Alcohol, tobacco & other drugs in Australia

The most recent data from the census of population and housing show that there were approximately 116,000 people experiencing homelessness in Australia in 2016 (ABS 2018). This is a rate of 50 people for every 10,000 population and includes people who were in supported accommodation for the homeless, in temporary accommodation, in severely crowded dwellings (those requiring 4 or more extra bedrooms to accommodate them adequately) and people who were ‘sleeping rough’ (ABS 2018).

The Journeys Home project (a longitudinal survey of Australians), found that of those people who had experienced housing instability or homelessness, risky use of substances was also reported for alcohol (57%), illicit drug use (39%) and the injection of drugs (14%) in the previous 6 to 12 months (Scutella et al. 2014).

Research from homelessness services in Melbourne showed that 43% of the homeless population reported that they had alcohol and other drug use problems. Of these, one-third reported that they had these problems prior to becoming homeless, with the remaining two-thirds reporting that they developed problems with alcohol and other drugs following homelessness (Johnson & Chamberlain 2008). The duration of substance use problems is often prolonged in the homeless population, because their social networks may perpetuate their alcohol and other drug problems.

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 or other drug issues.

In 2018–19 (AIHW 2019):

• 1 in 10 (10% or almost 28,000) SHS clients aged 10 and over reported problematic alcohol and or drug use.

Of those:

• 55% presented to SHS as homeless and 45% at risk of homelessness (Table S3.16).
• Most clients were males (54% or more than 15,000 clients) and had a younger age profile than other SHS client groups with around 8 in 10 (79%) clients aged under 44 years (Table S3.17).
• Clients with AOD issues also were less likely to be provided with accommodation, decreasing from 53% in 2014–15 to 50% in 2018–19 (Table S3.16) compared with clients without AOD issues over the 5 year period.
• Almost 1 in 5 (18.8%) clients had no shelter or improvised/inadequate dwelling when they sought services and over 1 in 10 (11.2%) exited services with no shelter or improvised/inadequate dwelling (Table S3.19).

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. For example:

• 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% (8,700) of SHS clients reported that they had sought assistance for problematic alcohol use, a similar proportion to previous years (AIHW 2019).
• Of the 28,000 (10%) clients with problematic drug and/or alcohol use in 2018–19, 74% (more than 20,800) were returning clients while 26% (or more than 7,100) 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 (AIHW 2019).
• 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 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). For example, around 6% of clients (18,148) who sought assistance from SHS in 2018–19 also reported problematic drug or substance use (AIHW 2019).

The Illicit Drug Reporting System (IDRS) is an annual survey of people who regularly inject drugs across Australia (Peacock et al. 2019). Of the 902 participants interviewed in 2019, less than one-fifth (17%) reported that they were homeless (i.e. that their current accommodation was either no fixed address, shelter / refuge or boarding house / hostel). The proportion of those who were homeless decreased from 23% in 2018 (Figure HOME1; Table S3.21).

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 3–5 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

Data from the SHSC (AIHW 2019) shows that in 2018–19:

• Around 1,400 (5.1%) of clients with problematic drug and/or alcohol use were formally referred to a SHS agency by an alcohol and drug treatment service.
• The Northern Territory had the highest rate of clients presenting to SHS with problematic drug or alcohol issues (39.4 per 10,000 population), followed by Tasmania (16.5 per 10,000), Victoria (14.9 per 10,000) and the ACT (11.7 per 10,000) (Table S3.23).  
• NSW and Victoria had the highest number of clients with a problematic drug and/or alcohol use issue receiving assistance at 8,300 and 9,600 respectively, while the ACT had the lowest at 500 (Table S3.23).

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 clients who seek treatment for alcohol and other drug 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 HOME2).

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).

Policy context

The National Housing and Homelessness Agreement

From July 1 2018, the National and Homelessness Agreement (NHHA) replaced the National Partnership Agreement on Homelessness and the National Affordable Housing Agreement (supported by the National Affordable Housing Specific Purpose Payment). The NHHA is a multilateral national agreement and its objective is to contribute to improving access to affordable, safe and sustainable housing across the housing spectrum, including to prevent and address homelessness, and to support social and economic participation (CFFR 2018).

The Federal Government in partnership with states and territories to outline priority homelessness cohorts and policy areas that must be addressed in homelessness strategies (CFFR 2018). The NHHA has a focus on policy areas that include achieving better outcomes for people, early intervention and prevention, and commitment to service program and design. The priority homelessness cohorts identified in the NHHA include:

• women and children affected by family and domestic violence
• children and young people
• Indigenous Australians
• people experiencing repeat homelessness
• people exiting institutions and care into homelessness
• older people.

Other priority homelessness cohorts may be identified with states in their respective bilateral schedules.

Whilst there is not a specific reference to those persons experiencing alcohol and other drug related problems and homelessness, some of the key groups will be likely to include this population.

Further information can be found at the Council on Federal Financial Relations. 

References

ABS (Australian Bureau of Statistics) 2018. Census of population and housing: Estimating homelessness, 2016. ABS cat. no. 2049.0. Canberra: ABS. Viewed 25 May 2018.

AIHW (Australian Institute of Health and Welfare) 2016. Exploring drug treatment and homelessness in Australia: 1 July 2011 to 30 June 2014. Cat. no. CSI 23. Canberra: AIHW. Viewed 10 January 2018.

AIHW 2019. Specialist homelessness services annual report 2018–19. Viewed 18 December 2019.

CFFR (Council on Federal Financial Relations) 2018. National Housing and Homelessness Agreement. Viewed 26 June 2018.

Johnson C & Chamberlain G 2008. Homelessness and substance abuse: which comes first? Australian Social Work, 61(4)342:356. Viewed 1 February 2018.

Johnson G, Scutella R, Tseng Y & Wood G 2015. Entries and exits from homelessness: a dynamic analysis of the relationship between structural conditions and individual characteristics. AHURI Final Report no. 248. Melbourne: Australian Housing and Urban Research Institute. Viewed 31 January 2018.

Kermode M, Crofts N, Miller P, Speed B & Streeton J 1998. Health Indicators and risks among people experiencing homelessness in Melbourne 1995–1996. Australia and New Zealand Public Health, 22:464–70.

Okuyemi KS, Caldwell AR, Thomas JL, Born W, Richter KP, Nollen N, et al. 2006. Homelessness and smoking cessation: Insights from focus groups. Nicotine & Tobacco Research, 8(2):287–96.

Peacock A, Uporova J, Karlsson A, Gibbs D, Swanton R, Kelly G, Price O, Bruno R, Dietze P, Lenton S, Salom C, Degenhardt L & Farrell M  2019. Australian Drug Trends 2019: Key findings from the National Illicit Drug Reporting System Interviews. Sydney: National Drug and Alcohol Research Centre, UNSW Australia.

Scutella R, Chigavazra, A Killackey E, Herault N, Johnson G, Moschion J et al. 2014. Journeys home research report no. 4. Melbourne: University of Melbourne.

Stafford J & Breen C, 2017. Australian Drug Trends 2016. Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trend series no. 163. Sydney: National Drug and Alcohol Research Centre, UNSW Australia.