents had been homeless
 Initiatives to tackle homelessness must
simultaneously tackle substance use
Promoting excellence in
local alcohol harm reduction
‘Rough sleeping, substance use and service provision in London’ NAC 2001
‘Sobering facts’ 2009 report
 13,872 NFA hospital admissions over the
last five years for drug or alcohol misuse
 Total drug and alcohol related admissions of
homeless people have risen by 117 per cent
since 2004
 ‘it is essential that the over-availability of
cheap alcohol is addressed’
 ‘ensuring that local GP services are linked
with homeless organisations and charities in
the area…better access to primary care
Promoting excellence in
Sobering facts: The Impact of Drugs and Alcohol on England’s
Population
local Homeless
alcohol harm reduction
Conservative Homelessness Foundation 2009
The challenges
 Alcohol can be both a symptom
and a cause of homelessness
 But is rarely an issue on its own –
mental/physical health problems, offending
behaviour, drug use, damaged lives
 Finding a balance between enforcement and
support
 Providing support or interventions that may
be palliative or respite only
 The cheap and ready availability of alcohol
Promoting excellence in
local alcohol harm reduction
Street populations?
Street drinking
Work seeking
Rough
Sleeping
Begging
Drug use
Promoting excellence in
local alcohol harm reduction
Central & Eastern Europeans (A10s)
 A8 countries joined EU May 2004 (A2 in
2007) to allow ‘free movement of workers’
i.e. economic migration
 Transitional arrangements until 2011 to
‘regulate access to labour market and
benefits’
 A10s have filled labour gaps; most are
young, without dependants and plan return
 No access to benefits, homelessness
assistance or social housing unless 12
continuous months employment
Promoting excellence in
local alcohol harm reduction
Central & Eastern Europeans
(A10s) issues
 Housing and employment:
 Street populations: rough sleeping, street
drinking, begging
 Houses Multiple Occupation (HMOs)
 Work: exploitation/gang masters
 Access to services: primary care only
 Crime? Inter-community crimes and
victimisation un-reported, Drink Driving
Promoting excellence in
local alcohol harm reduction
A10s – future alcohol-related issues?
 Future implications for alcohol trends and
impacts like other migrants have? E.g. Irish
immigration of 1950s impact on longer term
alcohol and mental health issues (www.icap.org.uk)
White
Irish
Chinese
Bangladeshi
Pakistani
Indian
Black African
Black Caribbean
-40
-20
0
20
in
40 Promoting excellence
60
local alcohol harm reduction
Male>4
Female>3
Male>8
Female>6
Alcohol-related hospital admissions trend
Promoting excellence in
local alcohol harm reduction
A10s – responses
 Though secondary care is not technically
available for homeless A10s, many PCTs/LAs
have been flexible/innovative in responding e.g.:
 Providing access to certain treatment and care
 Establishing specialised services ranging from
employment, language skills, alcohol treatment,
housing etc, Migration Impact Fund projects
 Specialised homeless approaches such as A10
outreach workers and ‘reconnections’ projects
 Homeless Link guidance and resources available
www.homeless.org.uk/cee-guidance
Promoting excellence in
local alcohol harm reduction
Cheap alcohol
 We know price and consumption are
directly correlated but…
 We don’t know the impact of pricing on those
who are already dependant
 We don’t know whether the scare stories
about ‘white cider’ are true, but the anecdotal
reports are worrying
 30 years ago, encouraging street drinkers off
meths was a common harm reduction
approach
Promoting excellence in
local alcohol harm reduction
‘Continuing drinkers’
 There is a recognition that for some
individuals, their level of alcohol dependency
and circumstances means only ‘controlled
drinking’ seems achievable
 Therefore carefully planning alcohol
consumption and managing risk-factors is the
focus as a ‘harm-minimization’ approach e.g.:
 Drink diaries, supervised drinking, alcohol
selection, timing with meals are common wet
hostel approaches
Promoting excellence in
local alcohol harm reduction
Further issues
and options?
Promoting excellence in
local alcohol harm reduction
Enforcement Vs Support?
 What is the balance between enforcement
and support?
 A staged approach is required to ensure
support and treatment is available, followed
by staged enforcement measures
 Strong local partnerships are imperative in
ensuring successful multi-agency working
Promoting excellence in
local alcohol harm reduction
Improving alcohol treatment
 We need to improve access to alcohol
treatment that can meet a wide range of
needs
 Improve alcohol treatment pathways and
ensure access is appropriate e.g. risks of
‘multiple respite detoxes’
 Primary care access and support to meet the
needs of homeless
 Hospital alcohol health worker/rough sleeper
discharge posts
Promoting excellence in
local alcohol harm reduction
A staged enforcement approach
 Low level Anti-Social Behaviour
interventions: Controlled Drinking Zones,
dispersal powers, ABCs etc.
 Individual enforcement measures:
individual case management, ASBOs,
Alcohol Treatment Requirements (ATRs
not for NFA)
Promoting excellence in
local alcohol harm reduction
Multi-agency partnership
Mental
health
Treatment
services
Police
Street
population or
partnership
lead
Housing
Outreach/
reconnection
Community
Safety
Promoting excellence in
local alcohol harm reduction
A staged approach: U.S model
1. Outreach and engagement
2. Motivational interviewing
3. Intensive case management
4. Stabilization & therapeutic communities in
shelters
5. Transitional and supportive housing
6. Confronting barriers
NIAAA Social Work Education
Module 10D
Promoting excellence in
local alcohol harm reduction
Conclusions
Promoting excellence in
local alcohol harm reduction
Thank you
www.alcoholacademy.net
www.alcoholpolicy.net
James Morris, AERC Alcohol Academy
james@alcoholacademy.net
0207 450 2930
Promoting excellence in
local alcohol harm reduction