Homeless with alcohol-use disorders - a social perspective

Authors: Cristina Proença, Carla Frazão, Paula Olas

Background: The social intervention with people with psychoactive substance abuse or dependency in Portugal within the scope of the Governmental Health Drug Treatment and Social Reinsertion Services is a fundamental area of intervention. It applies a social intervention model, based on social mediation and the definition of individual insertion plans. Social intervention contemplates the various dimensions of the individual and social systems. After social diagnosis (identification and prioritization of social needs) it is co-constructed the individual insertion plan and resources are mobilized and mediating strategies, both internal and external, are powered. Within this area, often emerge situations of homeless people in need of an intervention of greater proximity, that fosters social inclusion and empowerment to use social support networks, adapted to the each patient needs. This poster aims to characterize the social situation of homeless people in treatment and the analyses compare the social situation at the beginning of social intervention and after follow up.

Method: Retrospective analysis of the universe of 77 people in a situation of homeless with abuse or dependency of psychoactive substances accompanied by social workers in the Lisbon Alcohology Unit during the year 2017. The analysis is based in data collection from the patient clinical and social process, that include records of various dimensions: socio-demographic, history of homelessness, consumption of psychoactive substances, therapeutic project, social diagnosis (identified needs and identified areas of social intervention) and social support networks. The follow-up methodology was carried out from two strategies: for ambulatory active patients was collected in a face to face social consultation; for the non-active patients through telephone contact or through the social support network structure, including those that are integrated in Therapeutic Communities. Therefore, this analysis involve 77 patients, 91% of males, ranging from 27 to 65 years, with about 55% being over 50 years old.

Results: The majority of the patients had exclusively problems related to alcohol, but around 15% had other psychoactive substances use. At the time of entry into treatment, the majority did not maintain contact with family of origin and their main social support network came from formal structures of health and social protection. In terms of social diagnosis, the main needs identified are in the social intervention areas of health, social protection, housing and citizenship/justice. The analysis also allowed to understand the relationship between the therapeutic project (individual treatment plan) and individual insertion plan and adherence to both. The follow-up examines the current homeless situation, including the type of housing, whether or not they are homeless, their employment situation, therapeutic project and the social support networks.

Conclusion: The results allow to identify needs diversity associated with homeless people with substance abuse and / or dependency, which allows a greater reorganization of the formal services to support this population, as well as the identification of more appropriate intervention strategies that in fact promote social inclusion in their different dimensions at micro, meso and macro level.