The health encounter as a treatable moment for homeless substance-using adults: The role of homelessness, health seeking behavior, readiness for behavior change and motivation for treatment

Thomas P. O'Toole, Robin A. Pollini, Daniel E Ford, George Bigelow

Research output: Contribution to journalArticle

Abstract

Substance-using homeless persons frequent emergency departments and hospitals often. However, little is known about how homelessness affects when they seek care and their motivation for substance abuse treatment (SAT). We surveyed homeless (N = 266) and non-homeless (N = 104) substance-using adults sequentially admitted to an urban hospital medicine service, comparing demographics, readiness for change (URICA), and motivating reasons for SAT. Homeless respondents were more likely to be younger, uninsured, have hepatitis B/C, and <12th grade education. The majority in both groups were in either a precontemplative or contemplative stage of change, although more homeless respondents were in an action stage. They also had similar motivating reasons for wanting SAT, although being homeless was an additional motivator for the majority of homeless respondents. Almost half reported that being homeless caused them to delay seeking health care; paradoxically those citing physical health as a SAT motivator were 3.4 times more likely to have delayed care. While acutely ill homeless persons were at least as motivated for SAT, these data suggest the challenge is getting them to care in a timely manner and tailoring interventions during the care episode to avail of this motivation.

Original languageEnglish (US)
Pages (from-to)1239-1243
Number of pages5
JournalAddictive Behaviors
Volume33
Issue number9
DOIs
StatePublished - Sep 2008

Fingerprint

Homeless Persons
Substance-Related Disorders
Motivation
Health
Health care
Medicine
Education
Episode of Care
Hospital Medicine
Therapeutics
Urban Hospitals
Hepatitis C
Hepatitis B
Hospital Emergency Service
Demography
Delivery of Health Care
Surveys and Questionnaires

Keywords

  • Drug abuse
  • Health seeking behavior
  • Homeless
  • Medical complications
  • Motivation for treatment
  • Readiness for change

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

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title = "The health encounter as a treatable moment for homeless substance-using adults: The role of homelessness, health seeking behavior, readiness for behavior change and motivation for treatment",
abstract = "Substance-using homeless persons frequent emergency departments and hospitals often. However, little is known about how homelessness affects when they seek care and their motivation for substance abuse treatment (SAT). We surveyed homeless (N = 266) and non-homeless (N = 104) substance-using adults sequentially admitted to an urban hospital medicine service, comparing demographics, readiness for change (URICA), and motivating reasons for SAT. Homeless respondents were more likely to be younger, uninsured, have hepatitis B/C, and <12th grade education. The majority in both groups were in either a precontemplative or contemplative stage of change, although more homeless respondents were in an action stage. They also had similar motivating reasons for wanting SAT, although being homeless was an additional motivator for the majority of homeless respondents. Almost half reported that being homeless caused them to delay seeking health care; paradoxically those citing physical health as a SAT motivator were 3.4 times more likely to have delayed care. While acutely ill homeless persons were at least as motivated for SAT, these data suggest the challenge is getting them to care in a timely manner and tailoring interventions during the care episode to avail of this motivation.",
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