HOMELESS SHELTERS AND SUBSTANCE MISUSE

We read with interest Wendy Muckle and Jeffrey Turnbull's guest
editorial on homelessness.1 Although shelters are not perfect, they do
protect people from some aspects of homelessness. For example, there
is evidence of cognitive impairment in some homeless people,2 and this
association is partially dependent on housing quality.3

We compared substance misuse in 31 homeless people staying in
supportive shelters with that in 15 people who were literally roofless
in Sheffield in the United Kingdom. Thirteen (87%) of the roofless
people had injected drugs in the past month compared with only 4 (13%)
of the people in shelters. All 15 (100%) of the roofless people had
been using heroin or crack cocaine regularly in the past year compared
with only 10 (32%) of the people living in shelters.

Homelessness is inevitably harmful and can become self-perpetuating.
In our study, despite the lower level of drug use in people living in
shelters, 18 (58%) of the people in this group had started taking at
least 1 new drug since becoming homeless. If the homeless do not
receive significant levels of help, the problems they experience can
multiply. A public policy of increasing resources to address the
problems of the homeless would likely be highly cost-effective over
the longer term. Muckle and Turnbull are right to be concerned about
the possibility of cutbacks by the current Canadian government to the
homelessness funding program.

Graham Pluck, Kwang-Hyuk Lee and Randolph Parks,

University of Sheffield School of Medicine,

Sheffield, UK

REFERENCES

1. Muckle W, Turnbull J. Sheltering the homeless [editorial]. CMAJ
2006;175(10):1177.[Free Full Text] 2. Spence S, Stevens R, Parks R.
Cognitive dysfunction in homeless adults: a systematic review. J R Soc
Med 2004;97:375-9.[Abstract/Free Full Text] 3. Seidman LJ, Russell KS,
Caplan B, et al. The effect of housing interventions on
neuropsychological functioning among homeless persons with mental
illness. Psychiatr Serv 2003;54:905-8.[Abstract/Free Full Text]