Academic journal article Social Work Research

Personal and Situational Perspectives on Rejection of a Homelessness and Substance Abuse Program: An Exploratory Study

Academic journal article Social Work Research

Personal and Situational Perspectives on Rejection of a Homelessness and Substance Abuse Program: An Exploratory Study

Article excerpt

Services rejection is of special concern for outpatient substance abuse programs that treat adults who have experience with homelessness. Rejection is alleged to occur with alarming frequency among members of this population, and there is evidence that it has the potential to limit progress on drinking, drug, and homeless problems. This article tests the contribution to rejection of two sets of factors: (1) special personal attributes, which are widely believed to affect homeless clients' motivation or ability to participate in an intervention; and (2) situational factors (that is, external circumstances), which occasionally are alleged to influence clients' perceptions of the rewards of the services compared to the costs. The results more generally imply that client responses are more fully explained by environmental cues and experiences than by the measured personal deficits. Isolation is the only predictive special personal attribute.

Keywords: homelessness; intervention research; services rejection; substance abuse services

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Outpatient substance abuse treatment programs typically are rejected by over half of the homeless adults recruited (Blumberg, Shipley, & Shandler, 1973; Shipley, Shandler, & Penn, 1989; Stahler et al., 1993). Yet the lack of treatment can constrain severely recovery from both substance abuse and homelessness; that is, evidence suggests that the abuse problems (usually measured as alcohol abuse) are associated with longer periods of homelessness and higher rates of returns to homelessness (Piliavin, Sosin, Westerfelt, & Matsueda, 1993; Sosin, 1992), whereas substance abuse and homelessness are known to be ameliorated by certain outpatient interventions (Cox, Meijer, Carr, & Freng, 1993; Sosin, Bruni, & Reidy, 1995). From 30 percent to 60 percent of homeless adults have substance abuse problems (Fischer & Breakey, 1991; Lehman & Cordray, 1993; McCarthy, Argeriou, Huebner, & Lubran, 1991).

Some of the literature suggests that homeless individuals fail to participate in treatment because of three sets of special attributes (Bahr & Caplow, 1973; Baum & Burnes, 1993; Blumberg et al., 1973; Wallace, 1965; Wiseman, 1970). Disaffiliation, an alleged propensity of certain homeless adults to withdraw from social institutions in general, is argued to give rise also to a tendency to refuse the offer of treatment. Isolation, a simple lack of the social ties believed to help individuals maintain a residence, is alleged by at least one study to reduce access to the social supports that encourage seeking help (Fischer, 1989). Personal deficits, which are controversially tied to homelessness, are relatively widely claimed to limit client motivation and ability to make use of offered treatment; affected individuals allegedly either do not understand their problems or are too disoriented to appreciate the benefits of treatment. The deficits are said to include mental health, employment, or unusually severe substance abuse problems (Baum & Burnes, 1993; Breakey, 1987; Fischer, 1989; Grigsby, Baumann, Gregorich, & Roberts-Gray, 1990; Stahler et al., 1993). In essence, the literature implicitly suggests a special personal attribute perspective on services rejection. This does not focus on all individual characteristics that might affect rejection among the general population. Rather, it defines an alleged self-defeating homeless "syndrome"; clients with three types of traits are posited to lack motivation to participate in treatment, to be bereft of information about treatment, or to be unable to accept and make use of treatment.

The special personal attribute perspective is highly debatable because of the lack of evidence for its basic premises; it is unclear whether homeless individuals truly reject treatment more frequently than other adults (Baekeland & Lundwall, 1975; Stark, 1992). Moreover, it is possible to offer an alternative, social-situational perspective, which suggests that homeless clients reject treatment as a response to cues in their environment. …

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