The Influence of Substance-use to Recurring Homelessness in Utrecht.
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Background: It has become clear that addiction-problems often go hand in hand with a relapse in homelessness. This study investigated the relationship between homelessness and addiction-problems with Fitzpatrick’s realist model to consider the influence and relationships of the macro-structural to the micro-individual factors on homelessness and substance-use. Accordingly, the study aimed to answer the research question: How does substance-use relate to homelessness and what factors contribute to this relationship? Methods: Qualitative, semi-structured interviews were conducted among 41 respondents at two time points. Results: Results showed that indeed addiction-problems are often associated with homelessness and relapse in homelessness. Furthermore, the results show that the relationship between addiction and homelessness is bi-directional. This means that addiction can be the cause of homelessness, but that homelessness can also be the cause of addiction. Furthermore, respondents clearly indicate that multiple factors play a role in becoming homeless, including debts, the loss of important contacts (friends, family, divorce), and nuisance in the home. However, it appears that in most cases these other factors are related to the respondent's addiction-problems. This clearly illustrates Fitzpatrick's idea of interrelationships between the factors causing homelessness. Conclusion: The relationship between addiction and homelessness is complex, as addiction-problems affect a host of other factors that play a role in becoming homeless. This makes tackling addiction among the homeless very valuable. Therefore a review has been done on the two existing programs that focus on tackling addiction and homelessness, namely the continuum-of-care program and housing-first program. What appears is that both approaches are probably ineffective because they focus on one factor at the time, as this research found that addiction and homelessness always co-occur and should therefore be tackled together.