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Specialist homelessness services (SHS) are delivered by non-government organisations and include specific services for those persons seeking housing as well as other services that assist them to maintain housing. These include people who experience alcohol and/or other drug issues.
In 2020–21 (AIHW 2021):
- 1 in 10 (10%, or almost 27,200) SHS clients aged 10 and over reported problematic alcohol and/or drug use.
- the Northern Territory had the highest rate of clients presenting to SHS with problematic drug and/or alcohol issues (30.0 per 10,000 population, or 738 SHS clients), followed by Victoria (14.9 per 10,000, or 9,972) and the ACT (14.5 per 10,000, or 626) (Table S3.23).
Of the 27,200 SHS clients who reported problematic alcohol and/or drug use:
- 59% were experiencing homelessness and 38% were at risk of homelessness when they presented to SHS.
- Of the 27,200 (10%) clients with problematic drug and/or alcohol use in 2020–21, 78% (over 21,300) were returning clients while 22% (or almost 6,000) were new clients. That is, more clients had previously received services at some point since the collection began in 2011–12 than were new clients seeking assistance.
- Most clients were males (52% or 14,288 clients).
- Around 8 in 10 (78%) clients were aged under 45 years (Table S3.17).
- Of those who needed accommodation (22,103), almost two-thirds (64%) were provided accommodation while a further 14.8% were referred to another agency (Table S3.16).
- Almost 1 in 5 (18.9%) clients were sleeping rough (no shelter or improvised/inadequate dwelling) when they sought services and 1 in 10 (10.0%) exited services sleeping rough (Table S3.19).
- 44% had a current mental health issue, 8.1% had experienced family and domestic violence and 32% experienced both vulnerabilities (AIHW 2021).
- Around 1,300 (4.9%) clients with problematic drug and/or alcohol use were formally referred to a SHS agency by an alcohol and drug treatment service.
Tobacco smoking
The general health status of the people experiencing homelessness tends to be poorer than the general population.
- In the absence of national smoking rates for people experiencing homelessness, a study in Melbourne from 1995–96 found that 77% of people who were experiencing homelessness were smokers and this increased to 93% for those people experiencing homelessness who were sleeping rough (living on the streets) (Kermode et al. 1998).
- Studies have shown that people experiencing homelessness may adapt their smoking behaviours in order to save money, thus exposing themselves to greater health risks. This can include sharing cigarettes and smoking from used cigarette butts or filters (Okuyemi et al. 2006).
- The Journeys Home data showed that an average increase in consumption of one cigarette a day increased the risk of experiencing homelessness by 0.2% (Johnson et al. 2015).
Alcohol consumption
Research has found that problematic alcohol consumption is associated with homelessness.
- The Journeys Home data showed that an average increase in alcohol consumption of one drink a day, increased the risk of experiencing homelessness by 0.2% (Johnson et al. 2015).
- Around 3% (8,146) of SHS clients reported that they had sought assistance for problematic alcohol use in 2020–21, a similar proportion to previous years (AIHW 2021).
- Among those who received specialist alcohol and other drug treatment services, alcohol was the principal drug of concern (40.4%) for people who sought support from both SHS and alcohol and other drug (AOD) treatment services. This was slightly higher than those who had not sought assistance for homelessness (AIHW 2016) (Table S3.20).
Illicit drugs
Regular drug use is correlated with entries into homelessness (Johnson et al. 2015). In 2020–21, around 6% of clients (17,735) who sought assistance from SHS in 2020–21 reported problematic drug or substance use (AIHW 2021).
The Illicit Drug Reporting System (IDRS) is an annual survey of people who regularly inject illicit drugs across Australia (Sutherland et al. 2021). Of the 888 participants interviewed in 2021, one-quarter (27%) reported that they were homeless (that is, current accommodation was no fixed address, shelter/refuge or boarding house/hostel), an increase from 23% in 2020 (Table S3.21).
Data collection for 2021 took place from June to July. Due to COVID-19 restrictions being imposed in various jurisdictions during data collection periods, interviews in 2020 and 2021 were delivered face-to-face as well as via telephone. This change in methodology should be considered when comparing data from the 2020 and 2021 samples relative to previous years.
The 2016 IDRS also asked people who had recently injected drugs about their lifetime history and duration of experiences of homelessness (Stafford & Breen 2017). The report showed that:
- 80% had a history of homelessness
- 25% were currently homeless
- 25% total duration of their lifetime homelessness was 1–2 years.
Queensland (91%), New South Wales (NSW) (90%) and Victoria (86%) had the highest proportion of respondents reporting a lifetime history of homelessness, while Tasmania (70%) and the Australian Capital Territory (ACT) (73%) had the lowest.
Similarly, NSW (37%), Victoria (31%) and Queensland (29%) had the highest proportion of respondents currently homeless (Table S3.22).
Health and harms
For clients with problematic alcohol and/or other drug use, additional vulnerabilities such as mental health issues, may make them more vulnerable to homelessness. In 2019–20, 44% (or more than 12,400) clients with problematic drug and/or alcohol use also reported a current mental health issue and 31% (almost 8,700) reported a current mental health issue and experiencing family and domestic violence (AIHW 2020).For clients with problematic alcohol and/or other drug use, additional vulnerabilities such as mental health issues, may make them more vulnerable to homelessness. In 2019–20, 44% (or more than 12,400) clients with problematic drug and/or alcohol use also reported a current mental health issue and 31% (almost 8,700) reported a current mental health issue and experiencing family and domestic violence (AIHW 2020).
Treatment
Research has shown that there is often overlap between drug and alcohol misuse and homelessness (AIHW 2016). The Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) collects information on treatment provided to clients by publicly funded alcohol and other drug treatment services, yet it does not collect information on the client’s experience of homelessness.
To better understand the characteristics of those experiencing homelessness and alcohol and other drug issues, a recent study linked the AODTS NMDS to the SHS data collection (AIHW 2016). The key findings demonstrate that the homeless population experiences additional complexities. Specifically, clients who had sought assistance from both SHS and AODTS:
- had lower rates of unemployment (6%), compared to 13% of SHS-only clients
- comprised a higher proportion of Indigenous Australians (27%) compared to 13% of AODTS only clients
- sought treatment for multiple drugs (18%), 3 times higher than the AODTS only population
- had poor AOD treatment and housing outcomes compare to the AODTS-only and SHS-only populations.
Of those who had sought assistance for both homelessness and AOD treatment, the most common principal illicit drugs of concern (the main substance that the client sought treatment for) were cannabis (28.6%) and amphetamines (20.5%) (Figure HOME1).
Persons who sought assistance from both SHS and AODTS were twice as likely to report heroin as a principal drug of concern (11.3%) compared to 5.7% for AODTS only (AIHW 2016) (Table S3.20).