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The challenges of comorbidities: a qualitative analysis of substance use disorders and offending behaviour within homelessness in the UK

The challenges of comorbidities: a qualitative analysis of substance use disorders and offending... JOURNAL OF SOCIAL DISTRESS AND HOMELESSNESS https://doi.org/10.1080/10530789.2023.2205189 The challenges of comorbidities: a qualitative analysis of substance use disorders and offending behavior within homelessness in the UK a b a Honor Sibthorp Protts , Stephen Sharman and Amanda Roberts a b School of Psychology, University of Lincoln, Lincoln, UK; National Addiction Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, Camberwell, UK ABSTRACT ARTICLE HISTORY Received 5 September 2022 Homelessness and rough sleeping are currently on the rise in England. Literature evidences an Revised 11 April 2023 empirical relationship between substance use disorders and offending behavior within Accepted 17 April 2023 homelessness. This qualitative study explores this relationship from the perspective of those currently experiencing homelessness and substance use disorders, with an offending history. KEYWORDS Thematic analysis identified substance use disorders as the dominant factor in the continuous Homeless; substance; relationship between three. Furthermore, when discussing their experiences of prison, offending; rough sleeping; participants did not identify prison as a deterrent from committing offenses. Feelings of marginalized stigmatization and marginalization from mainstream society were also identified, but participants expressed feelings of social inclusion within their marginalized groups. These findings, and their implications for support services in the community, are discussed in this paper. Introduction with specific support needs, including substance use disorders, and offending, when compared with other Homelessness in England forms of homelessness (Dorney-Smith et al., 2019; Homelessness can be categorized in different ways, Fitzpatrick & Pleace, 2012). including temporary accommodation, sofa surfing and, the most commonly known and visible form, Causation of homelessness rough sleeping. Since 2010, homelessness has steadily increased in England, and figures from 2018 estimate As highlighted by Bramley and Fitzpatrick (2018), to that approximately 4677 individuals rough slept in avoid marginalization and labeling of those suffering England on a single night, a 165% increase since from homelessness, charities and other organizations 2010 (Ministry of Housing, Communities & Local share the view that homelessness can happen to any- Government, 2019). The office of national statistics one (Brown, 2018; Marsh, 2016; St Mungos, n.d.). also published an estimated number of 4266 rough Whilst this statement is not incorrect, it arguably sleeping on a single night in 2019, and 2688 individ- gives the misconception that homelessness is random uals rough sleeping on a single night in 2020 (ONS, and diverse. However, there is a clear pattern which 2021). The significantly lower figures in 2020 may be highlights the individual factors most likely to increase attributed to the introduction of temporary new vulnerability to homelessness. measures, the “Everyone In” scheme, that provided Poverty has been highlighted as the most common emergency accommodation to those rough sleeping cause of homelessness (Aldridge, 2020; Anderson & during the coronavirus pandemic (Cooney, 2021), Christian, 2003; Bramley & Fitzpatrick, 2018;O’Calla- therefore is not a reliable indicator of rough sleeping ghan et al., 1996). However, this broad term has been when society is functioning fully (ONS, 2021). For criticized, as it disregards the complexity of homeless- the purpose of this study, all participants were inter- ness, explaining only a heightened vulnerability to viewed prior to the COVID 19 lockdown, and the potential issues including substance use and offending introduction of the “Everyone In” scheme. (Benjaminsen & Andrade, 2015). For example, Rough sleepers can be defined as “People sleeping, research has found that entrenched poverty is associ- about to bed down or actually bedded down in open ated with substance use disorders and chronic offend- air” (Public Health England, 2020) and are often single ing (Aldridge, 2020; Bramley et al., 2015), both of homeless adults without partners or dependent chil- which are strongly associated with homelessness dren (Shelter, 2012). Single homeless often need (Aldridge, 2020; England et al., 2022; Rowlands, higher support and are more strongly associated 2011). It could be inferred that substance use disorders CONTACT Honor Sibthorp Protts honor.sibthorpprotts@nhs.net School of Psychology, University of Lincoln, Lincoln, LN6 7TS, UK © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrest- ricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. 2 H. S. PROTTS ET AL. and offending, within the context of poverty, may have Most significantly, the Homelessness Reduction contributed to this conclusion that poverty is the most Act (HRA) 2017, came into force in England in common cause of homelessness. However, as pointed April 2018, meaning it was in place for four of the out by O’Sullivan et al. (2020), current literature avail- ten participants interviewed in this study, and placed able on homelessness seems to primarily focus on new responsibility on local authorities (Madoc-Jones homelessness within specific contexts, such as sub- et al., 2018). The HRA 2017 updated legislation in stance use or offending. the Homelessness Act 2002, s. 193, which stated that A small number of studies have identified other the local authority had a duty to provide suitable experiences which are more prevalent in the homeless accommodation for individuals categorized as “pri- population compared to the general population. This ority need.” This refers to those who are deemed includes Edalati and Nicholls (2019) and Larkin and highly vulnerable, and no participants in this study Park (2012) who reported early experiences of child- would meet the “priority need” threshold. Compara- hood trauma, including neglect, physical and tively, S. 5 of the HRA 2017 states that the local auth- emotional abuse, as risk factors for homelessness. ority “must take reasonable steps” to help the Bramley and Fitzpatrick (2018) also found that care applicant secure suitable accommodation, this applies leavers were at an increased risk of homelessness, to all applicants who are homeless, and not just those and Shelton et al. (2012) identified exclusion from who are priority need. Reasonable steps include the school as a predictor of homelessness. It is also well implementation of personal housing plans and holistic evidenced that mental and physical health issues are assessments, ensuring local authorities assess and con- common among those who are homeless and facing sider factors such as circumstances leading to home- other challenges including substance use disorders lessness and support needs (Garvie, 2018). and offending (Bramley et al., 2020; England et al., Whilst the implementation of these new measures 2022; Fitzpatrick et al., 2013; Philippot et al., 2007). should see a general improvement in housing and The range of studies evidence broad spectrum of vul- homelessness support, other factors related to the par- nerabilities that are associated with homelessness, and ticipants in this study will impact the effectiveness of the wider issues that would benefit from further the HRA 2017 in supporting their needs. For example, exploration. under s.5 of the HRA 2017 local authorities do not have to provide this support if an individual does not reasonably cooperate. Whereas those who are liv- Support and services ing with homelessness, substance use disorders, and In an attempt to reduce rough sleeping, the UK gov- an offending history, often lead an unstable and chao- ernment has introduced initiatives such as “No Second tic lifestyle, this can make cooperating with services Night Out” (NSNO), which directly supports rough more challenging (Bramley et al., 2020; ONS, 2021). sleepers in accessing emergency accommodation Furthermore, the legislation does not state that an (NSNO, n.d.) and Streetlink, which provides a con- applicant must be provided accommodation, only necting service for rough sleepers and local services that they should be supported to access suitable (Streetlink, n.d.). Additionally, specialist primary accommodation. After 56 days, the local authority healthcare centers were established for individuals can end their support, whether the accommodation facing homelessness to overcome barriers they experi- has been found or not. For those with substance use ence when accessing healthcare services (Gunner et al., disorders, and offending histories, they are much 2019). For example, “Housing First,” is a scheme that more likely to be excluded or unsuccessful in finding aims to house individuals, before engaging them with accommodation (Bramley & Fitzpatrick, 2018; Wil- support including healthcare, mental health, and sub- liams et al., 2012), making it more challenging to stance use services (Baxter et al., 2019). More targeted access accommodation in the time period. schemes have also been implemented, including the Furthermore, although the changes brought in by the Ministry of Justice’s new resettlement approach to HRA 2017 may still impact responses from participants, preventing homelessness amongst the prison popu- the challenges faced by those living with homelessness, lation (Madoc-Jones et al., 2018). who have substance use disorder and offending his- Whilst these initiatives, and many other services are tories, are severe and enduring (Bramley & Fitzpatrick, available for rough sleepers, rough sleeping remains 2018; Fitzpatrick et al., 2013). Therefore, unlikely to be stubbornly high, and many are not actively engaging overcome by the introduction of the HRA 2017. with services (ONS, 2021). Johnsen and Jones (2015) also report that the resources available and time press- Homelessness and substance use disorders ures often mean support, assessments and services for rough sleepers are limited, and although good practice Evidence suggests substance use disorders are strongly guidelines are provided nationally, implementation of related to homelessness (Aldridge et al., 2018; ONS, these often deviate substantially. 2019), with as many as 60% of rough sleepers recorded JOURNAL OF SOCIAL DISTRESS AND HOMELESSNESS 3 as experiencing drug or alcohol problems. However, When looking at prison sentences, Geller and Cur- this figure may be an underestimation as it does not tis (2011) and Greenberg and Rosenheck (2008) account for those who do not engage with services. reported that those who had been imprisoned pre- Despite this, the question remains as to whether sub- viously were at a greater risk of homelessness, irre- stance use disorders precede or succeed homelessness. spective of whether they had been homeless before. Shelton et al. (2009) found that, for the majority of Egleton et al. (2016) found that serving a prison sen- participants, substance use disorders preceded and tence often had knock-on-effects such as unemploy- contributed to homelessness. This is supported by ment, poorer mental health, and difficulties Rowlands (2011) who found that participants reintegrating back into society, ultimately leading to described drug use as leading to eviction from the problems finding accommodation. Moschion et al.’s family home. A further study found substance use dis- (2019) study found that homelessness does not orders predominantly preceded homelessness, even increase the likelihood of going to prison, whilst a though it may not be the primary cause (Fitzpatrick prison sentence did increase the likelihood of home- et al., 2013; Philippot et al., 2007). lessness. Therefore, suggesting that offending could However, Clatts et al. (2005) identified drug use in precede homelessness. homeless individuals as an “adaptation of behaviour” Although the studies on this relationship are lim- succeeding homelessness, rather than a cause, which ited, the variation of the findings implies that home- Fitzpatrick et al. (2013) attributed to a coping/survival lessness can either precede or succeed offending and response. Research also indicates that individuals prison sentences, and the complexities of this relation- report using substances as self-medication, or as an ship may be more impacted by other support needs escape from reality, and that substance use disorders associated with homelessness. can evolve as a consequence of homelessness. How- Studies that examine the relationship between ever, pre-homeless substance use can also predispose homelessness and offending also highlight the associ- the individual to increased substance use after home- ation with substance use disorders (Bozkina & Hard- lessness (Fitzpatrick et al., 2013; Stablein, Hill, Kesha- wick, 2021; Bramley et al., 2020; Gray et al., 2020; varz & Llorente., 2021). It should be noted that some Kushel et al., 2005; Lankenau et al., 2005; Rowlands, studies address drug and alcohol use separately; Row- 2011). Some papers identified an interplay between lands (2011) and Clatts et al. (2005) focused on drug substance use disorders and offending in homeless use and did not include alcohol, which Fitzpatrick participants, and found that offenses often related to et al. (2013) highlighted as a major issue. substance habits (Gray et al., 2020; Rowlands, 2011; Willis, 2004). Papers also identified the high presence of substance use disorders in those with housing needs Homelessness and offending behavior in the offending population (Bozkina & Hardwick, Evidence suggests a strong link between homeless- 2021; Bramley et al., 2020; Madoc-Jones et al., 2018; ness and offending. Figures from the Ministry of Jus- Williams et al., 2012). Such studies evidence an associ- tice reported that 26% of prison releases are ation between offending, homelessness, and substance “homelessness, rough sleeping or unsettled accom- use disorders, however, the sparsity of research modation” (Bozkina & Hardwick, 2021). Williams ensures the relationship is not yet fully understood. et al. (2012) reported that 79% of prisoners who were homeless before custody were reconvicted Aims within one year of release, compared with 47% of those who had not been homeless. The strong stat- In the current study, a qualitative approach was used istical link between offending and homelessness can to gain a more detailed insight into the challenges be found across a large number of studies (Bozkina directly from the perspective of those with lived & Hardwick, 2021; Bramley et al., 2020; Madoc- experience. This qualitative study sought to explore Jones et al., 2018). However, there is only a small the relationship between substance use disorders and number of studies exploring the reasons behind offending behavior within homelessness and to gather this relationship. information to better inform approaches to breaking Similar to homelessness and substance use dis- the cycle of homelessness. To achieve this, the study orders, there remains a question as to whether offend- explored three main questions and identified themes ing precedes or succeeds homelessness. Gray et al. and patterns within these. The first aim was to identify (2020), and Willis (2004) found that for homeless what is preceding or succeeding, and the causal and individuals, offending was often a means of survival perpetuating influences between substance use, e.g. stealing to eat, fueling drug habits, or paying for offending, and homelessness. The second aim was to accommodation, which could consequently lead to determine if a dominant support need is present and prison sentences. Therefore, suggesting offending which has a greater causal or perpetuating influence could succeed homelessness. on the other support needs. The third aim was to 4 H. S. PROTTS ET AL. understand how this may be impacting interactions the growth of evidence (Braun & Clarke, 2006), and with support services and recovery. this study aims to find common knowledge among participants regarding their shared experiences of homelessness. Method Design Participants This study used thematic analysis, guided by Braun and Ten adult, male participants were recruited through Clarke’s(2006) paper, and the framework of Neale’s an outreach support service available for rough slee- (2016) Iterative Categorisation. Thematic analysis pers, or those at risk of rough sleeping, in the local involves a process of identifying, analyzing, and area. The service was in an affluent town in the extracting patterns/themes from within a dataset, south of England and connected to the night-shelter which allows for a more flexible, detailed, and rich where some participants were temporarily residing, analysis (Braun & Clarke, 2006). However, the flexi- and the day center where all participants were inter- bility of the approach has been criticized for its lack viewed. Participants were identified by the service of clear guidelines (Braun & Clarke, 2006; Tuckett, staff and the researcher collaboratively, using an 2005). Iterative categorization provides a more struc- opportunity sampling method, they approached tured and standardized technique designed to be potential participants regarding involvement. applied to a range of qualitative analyses, including the- The inclusion criteria were adult males, either matic, and whilst time-consuming, should increase the rough sleeping or known rough sleepers residing in validity and reliability of the findings (Neale, 2016). the local night shelter. Participants had current sub- In completing the interviews, the researcher also stance use disorders, offending histories, and had considered how a smaller sample size may impact spent time in UK prison. All were fluent English the saturation of the paper. Saturation being reached speakers, with recent experience in support service is described as the point at which little or no relevant engagement. Participants were excluded if they information can be found in the data (Hennink & Kai- appeared under the influence of substances, had sig- ser, 2022). Guest et al.’s(2020) paper highlights that in nificant mental health concerns, learning disabilities, general the vast majority of themes are identified in or any other concerns related to lack of capacity to the first five to twelve interviews, as evidenced in Fran- consent. An eleventh participant was interviewed; cis et al. (2012), Guest et al. (2006), and Namey et al. however, due to concerns over his mental capacity (2016). Therefore, considering this paper focuses on during the interview, the recording was deleted and a specific hard-to-reach population, ten interviews data were omitted (Table 1). should satisfy the saturation need. Interviews Epistemology Before the interview, participants were given an infor- mation sheet, asked to sign a consent form, and A critical realist epistemological approach was used, informed of their right to withdraw. Interviews were which is defined by the assumption that knowledge conducted following a semi-structured format, lasting exists and can be shared among individuals (Braun between 20 and 40 min. Interviews were recorded by & Clarke, 2006). However, knowledge can only be Dictaphone, and were conducted, recorded, and tran- “imperfectly” known, due to our sensory capacity scribed by the lead researcher. This helped with main- and social construction, meaning knowledge is always taining confidentiality, whilst also aiding thematic subjective and subject to change (Braun et al., 2014, analysis and familiarization with the data. After the p. 22). The quality of knowledge is strengthened by interview, participants were debriefed. Interviews were conducted at a day center, a location with Table 1. Infographic data on participants. which all participants were familiar. Housing status at Length of time homeless (inc. Age interview on/off) P. 1 52 Rough sleeping 1 year Analysis P. 2 52 Night-shelter 37 years P. 3 40 Rough sleeping 24 years P. 4 29 Rough sleeping 3 years Following the framework of Neale’s(2016) IC and P. 5 53 Rough sleeping 15 years Braun and Clarke’s(2006) guidelines for thematic P. 6 53 Night-shelter 13 years analysis, the interview transcripts were read, notes P. 31 Night-shelter 4 years made, and initial themes drafted. Next, the transcripts P. 60 Rough sleeping 1 year were re-read, and quotations were coded in accord- P. 32 Rough sleeping 15 years ance with the drafted themes. Themes and ideas were drawn out based on importance and relevance JOURNAL OF SOCIAL DISTRESS AND HOMELESSNESS 5 to the research question. Once all transcripts had The relationship between homelessness, been coded, quotations were grouped by theme and offending, and substance use disorders collated into one document. This facilitated detailed Homelessness and substance use disorders comparisons of quotations made by different partici- For nine of the ten participants, substance use pre- pants and aided further development of richer, more ceded homelessness and was often the cause or a con- detailed themes. Using this document, theme boards tributing factor to their homelessness. were created. During this process, less relevant themes were discarded, similar themes were merged P.3 “Yeah, heroin addiction, yeah. It’s ALL been to do with my heroin addiction.” and subthemes were created, aiding more concise results. The theme boards were reviewed, refined, P.12 “Drinking is the reason I am homeless.” and ordered to ensure the most fitting narrative was Several other factors that led to homelessness were used. Lastly, the original transcripts were revisited also identified, including relationship breakdowns, to ensure the final themes were still representative evictions, and traumatic life experiences. These illus- of the raw data and had not been skewed during trated the unique pathways to each participant that the analysis process. resulted in their homelessness. 1. P. 3 “Sort of around, fifteen, just turning sixteen, Ethical considerations step dad kicked me out, he was an alcoholic, he The study was approved by The School of Psychology couldn’t sort his life out, so he just decided to take it all out on me.” Research Ethics Committee (SOPREC) at the Univer- sity of Lincoln, approval number PSY171874. In P.6 That’s why I’ve become homeless, because, I had a regard to ethical considerations, the lead researcher rented house in Grimsby in 2004, I was working for verbally explained informed consent, participant the Council, but my mum got cancer, she, so I gave my job up, gave my house and up moved into her information sheet, and right to withdraw before the one bedroom flat with, to look after her. interview. Due to the sensitive nature of the research and participants’ circumstances, there was a risk of But despite different journeys, all participants psychological harm. Therefore, when debriefed, infor- described substance use as a perpetuating factor of mation about support services for homelessness and their homelessness, implying that the causation of substance use was given to participants, and a further homelessness is less significant once an individual copy to their keyworker. Their keyworker was also finds themselves in the vicious cycle of homelessness informed if any concerns arose during their interview. and substance use. Participants were informed that no personal infor- The perpetuation of homelessness was both directly mation would be shared and were provided with a preventing them from accessing housing, and unique number should they wish to withdraw their indirectly, such as eviction due to rent arrears after data later. Participants were also informed that confi- spending their finances on substances. dentiality would be broken if information reported P.6 “I: Do you think drugs is what’s part of what kept was “likely to cause serious harm to the physical or you coming in and out of homelessness? /P: Yeah I mental health of the data subject or another individ- do, yeah. I think drugs has got the, I think it’s the big- ual,” in accordance with Section 15 of the Data Protec- gest factor in in my life." tion Act, 2018. 1. P. 13 “The drug use, led me to being homeless. I then got private rented, which then, I’ve lost again, Results and discussion because of drug use.” Findings initially discuss participant’s current experi- Although participant’s responses evidenced that their ences of homelessness, substance use, and offending, homelessness also perpetuated their substance use, identifying substance use as the dominant function participants also described substance use when in for both the onset and continuation of these experi- stable accommodation, which eventually led to home- ences. Next, participant’s experiences of support ser- lessness again. This suggests that when the element of vices are explored. Participant’s experience of prison homelessness is no longer relevant, the participants yielded an interesting combination of negative and are still unable to address their substance use dis- positive comments, indicating that prison was not a orders. However, even though most participants deterrent for committing offenses. Participant’s feel- referred to detoxing for short periods of time over ings of stigmatization and marginalization are also their life, the substance use was still identified as one discussed. Participants identify feelings of judgement of the biggest barriers to accommodation. Therefore, and distance from “mainstream society,” whilst also if participants were not using substances, it’s more forming support networks within their own margina- likely they would be able to maintain stable lized groups. accommodation. 6 H. S. PROTTS ET AL. because I was selling drugs at one point to fund my A substantial amount of research evidences the habit.” relationship between substance use disorders and homelessness. Findings illustrate that for the majority, 1. P. 13 Well, when I stopped dealing, I had to shop substance use precedes homelessness (Fitzpatrick lift. I still had to have it, and I had to keep the drug et al., 2013; Philippot et al., 2007; Rowlands, 2011; use up, or I was getting severely sick. Shelton et al., 2009), and further that substance use Interestingly, regardless as to whether they had been prior to homelessness can predispose the individual exposed to criminal activity in childhood, or whether to increased substance use after homelessness (Fitzpa- had or had not offended prior to substance use dis- trick et al., 2013; Stablein et al., 2021). A small number orders, it was apparent that once the participants of studies suggest substance use can be a consequence were experiencing substance use disorders, this was of homelessness (Clatts et al., 2005; Glasser & Zywiak, one of the biggest influences on their offending 2003), however, findings are comparatively scarce. behavior. Overall, literature has a general consensus that, The link between substance use and offending is whether substance use precedes or succeeds homeless- empirically supported by current literature (Bozkina ness, when an individual is experiencing homeless- & Hardwick, 2021; Bramley et al., 2020). For example, ness, there is a significant risk of heightened issues studies report a strong relationship between alcohol around substance use. consumption and criminal activity (Mason et al., Although one participant reported that his substance 2010; Popovici et al., 2012), and drug use and criminal use succeeded in his homelessness, it was not identified activity within the homeless population (Gray et al., as a causal factor. Therefore, with no participants identi- 2020; McNiel et al., 2005; Rowlands, 2011). fying homelessness as an initial causal factor for sub- In general, these findings point toward substance stance use disorders, this indicates that the substance use disorders as a direct perpetuating factor of offend- use may serve as the dominant function in the relation- ing behavior, such as committing offenses to fuel ship between homelessness and substance use disorders. addictions or whilst under the influence of substances (Gray et al., 2020; Willis, 2004). However, these studies focus on the active relationship between Offending behavior and substance use disorders offending behavior and substance use disorders in Many participants reported being exposed to a range homelessness, as opposed to what led to the relation- of criminal activities from a young age, which ship, making it difficult to ascertain which is more appeared to influence their own behaviors. likely to precede the other. Considering all participants identified substance 1. P. 1 “I have been bought up in sort of, everyone used to steal sweets and stuff, and um, so it just use disorders as a direct perpetuating factor of offend- depends who you are around with basically. So it ing, no participants identified offending as a direct just sort of becomes normal.” causal or perpetuating factor of substance use, and participants offending behavior was predominantly 2. P. 11 “First time I remember getting taken home by the police was when I was about 7, me and my brother influenced by their substance use. This would indicate and a couple of other lads nicked an army down at the that substance use serves as the dominant function in beach yard.” the relationship between offending and substance use disorders within homelessness. Seven of the ten participants reported that substance use disorders preceded their offending behavior and were often the cause or a contributing factor. This Homelessness and offending behavior included being under the influence of substances Participants described their offending behavior as when committing a crime and/or offending to fund both preceding and succeeding homelessness, and a habit. both causal and perpetuating of each other. There 1. P. 5 “The only reason why I did crime was because I was no pattern of behavior that significantly was homeless, on the streets and couldn’t see any influenced the other more. future, right.” P.10 “I first become homeless because of a prison sen- P.6 “all the crime what I have committed has been tence about 4 years ago, and like not having my own while under the influence of drugs.” house.” All participants also described the substance use as P.2 “When I was on the streets, you know, you got a perpetuating their offending behavior. However, nice pie and chips right, and you wanna nick it, and there was little evidence that offending behavior per- you can feel it in your heart mate.” petuated or caused substance use disorders. P.5 “The only reason why I did crime was either P.3 “I: what type of offences? /P: everything, from because I was homeless, on the streets and couldn’t theft to burglary, to robbery, drugs, intent to supply, see any future, right.” JOURNAL OF SOCIAL DISTRESS AND HOMELESSNESS 7 sentence. I lost the flat because I couldn’t pay for Participants in this study suggest that their offending the flat whilst I was in prison.” behavior was driven by survival needs or hopelessness, alongside substance use disorders, consistent with It is apparent that after individuals find themselves in (2020) and Rowlands (2011). This suggests that the this “vicious cycle,” their substance use, homelessness, type of offending behavior and motivation behind it and offending behavior begins developing further may differ from those who are not homeless, which negative functions. For example, if an individual was identified during interviews. were homeless with an offending history, but with no substance use disorder, then addressing their 1. P. 13 “I’m not really a criminal, I’m not criminally minded. Like, I don’t look at a situation and think in a homelessness would present fewer challenges (St criminal way of making some money.” Mungos, 2016). However, if a substance use disorder is present, this would have a negative impact on the This is supported further by the earlier theme, which homeless support, meaning an increased likelihood evidenced the impact of substance use disorders on of homelessness, which in turn would perpetuate the offending behavior, identifying the main motives as substance use, and increase the likelihood of offending funding substance use, or being under the influence behavior. of substances. Whilst all factors are intertwined, these findings There is an empirical foundation in literature to indicate that the dominant function for the onset support this relationship, with a generally shared con- and continuation of these factors is substance use dis- sensus that offending behavior can both precede and orders. Substance use, compared with homelessness succeed homelessness (Bender et al., 2007; Bozkina and offending, has an empirically supported addictive & Hardwick, 2021; Egleton et al., 2016; Kushel et al., element, which research would suggest impacts an 2005; Lankenau et al., 2005; Metraux & Culhane, individual’s “self-control, comprising the agency of 2006). Although, there is only a small number of free-will” (Volpone, 2018; Vonasch et al., 2017), and studies exploring this, many focusing on rates of could be an explanation for its dominant role. offenses, as opposed to the types of crimes (Bozkina This suggests that overcoming a substance addic- & Hardwick, 2021; Bramley et al., 2020; England tion may be the most effective way to break the et al., 2022). vicious cycle. However, it cannot be ignored that In this study, the previous subthemes identify sub- overcoming an addiction will be more challenging stance use as the dominant function in the continued when also facing homelessness and engaging in relationship between homelessness, offending, and offending behavior. substance use. Therefore, it is unsurprising that In an attempt to overcome comorbidities, “Housing when substance use is not directly observed in the First” was introduced, a scheme to house individuals analysis, a more bidirectional relationship is apparent. before engaging them in support for their needs The implication being that if you were to remove the (Pleace, 2016). Baxter et al. (2019) completed a element of substance use disorders from participants’ meta-analysis, with results reporting no clear differ- lives, they would be more likely to maintain stable ence in improvement of substance use and quality of accommodation, and less likely to offend. life when comparing housing first participants with those engaging in treatment as usual. Therefore, Homelessness, substance use disorders, and suggesting that addressing homelessness first, does offending behavior not have a significant impact on substance use dis- When participants spoke about these three experiences orders. However, Baxter et al.’s meta-analysis did together, it was clear that their substance use disorders highlight a reduction in the need for other healthcare were central to the complex and continued experience appointments, suggesting that being accommodated of homelessness, offending behavior, and substance use. can improve other areas of support needs. 1. P. 3 “So yeah, um, well, I went, I started taking little things [drugs] and that and then a few travellers took advantage of me because I was homeless and that, and Prison is not a deterrent just pretty vulnerable person. Then they just started feeding me Heroin and got me addicted to, addicted Deterrence to criminality as a broader concept has to Heroin, and that’s basically what started my steam- been described as either “general deterrence” or rolling. Then steamed me onto like a criminal career “specific deterrence” (Chalfin & McCrary, 2017). Gen- type of thing.” eral deterrence refers to when the threat of punish- 2. P. 13 “I was ill at home, couldn’t get a job because of ment acts as the deterrent, and specific deterrence is my drug use. Not much money, got involved with a when the experience of the punishment acts as the lot of people through my drug use. They used to deterrent for future actions (Loeffler & Nagin, 2022). come round in the day, started dealing drugs. I was Research exploring prison as a deterrent focusses on dealing the drugs that led to me dealing harder drugs. Which then took the frame of a prison how the different mechanisms function to prevent 8 H. S. PROTTS ET AL. crime. However, interestingly, one common theme in prison, which were more negative. Although, a review this study is that prison did not deter these partici- of the prison system in 2020 reported a significant pants from committing crime. This became apparent increase in overcrowding, unsuitable living con- through the way participants expressed their opinions ditions, violence, and self-harm in prisons between and experiences of prison, making both the positive the period of 2010 and 2020 (House of Commons and negative comments. Public Accounts Committee, 2020), suggesting the During interviews, six out of ten participants gave prison experience has worsened over time, as opposed of positive comments about their prison experience, to improved. It is plausible that due to the length of which were generally related to basic survival needs. time out of prison, these participants’ memory of prison may be less accurate than other participants. 1. P. 6 “You’ve got a roof over your head, you’ve got Nonetheless, as their experiences of prison are more your meals, you’ve got a job if you want it, you’ve got historical, they are comparably less applicable when a tele, you can sit in bed all day if you want, it’s far more normal than being out here to be honest.” looking to explore the current issues around the topic. In relation to the two participants who have been 2. P. 12 “You get three meals a day and then if you homeless for the shortest amount of time, it could can’t go down, they get the food bought to ya.” be assumed their more recent and lengthy experience Despite the positive comments, nine of the ten partici- of stable accommodation compared with the other pants still referred to negative aspects of prison, participants may have impacted their views. For describing it as “depressing,”“dangerous” and “mental example, the basic amenities provided in custody are torture.” viewed less positively by these participants due to their comparative of a stable accommodation, even 1. P. 1 “It’s like torture, mental torture, they put me in though it may not be their current housing situation. the worst cell for a month” In general, the findings support the notion that P.6 “it’s not an easy environment, it’s far from, it’s prison not being a deterrent is exclusive to those dangerous.” who find themselves in the entrenching cycle of home- lessness, offending, and substance use. There appeared A few participants even disclosed that they had/would to be no difference in responses when comparing reoffend to return to prison, an observation also those in the night shelter with those rough sleeping. shared by Gunner et al. (2019), Reeve (2011), and This study’s findings challenge the inferences made Rowlands (2011). from quantitative studies, such as Greenberg and P.10 “To the point I have got myself recalled on pur- Rosenheck (2008), Snow et al. (1989), and Willis pose because I have known someone has been in (2004), who reported the motives behind crimes are there. I will just get my TV time for two weeks.” mainly for tangible survival needs, due to their nature. From the participants, who made negative comments, Instead, suggesting that homeless individuals may also five also made positive comments. Generally, the posi- have an ulterior motive to return to prison. tive aspects of participants’ prison experiences focus on In either regard, it does not seem that prison is a basic amenities, which the layperson may take for deterrent to committing a crime. In fact, the concept granted, including food, shelter, warmth, and edu- that prison may be a better option than homelessness cation. It seems that a lack of these basic amenities for these participants, suggests that prison can even be for individuals who are homeless or rough sleeping, a motivation to commit a crime. This supports the ear- with substance use disorders, means prison may pro- lier idea that the type of offending committed by vide a preferable environment and not be viewed as a homeless individuals with substance use disorders punishment. By removing the punitive element, both differs from other forms of offending, raising the ques- the general and specific deterrents, as described by tion as to whether prison is the right solution for Chalfinand McCrary (2017), are no longer functional. attempting to reduce crime within this particular Interestingly, of the four participants who only group of individuals. made negative comments about prison, two (P. 2 and P. 13) had not been to prison in over ten years Stigmatization and marginalization but had still had recent experience with the criminal justice system, and two (P. 1 and P. 11) had only In this study nine of the ten participants disclosed feel- been homeless for a year after spending the vast ings of marginalization and separation from main- majority of their life in stable accommodation. These stream society. account for the only two participants who with more P.3 “I am just so far away from society, people can’t historical prison sentences, and the two participants sort of reach out and grab me kinda thing.” with the shortest amount of time being homeless. It may be that, due to the historical prison sen- P.5 “So it’s a tier system, you know, and we are the tences, two participants had different experiences of bottom tier.” JOURNAL OF SOCIAL DISTRESS AND HOMELESSNESS 9 Marginalization of homeless individuals is a phenom- suggestions on what might make support services enon which has existed for decades, characterized by more effective, a strong theme of being supported by an individual’s lack of personal residence, setting someone who has experienced their situation was them apart from the rest of society and making it evident. more challenging for them to ever regain access to P.1 “At certain times you sit down and you talk to mainstream society (Fitzpatrick et al., 2013; Goetz & them and most people that actually help them are Schmiege, 1996; Melnitzer, 2007). people that have actually had it themselves.” Nine of the ten participants also disclosed feelings 1. P. 11 “Yeah, and I think it should be someone who of stigmatization (stigma), stereotyping, and judge- has been there themselves really.” ment, which seemed to serve as a barrier to rehabilita- tion and reintegration into mainstream society. This seems to be related to a desire to be felt under- stood by support services. P.1 “It’s been because of what’s written down and my records. See, people seem to read them and they go off 1. P. 4 “So, there needs to be a bit more understanding them, rather than not take someone at face value.” in why people commit offence. Why people shoplift. Why people do this, why people do that.” P.4 “When you come out of jail, look, people do look at you like you are scum, because you have got a crim- 2. P. 13 P: “Well, you can walk in here [day centre], inal record.” you get a friendly face, ‘who are you? We’d like to know who you are,’ they talk to you a little bit, you Considering research has identified that those who are can get a free cup of tea, you know.” homeless do suffer from stigma when using services (Gunner et al., 2019; Lloyd, 2010; Martineau & Man- Whilst these findings are important to consider, thorpe, 2020), it is unsurprising that this study has there have been positive developments to improve yielded findings of stigma and judgement toward par- services, and the outcomes for service users. These ticipants. Pauly (2014) reported that those who are include introductions of specialized primary health- homeless are often perceived as the “underclass,” care centers for individuals facing homelessness highlighting that, as a society, they are seen as “differ- (Gunner et al., 2019), and an adaptation of the ent” or “threatening,” in turn viewing them as outsi- “Chronic Care Model” to better support homeless ders (Becker & O’keefe, 2002). Due to these individuals with substance use disorders by provid- marginalizing views, homelessness services seem to ing integrated care and “wrap-around services” (Sta- have focussed on subsistence alone, providing support blein et al., 2021). However, despite the only for basic survival (Pauly, 2014). However, mini- implementation of new services, it does not directly mal support does not provide a realistic chance for address the attitudes of a society or continued feel- homeless individuals to escape marginalization and ings of marginalization and stigma. stigma and reintegrate with mainstream society (Tsemberis, 2010). This should make us question cur- Marginalization and social exclusion rent societal attitudes toward those who are margina- Whilst exploring the topic of marginalization during lized, as it could be argued that, as a society, we hold interviews, it became apparent that the participant’s oppressing views toward those with criminal records, experiences of marginalization differed from the per- substance use disorders, and those who are homeless. ceived meaning of marginalization in today’s society. Participants also identified perceived negative atti- Many research papers on homelessness describe tudes toward them from service providers as a barrier marginalization using terms such as “social exclusion” to receiving good support from services. and “social isolation” (Fitzpatrick et al., 2013; Fitzpa- P.1 “They [probation on release] didn’t care about me trick & Stephens, 2007; Gunner et al., 2019; Martineau anyway.” & Manthorpe, 2020), and the phrases seem to be gen- These viewpoints appeared to be driven by feelings of erally accepted as interchangeable. However, many continuous failures of support services to meet their participants in this study did not display social iso- needs. lation/exclusion but were affected by marginalization, thereby, highlighting “marginalisation” and “social P.4 “you are so used to getting push down, pushed exclusion” as two dichotomous concepts. down, so what’s the point of fucking engaging? You Despite identifying feelings of stigma and exclusion know you are going to get nowhere.” from mainstream society, six participants expressed P.5 “It’s the authorities, and my probation officer said feelings of inclusion and belonging within their own couldn’thelp mewith housing, couldn’t help me with marginalized group. Participants also expressed often clothing myself, couldn’t help me with a food voucher.” relying on those within this group for support with Interestingly, when participants were discussing when shared issues including substance use, homelessness, support services had been effective or given and/or offending. 10 H. S. PROTTS ET AL. P.1 “I mean I’d understand, I’d be able to detox some- This study used opportunistic sampling, whereby body. If I knew how/what their intake is I know I participants volunteered themselves, potentially could detox someone much more comfortable than resulting in a selection bias, as participants may not they [support services] actually do.” be representative of those who did not volunteer. As P.13 “Which I found it very difficult communicate an example, perspectives of those who are currently with normal people, um, I call normal people, people in prison, or perspectives of those who are not actively who don’t use drugs. So, I started dealing the drugs to engaging with the services, would not be included in find the people who were on drugs.” this study. This highlights a potential barrier to successful out- Furthermore, all participants were sourced from comes through the unrealistic view that marginaliza- the same location, which can result in geographical tion also means social exclusion, and that recovery bias, as the views may not be representative of individ- is, in part, measured by an individual’s ability to uals experiencing homelessness in other locations. reintegrate into a mainstream society that does not Especially, considering support services in different reflect their social experience. These findings evidence locations will differ to some degree (Johnsen & that social inclusion exists within marginalized Jones, 2015). Ten interviews were used in this study, groups, challenging the assumption that the meaning a relatively small sample size, and may make the of society is common to all people, regardless of study less generalizable (Thomson, 2011). Although, their social background. It is self-evident that “main- it is worth noting that the population of homeless stream society,” and its views therewith, coexists individuals, with substance use disorder and offending with other societies, whose views, beliefs, and societal histories, is much smaller than the general population, expectations will vary. and Guest et al. (2020) would suggest that a smaller With this in mind, it could be argued that the goal sample size would still be enough for saturation to of reintegration with mainstream society placed on be reached. support services may be restrictive to recovery. Work- The interviews for this study were conducted over a ing with individuals in their own societal constructs large time frame (six interviews in 2018, and four in and aiding them to lead a life within the realms of 2020). During this time, The Homelessness Reduction their capabilities so they can coexist with mainstream Act (HRA) 2017 was introduced, an extension of part society, may be more effective. An example of an VII of the Housing Act 1996, and placed new legal approach of this kind is the introduction of specialist duties on English local authorities to ensure all those primary healthcare centers for individuals facing who are homeless or at risk of homelessness have homelessness, which provide a multitude of healthcare access to an appropriate support (The National services under one roof (Gunner et al., 2019). These Archives, n.d.). The 2017 Act came into force April centers are known for their appointment flexibility 2018 and would have applied to four of the ten partici- compared with mainstream services, addressing mul- pants in this study. The HRA 2017 was not directly tiple issues in one session and a greater tolerance for discussed in the interviews, yet participant’s experi- working with antisocial behavior, and have yielded ences of homelessness services may have been positive outcomes (Gunner et al., 2019). However, impacted by the HRA 2017 in the later interviews. the reality of the negative influences within an individ- However, the HRA 2017 does not fully address the ual’s current social or societal circles may impede complexity of issues often faced by rough sleepers recovery, such as antisocial peers and harmful family including offending behavior and substance issues relations (Andrews & Bonta, 2014; Pratt et al., 2010). (Fitzpatrick et al., 2018). To overcome these barriers, current support services are also showing an increased initiative to employ those with “lived-experience,” which has shown to Conclusion benefit building relationships between service provi- der and service user (Fox, 2022; Welford et al., 2021). The findings of this study are generally consistent with previous literature in evidencing the complex, and often bidirectional relationships between homeless- ness, offending behavior, and substance use disorders. Limitations However, the use of qualitative analysis allowed for This study provides a unique insight into the experi- more detailed findings, which highlight that substance ences of homeless individuals, but nonetheless, limit- use disorders serve as the dominant function in the ations must be considered when interpreting the onset and continuation of the relationship between all findings. Most pertinent to this research would be three. With this in mind, the effectiveness of recovery the consideration of biases, being anything that may be improved if overcoming substance use dis- might influence or distort the study’s findings (Polit orders is central to the care plan, whilst also addressing & Beck, 2014). homelessness and offending simultaneously. JOURNALOFSOCIALDISTRESS AND HOMELESSNESS 11 District Council, Health and Care Research Wales, Public Furthermore, this study’s results are consistent with Health Lincoln, Santander. Steve Sharman is currently literature that reports those who are homeless with funded by an MRC / UKRI Future Leaders Fellowship. He substance use disorders are more likely to commit has previously received funding from the King’s Prize acquisitive offenses, crimes for survival purposes, Fund, the Society for the Study of Addiction Academic Fel- and/or to fund an addiction. However, this study lowship Scheme, Gambling Research Exchange Ontario also highlights that the motives behind the offenses (GREO) and Honoria from Taylor Francis Publishing. may be specific to those who are homeless with a sub- stance use disorder, raising the question as to whether Notes on Contributors prison is an effective form of rehabilitation for these individuals. This study would suggest otherwise, Honor Sibthorp Protts has a Master’s Degree in Forensic Psychology from The University of Lincoln, UK, and has with participants not only describing that prison was worked with vulnerable individuals facing homelessness not a deterrent, but that it often provides respite and and housing issues for a number of years. She currently basic needs, motivating further crime. For those com- works as Forensic Mental Health Practitioner within the mitting crime for this reason, prison sentences may criminal justice system and hopes to continue working to not be effective at reducing crime. Instead, a focus improve the support services available to vulnerability on support for overcoming the needs behind the individuals. motives may yield greater results. Amanda Roberts is a Professor of Psychology at the Univer- Considering there is a foundation of literature sity of Lincoln, UK, with a PhD in Behavioural Neuro- science from Cardiff University and previous research and which links prison sentences, homelessness, and hous- lectureship positions at UK academic institutions including ing instability, further research exploring how prison Kings College London, The Institute of Psychiatry, Queen sentences impact housing stability and homelessness Mary University London, The Wolfson Institute, and for those who have substance use disorders would be UEL. She has numerous multidisciplinary national and beneficial. international collaborations including an honorary research contract at the National Problem Gambling Clinic and a Lastly, when discussing support services, it was Research Fellowship at the Gambling Addictions Research apparent that participants experienced feelings of Centre, AUT, NZ. Amanda’s research interests include the stigma and marginalization. However, many did not evaluation of gambling addiction treatment programs both experience social exclusion, a term commonly used in the community and in UK prisons, and additional inter- interchangeably with marginalization. Instead, partici- ests extend across topics that relate to gambling comorbid- pants described social inclusion within their own ity, gambling in vulnerable populations, homelessness, women and gambling, and gambling and interpersonal social group. These findings suggest “marginalisation” violence. and “social exclusion” are two separate concepts, and Steve Sharman is a Research Fellow at King’s College individuals with shared experiences of homelessness, London and the first behavioral addictions focused Research substance use disorders, and offending behavior have Fellow within the National Addiction Centre. He has held their own “society” in which they do not experience previous post-doctoral positions at the University of East marginalization. Therefore, suggesting that the aim London, and the University of Lincoln. Steve completed to reintegrate individuals back into mainstream his PhD in Experimental Psychology at the University of Cambridge, and his MSc in Cognitive Neuroscience at society is restrictive to recovery, due to the notion UCL. He is a current recipient of a UKRI Future Leaders and experience of “society” varying for each individ- Fellowship, and has previously been awarded the King’s ual. The focus should instead be on how to help Prize Fellowship, and the Society for the Study of Addic- them recover within their “society.” tion’s Griffith Edwards Academic Fellowship. His research interest’s include gambling behavior, gambling in virtual reality, and problem gambling in specific vulnerable popu- Acknowledgements lations. Steve is a member of The National UK Research Network for Behavioural Addictions (NUK-BA) and is The authors would like to thank the individuals who partici- part of the organizing committee for the Current Advances pated in this research and for their willingness to share their in Gambling Research Conference. He also supervises final- personal experiences. We would also like to thank the ser- year undergraduate and post-graduate dissertations and tea- vices which supported us with recruiting participants. ches undergraduate and post-graduate psychology. Disclosure statement References No potential conflict of interest was reported by the authors. 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The challenges of comorbidities: a qualitative analysis of substance use disorders and offending behaviour within homelessness in the UK

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JOURNAL OF SOCIAL DISTRESS AND HOMELESSNESS https://doi.org/10.1080/10530789.2023.2205189 The challenges of comorbidities: a qualitative analysis of substance use disorders and offending behavior within homelessness in the UK a b a Honor Sibthorp Protts , Stephen Sharman and Amanda Roberts a b School of Psychology, University of Lincoln, Lincoln, UK; National Addiction Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, Camberwell, UK ABSTRACT ARTICLE HISTORY Received 5 September 2022 Homelessness and rough sleeping are currently on the rise in England. Literature evidences an Revised 11 April 2023 empirical relationship between substance use disorders and offending behavior within Accepted 17 April 2023 homelessness. This qualitative study explores this relationship from the perspective of those currently experiencing homelessness and substance use disorders, with an offending history. KEYWORDS Thematic analysis identified substance use disorders as the dominant factor in the continuous Homeless; substance; relationship between three. Furthermore, when discussing their experiences of prison, offending; rough sleeping; participants did not identify prison as a deterrent from committing offenses. Feelings of marginalized stigmatization and marginalization from mainstream society were also identified, but participants expressed feelings of social inclusion within their marginalized groups. These findings, and their implications for support services in the community, are discussed in this paper. Introduction with specific support needs, including substance use disorders, and offending, when compared with other Homelessness in England forms of homelessness (Dorney-Smith et al., 2019; Homelessness can be categorized in different ways, Fitzpatrick & Pleace, 2012). including temporary accommodation, sofa surfing and, the most commonly known and visible form, Causation of homelessness rough sleeping. Since 2010, homelessness has steadily increased in England, and figures from 2018 estimate As highlighted by Bramley and Fitzpatrick (2018), to that approximately 4677 individuals rough slept in avoid marginalization and labeling of those suffering England on a single night, a 165% increase since from homelessness, charities and other organizations 2010 (Ministry of Housing, Communities & Local share the view that homelessness can happen to any- Government, 2019). The office of national statistics one (Brown, 2018; Marsh, 2016; St Mungos, n.d.). also published an estimated number of 4266 rough Whilst this statement is not incorrect, it arguably sleeping on a single night in 2019, and 2688 individ- gives the misconception that homelessness is random uals rough sleeping on a single night in 2020 (ONS, and diverse. However, there is a clear pattern which 2021). The significantly lower figures in 2020 may be highlights the individual factors most likely to increase attributed to the introduction of temporary new vulnerability to homelessness. measures, the “Everyone In” scheme, that provided Poverty has been highlighted as the most common emergency accommodation to those rough sleeping cause of homelessness (Aldridge, 2020; Anderson & during the coronavirus pandemic (Cooney, 2021), Christian, 2003; Bramley & Fitzpatrick, 2018;O’Calla- therefore is not a reliable indicator of rough sleeping ghan et al., 1996). However, this broad term has been when society is functioning fully (ONS, 2021). For criticized, as it disregards the complexity of homeless- the purpose of this study, all participants were inter- ness, explaining only a heightened vulnerability to viewed prior to the COVID 19 lockdown, and the potential issues including substance use and offending introduction of the “Everyone In” scheme. (Benjaminsen & Andrade, 2015). For example, Rough sleepers can be defined as “People sleeping, research has found that entrenched poverty is associ- about to bed down or actually bedded down in open ated with substance use disorders and chronic offend- air” (Public Health England, 2020) and are often single ing (Aldridge, 2020; Bramley et al., 2015), both of homeless adults without partners or dependent chil- which are strongly associated with homelessness dren (Shelter, 2012). Single homeless often need (Aldridge, 2020; England et al., 2022; Rowlands, higher support and are more strongly associated 2011). It could be inferred that substance use disorders CONTACT Honor Sibthorp Protts honor.sibthorpprotts@nhs.net School of Psychology, University of Lincoln, Lincoln, LN6 7TS, UK © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrest- ricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. 2 H. S. PROTTS ET AL. and offending, within the context of poverty, may have Most significantly, the Homelessness Reduction contributed to this conclusion that poverty is the most Act (HRA) 2017, came into force in England in common cause of homelessness. However, as pointed April 2018, meaning it was in place for four of the out by O’Sullivan et al. (2020), current literature avail- ten participants interviewed in this study, and placed able on homelessness seems to primarily focus on new responsibility on local authorities (Madoc-Jones homelessness within specific contexts, such as sub- et al., 2018). The HRA 2017 updated legislation in stance use or offending. the Homelessness Act 2002, s. 193, which stated that A small number of studies have identified other the local authority had a duty to provide suitable experiences which are more prevalent in the homeless accommodation for individuals categorized as “pri- population compared to the general population. This ority need.” This refers to those who are deemed includes Edalati and Nicholls (2019) and Larkin and highly vulnerable, and no participants in this study Park (2012) who reported early experiences of child- would meet the “priority need” threshold. Compara- hood trauma, including neglect, physical and tively, S. 5 of the HRA 2017 states that the local auth- emotional abuse, as risk factors for homelessness. ority “must take reasonable steps” to help the Bramley and Fitzpatrick (2018) also found that care applicant secure suitable accommodation, this applies leavers were at an increased risk of homelessness, to all applicants who are homeless, and not just those and Shelton et al. (2012) identified exclusion from who are priority need. Reasonable steps include the school as a predictor of homelessness. It is also well implementation of personal housing plans and holistic evidenced that mental and physical health issues are assessments, ensuring local authorities assess and con- common among those who are homeless and facing sider factors such as circumstances leading to home- other challenges including substance use disorders lessness and support needs (Garvie, 2018). and offending (Bramley et al., 2020; England et al., Whilst the implementation of these new measures 2022; Fitzpatrick et al., 2013; Philippot et al., 2007). should see a general improvement in housing and The range of studies evidence broad spectrum of vul- homelessness support, other factors related to the par- nerabilities that are associated with homelessness, and ticipants in this study will impact the effectiveness of the wider issues that would benefit from further the HRA 2017 in supporting their needs. For example, exploration. under s.5 of the HRA 2017 local authorities do not have to provide this support if an individual does not reasonably cooperate. Whereas those who are liv- Support and services ing with homelessness, substance use disorders, and In an attempt to reduce rough sleeping, the UK gov- an offending history, often lead an unstable and chao- ernment has introduced initiatives such as “No Second tic lifestyle, this can make cooperating with services Night Out” (NSNO), which directly supports rough more challenging (Bramley et al., 2020; ONS, 2021). sleepers in accessing emergency accommodation Furthermore, the legislation does not state that an (NSNO, n.d.) and Streetlink, which provides a con- applicant must be provided accommodation, only necting service for rough sleepers and local services that they should be supported to access suitable (Streetlink, n.d.). Additionally, specialist primary accommodation. After 56 days, the local authority healthcare centers were established for individuals can end their support, whether the accommodation facing homelessness to overcome barriers they experi- has been found or not. For those with substance use ence when accessing healthcare services (Gunner et al., disorders, and offending histories, they are much 2019). For example, “Housing First,” is a scheme that more likely to be excluded or unsuccessful in finding aims to house individuals, before engaging them with accommodation (Bramley & Fitzpatrick, 2018; Wil- support including healthcare, mental health, and sub- liams et al., 2012), making it more challenging to stance use services (Baxter et al., 2019). More targeted access accommodation in the time period. schemes have also been implemented, including the Furthermore, although the changes brought in by the Ministry of Justice’s new resettlement approach to HRA 2017 may still impact responses from participants, preventing homelessness amongst the prison popu- the challenges faced by those living with homelessness, lation (Madoc-Jones et al., 2018). who have substance use disorder and offending his- Whilst these initiatives, and many other services are tories, are severe and enduring (Bramley & Fitzpatrick, available for rough sleepers, rough sleeping remains 2018; Fitzpatrick et al., 2013). Therefore, unlikely to be stubbornly high, and many are not actively engaging overcome by the introduction of the HRA 2017. with services (ONS, 2021). Johnsen and Jones (2015) also report that the resources available and time press- Homelessness and substance use disorders ures often mean support, assessments and services for rough sleepers are limited, and although good practice Evidence suggests substance use disorders are strongly guidelines are provided nationally, implementation of related to homelessness (Aldridge et al., 2018; ONS, these often deviate substantially. 2019), with as many as 60% of rough sleepers recorded JOURNAL OF SOCIAL DISTRESS AND HOMELESSNESS 3 as experiencing drug or alcohol problems. However, When looking at prison sentences, Geller and Cur- this figure may be an underestimation as it does not tis (2011) and Greenberg and Rosenheck (2008) account for those who do not engage with services. reported that those who had been imprisoned pre- Despite this, the question remains as to whether sub- viously were at a greater risk of homelessness, irre- stance use disorders precede or succeed homelessness. spective of whether they had been homeless before. Shelton et al. (2009) found that, for the majority of Egleton et al. (2016) found that serving a prison sen- participants, substance use disorders preceded and tence often had knock-on-effects such as unemploy- contributed to homelessness. This is supported by ment, poorer mental health, and difficulties Rowlands (2011) who found that participants reintegrating back into society, ultimately leading to described drug use as leading to eviction from the problems finding accommodation. Moschion et al.’s family home. A further study found substance use dis- (2019) study found that homelessness does not orders predominantly preceded homelessness, even increase the likelihood of going to prison, whilst a though it may not be the primary cause (Fitzpatrick prison sentence did increase the likelihood of home- et al., 2013; Philippot et al., 2007). lessness. Therefore, suggesting that offending could However, Clatts et al. (2005) identified drug use in precede homelessness. homeless individuals as an “adaptation of behaviour” Although the studies on this relationship are lim- succeeding homelessness, rather than a cause, which ited, the variation of the findings implies that home- Fitzpatrick et al. (2013) attributed to a coping/survival lessness can either precede or succeed offending and response. Research also indicates that individuals prison sentences, and the complexities of this relation- report using substances as self-medication, or as an ship may be more impacted by other support needs escape from reality, and that substance use disorders associated with homelessness. can evolve as a consequence of homelessness. How- Studies that examine the relationship between ever, pre-homeless substance use can also predispose homelessness and offending also highlight the associ- the individual to increased substance use after home- ation with substance use disorders (Bozkina & Hard- lessness (Fitzpatrick et al., 2013; Stablein, Hill, Kesha- wick, 2021; Bramley et al., 2020; Gray et al., 2020; varz & Llorente., 2021). It should be noted that some Kushel et al., 2005; Lankenau et al., 2005; Rowlands, studies address drug and alcohol use separately; Row- 2011). Some papers identified an interplay between lands (2011) and Clatts et al. (2005) focused on drug substance use disorders and offending in homeless use and did not include alcohol, which Fitzpatrick participants, and found that offenses often related to et al. (2013) highlighted as a major issue. substance habits (Gray et al., 2020; Rowlands, 2011; Willis, 2004). Papers also identified the high presence of substance use disorders in those with housing needs Homelessness and offending behavior in the offending population (Bozkina & Hardwick, Evidence suggests a strong link between homeless- 2021; Bramley et al., 2020; Madoc-Jones et al., 2018; ness and offending. Figures from the Ministry of Jus- Williams et al., 2012). Such studies evidence an associ- tice reported that 26% of prison releases are ation between offending, homelessness, and substance “homelessness, rough sleeping or unsettled accom- use disorders, however, the sparsity of research modation” (Bozkina & Hardwick, 2021). Williams ensures the relationship is not yet fully understood. et al. (2012) reported that 79% of prisoners who were homeless before custody were reconvicted Aims within one year of release, compared with 47% of those who had not been homeless. The strong stat- In the current study, a qualitative approach was used istical link between offending and homelessness can to gain a more detailed insight into the challenges be found across a large number of studies (Bozkina directly from the perspective of those with lived & Hardwick, 2021; Bramley et al., 2020; Madoc- experience. This qualitative study sought to explore Jones et al., 2018). However, there is only a small the relationship between substance use disorders and number of studies exploring the reasons behind offending behavior within homelessness and to gather this relationship. information to better inform approaches to breaking Similar to homelessness and substance use dis- the cycle of homelessness. To achieve this, the study orders, there remains a question as to whether offend- explored three main questions and identified themes ing precedes or succeeds homelessness. Gray et al. and patterns within these. The first aim was to identify (2020), and Willis (2004) found that for homeless what is preceding or succeeding, and the causal and individuals, offending was often a means of survival perpetuating influences between substance use, e.g. stealing to eat, fueling drug habits, or paying for offending, and homelessness. The second aim was to accommodation, which could consequently lead to determine if a dominant support need is present and prison sentences. Therefore, suggesting offending which has a greater causal or perpetuating influence could succeed homelessness. on the other support needs. The third aim was to 4 H. S. PROTTS ET AL. understand how this may be impacting interactions the growth of evidence (Braun & Clarke, 2006), and with support services and recovery. this study aims to find common knowledge among participants regarding their shared experiences of homelessness. Method Design Participants This study used thematic analysis, guided by Braun and Ten adult, male participants were recruited through Clarke’s(2006) paper, and the framework of Neale’s an outreach support service available for rough slee- (2016) Iterative Categorisation. Thematic analysis pers, or those at risk of rough sleeping, in the local involves a process of identifying, analyzing, and area. The service was in an affluent town in the extracting patterns/themes from within a dataset, south of England and connected to the night-shelter which allows for a more flexible, detailed, and rich where some participants were temporarily residing, analysis (Braun & Clarke, 2006). However, the flexi- and the day center where all participants were inter- bility of the approach has been criticized for its lack viewed. Participants were identified by the service of clear guidelines (Braun & Clarke, 2006; Tuckett, staff and the researcher collaboratively, using an 2005). Iterative categorization provides a more struc- opportunity sampling method, they approached tured and standardized technique designed to be potential participants regarding involvement. applied to a range of qualitative analyses, including the- The inclusion criteria were adult males, either matic, and whilst time-consuming, should increase the rough sleeping or known rough sleepers residing in validity and reliability of the findings (Neale, 2016). the local night shelter. Participants had current sub- In completing the interviews, the researcher also stance use disorders, offending histories, and had considered how a smaller sample size may impact spent time in UK prison. All were fluent English the saturation of the paper. Saturation being reached speakers, with recent experience in support service is described as the point at which little or no relevant engagement. Participants were excluded if they information can be found in the data (Hennink & Kai- appeared under the influence of substances, had sig- ser, 2022). Guest et al.’s(2020) paper highlights that in nificant mental health concerns, learning disabilities, general the vast majority of themes are identified in or any other concerns related to lack of capacity to the first five to twelve interviews, as evidenced in Fran- consent. An eleventh participant was interviewed; cis et al. (2012), Guest et al. (2006), and Namey et al. however, due to concerns over his mental capacity (2016). Therefore, considering this paper focuses on during the interview, the recording was deleted and a specific hard-to-reach population, ten interviews data were omitted (Table 1). should satisfy the saturation need. Interviews Epistemology Before the interview, participants were given an infor- mation sheet, asked to sign a consent form, and A critical realist epistemological approach was used, informed of their right to withdraw. Interviews were which is defined by the assumption that knowledge conducted following a semi-structured format, lasting exists and can be shared among individuals (Braun between 20 and 40 min. Interviews were recorded by & Clarke, 2006). However, knowledge can only be Dictaphone, and were conducted, recorded, and tran- “imperfectly” known, due to our sensory capacity scribed by the lead researcher. This helped with main- and social construction, meaning knowledge is always taining confidentiality, whilst also aiding thematic subjective and subject to change (Braun et al., 2014, analysis and familiarization with the data. After the p. 22). The quality of knowledge is strengthened by interview, participants were debriefed. Interviews were conducted at a day center, a location with Table 1. Infographic data on participants. which all participants were familiar. Housing status at Length of time homeless (inc. Age interview on/off) P. 1 52 Rough sleeping 1 year Analysis P. 2 52 Night-shelter 37 years P. 3 40 Rough sleeping 24 years P. 4 29 Rough sleeping 3 years Following the framework of Neale’s(2016) IC and P. 5 53 Rough sleeping 15 years Braun and Clarke’s(2006) guidelines for thematic P. 6 53 Night-shelter 13 years analysis, the interview transcripts were read, notes P. 31 Night-shelter 4 years made, and initial themes drafted. Next, the transcripts P. 60 Rough sleeping 1 year were re-read, and quotations were coded in accord- P. 32 Rough sleeping 15 years ance with the drafted themes. Themes and ideas were drawn out based on importance and relevance JOURNAL OF SOCIAL DISTRESS AND HOMELESSNESS 5 to the research question. Once all transcripts had The relationship between homelessness, been coded, quotations were grouped by theme and offending, and substance use disorders collated into one document. This facilitated detailed Homelessness and substance use disorders comparisons of quotations made by different partici- For nine of the ten participants, substance use pre- pants and aided further development of richer, more ceded homelessness and was often the cause or a con- detailed themes. Using this document, theme boards tributing factor to their homelessness. were created. During this process, less relevant themes were discarded, similar themes were merged P.3 “Yeah, heroin addiction, yeah. It’s ALL been to do with my heroin addiction.” and subthemes were created, aiding more concise results. The theme boards were reviewed, refined, P.12 “Drinking is the reason I am homeless.” and ordered to ensure the most fitting narrative was Several other factors that led to homelessness were used. Lastly, the original transcripts were revisited also identified, including relationship breakdowns, to ensure the final themes were still representative evictions, and traumatic life experiences. These illus- of the raw data and had not been skewed during trated the unique pathways to each participant that the analysis process. resulted in their homelessness. 1. P. 3 “Sort of around, fifteen, just turning sixteen, Ethical considerations step dad kicked me out, he was an alcoholic, he The study was approved by The School of Psychology couldn’t sort his life out, so he just decided to take it all out on me.” Research Ethics Committee (SOPREC) at the Univer- sity of Lincoln, approval number PSY171874. In P.6 That’s why I’ve become homeless, because, I had a regard to ethical considerations, the lead researcher rented house in Grimsby in 2004, I was working for verbally explained informed consent, participant the Council, but my mum got cancer, she, so I gave my job up, gave my house and up moved into her information sheet, and right to withdraw before the one bedroom flat with, to look after her. interview. Due to the sensitive nature of the research and participants’ circumstances, there was a risk of But despite different journeys, all participants psychological harm. Therefore, when debriefed, infor- described substance use as a perpetuating factor of mation about support services for homelessness and their homelessness, implying that the causation of substance use was given to participants, and a further homelessness is less significant once an individual copy to their keyworker. Their keyworker was also finds themselves in the vicious cycle of homelessness informed if any concerns arose during their interview. and substance use. Participants were informed that no personal infor- The perpetuation of homelessness was both directly mation would be shared and were provided with a preventing them from accessing housing, and unique number should they wish to withdraw their indirectly, such as eviction due to rent arrears after data later. Participants were also informed that confi- spending their finances on substances. dentiality would be broken if information reported P.6 “I: Do you think drugs is what’s part of what kept was “likely to cause serious harm to the physical or you coming in and out of homelessness? /P: Yeah I mental health of the data subject or another individ- do, yeah. I think drugs has got the, I think it’s the big- ual,” in accordance with Section 15 of the Data Protec- gest factor in in my life." tion Act, 2018. 1. P. 13 “The drug use, led me to being homeless. I then got private rented, which then, I’ve lost again, Results and discussion because of drug use.” Findings initially discuss participant’s current experi- Although participant’s responses evidenced that their ences of homelessness, substance use, and offending, homelessness also perpetuated their substance use, identifying substance use as the dominant function participants also described substance use when in for both the onset and continuation of these experi- stable accommodation, which eventually led to home- ences. Next, participant’s experiences of support ser- lessness again. This suggests that when the element of vices are explored. Participant’s experience of prison homelessness is no longer relevant, the participants yielded an interesting combination of negative and are still unable to address their substance use dis- positive comments, indicating that prison was not a orders. However, even though most participants deterrent for committing offenses. Participant’s feel- referred to detoxing for short periods of time over ings of stigmatization and marginalization are also their life, the substance use was still identified as one discussed. Participants identify feelings of judgement of the biggest barriers to accommodation. Therefore, and distance from “mainstream society,” whilst also if participants were not using substances, it’s more forming support networks within their own margina- likely they would be able to maintain stable lized groups. accommodation. 6 H. S. PROTTS ET AL. because I was selling drugs at one point to fund my A substantial amount of research evidences the habit.” relationship between substance use disorders and homelessness. Findings illustrate that for the majority, 1. P. 13 Well, when I stopped dealing, I had to shop substance use precedes homelessness (Fitzpatrick lift. I still had to have it, and I had to keep the drug et al., 2013; Philippot et al., 2007; Rowlands, 2011; use up, or I was getting severely sick. Shelton et al., 2009), and further that substance use Interestingly, regardless as to whether they had been prior to homelessness can predispose the individual exposed to criminal activity in childhood, or whether to increased substance use after homelessness (Fitzpa- had or had not offended prior to substance use dis- trick et al., 2013; Stablein et al., 2021). A small number orders, it was apparent that once the participants of studies suggest substance use can be a consequence were experiencing substance use disorders, this was of homelessness (Clatts et al., 2005; Glasser & Zywiak, one of the biggest influences on their offending 2003), however, findings are comparatively scarce. behavior. Overall, literature has a general consensus that, The link between substance use and offending is whether substance use precedes or succeeds homeless- empirically supported by current literature (Bozkina ness, when an individual is experiencing homeless- & Hardwick, 2021; Bramley et al., 2020). For example, ness, there is a significant risk of heightened issues studies report a strong relationship between alcohol around substance use. consumption and criminal activity (Mason et al., Although one participant reported that his substance 2010; Popovici et al., 2012), and drug use and criminal use succeeded in his homelessness, it was not identified activity within the homeless population (Gray et al., as a causal factor. Therefore, with no participants identi- 2020; McNiel et al., 2005; Rowlands, 2011). fying homelessness as an initial causal factor for sub- In general, these findings point toward substance stance use disorders, this indicates that the substance use disorders as a direct perpetuating factor of offend- use may serve as the dominant function in the relation- ing behavior, such as committing offenses to fuel ship between homelessness and substance use disorders. addictions or whilst under the influence of substances (Gray et al., 2020; Willis, 2004). However, these studies focus on the active relationship between Offending behavior and substance use disorders offending behavior and substance use disorders in Many participants reported being exposed to a range homelessness, as opposed to what led to the relation- of criminal activities from a young age, which ship, making it difficult to ascertain which is more appeared to influence their own behaviors. likely to precede the other. Considering all participants identified substance 1. P. 1 “I have been bought up in sort of, everyone used to steal sweets and stuff, and um, so it just use disorders as a direct perpetuating factor of offend- depends who you are around with basically. So it ing, no participants identified offending as a direct just sort of becomes normal.” causal or perpetuating factor of substance use, and participants offending behavior was predominantly 2. P. 11 “First time I remember getting taken home by the police was when I was about 7, me and my brother influenced by their substance use. This would indicate and a couple of other lads nicked an army down at the that substance use serves as the dominant function in beach yard.” the relationship between offending and substance use disorders within homelessness. Seven of the ten participants reported that substance use disorders preceded their offending behavior and were often the cause or a contributing factor. This Homelessness and offending behavior included being under the influence of substances Participants described their offending behavior as when committing a crime and/or offending to fund both preceding and succeeding homelessness, and a habit. both causal and perpetuating of each other. There 1. P. 5 “The only reason why I did crime was because I was no pattern of behavior that significantly was homeless, on the streets and couldn’t see any influenced the other more. future, right.” P.10 “I first become homeless because of a prison sen- P.6 “all the crime what I have committed has been tence about 4 years ago, and like not having my own while under the influence of drugs.” house.” All participants also described the substance use as P.2 “When I was on the streets, you know, you got a perpetuating their offending behavior. However, nice pie and chips right, and you wanna nick it, and there was little evidence that offending behavior per- you can feel it in your heart mate.” petuated or caused substance use disorders. P.5 “The only reason why I did crime was either P.3 “I: what type of offences? /P: everything, from because I was homeless, on the streets and couldn’t theft to burglary, to robbery, drugs, intent to supply, see any future, right.” JOURNAL OF SOCIAL DISTRESS AND HOMELESSNESS 7 sentence. I lost the flat because I couldn’t pay for Participants in this study suggest that their offending the flat whilst I was in prison.” behavior was driven by survival needs or hopelessness, alongside substance use disorders, consistent with It is apparent that after individuals find themselves in (2020) and Rowlands (2011). This suggests that the this “vicious cycle,” their substance use, homelessness, type of offending behavior and motivation behind it and offending behavior begins developing further may differ from those who are not homeless, which negative functions. For example, if an individual was identified during interviews. were homeless with an offending history, but with no substance use disorder, then addressing their 1. P. 13 “I’m not really a criminal, I’m not criminally minded. Like, I don’t look at a situation and think in a homelessness would present fewer challenges (St criminal way of making some money.” Mungos, 2016). However, if a substance use disorder is present, this would have a negative impact on the This is supported further by the earlier theme, which homeless support, meaning an increased likelihood evidenced the impact of substance use disorders on of homelessness, which in turn would perpetuate the offending behavior, identifying the main motives as substance use, and increase the likelihood of offending funding substance use, or being under the influence behavior. of substances. Whilst all factors are intertwined, these findings There is an empirical foundation in literature to indicate that the dominant function for the onset support this relationship, with a generally shared con- and continuation of these factors is substance use dis- sensus that offending behavior can both precede and orders. Substance use, compared with homelessness succeed homelessness (Bender et al., 2007; Bozkina and offending, has an empirically supported addictive & Hardwick, 2021; Egleton et al., 2016; Kushel et al., element, which research would suggest impacts an 2005; Lankenau et al., 2005; Metraux & Culhane, individual’s “self-control, comprising the agency of 2006). Although, there is only a small number of free-will” (Volpone, 2018; Vonasch et al., 2017), and studies exploring this, many focusing on rates of could be an explanation for its dominant role. offenses, as opposed to the types of crimes (Bozkina This suggests that overcoming a substance addic- & Hardwick, 2021; Bramley et al., 2020; England tion may be the most effective way to break the et al., 2022). vicious cycle. However, it cannot be ignored that In this study, the previous subthemes identify sub- overcoming an addiction will be more challenging stance use as the dominant function in the continued when also facing homelessness and engaging in relationship between homelessness, offending, and offending behavior. substance use. Therefore, it is unsurprising that In an attempt to overcome comorbidities, “Housing when substance use is not directly observed in the First” was introduced, a scheme to house individuals analysis, a more bidirectional relationship is apparent. before engaging them in support for their needs The implication being that if you were to remove the (Pleace, 2016). Baxter et al. (2019) completed a element of substance use disorders from participants’ meta-analysis, with results reporting no clear differ- lives, they would be more likely to maintain stable ence in improvement of substance use and quality of accommodation, and less likely to offend. life when comparing housing first participants with those engaging in treatment as usual. Therefore, Homelessness, substance use disorders, and suggesting that addressing homelessness first, does offending behavior not have a significant impact on substance use dis- When participants spoke about these three experiences orders. However, Baxter et al.’s meta-analysis did together, it was clear that their substance use disorders highlight a reduction in the need for other healthcare were central to the complex and continued experience appointments, suggesting that being accommodated of homelessness, offending behavior, and substance use. can improve other areas of support needs. 1. P. 3 “So yeah, um, well, I went, I started taking little things [drugs] and that and then a few travellers took advantage of me because I was homeless and that, and Prison is not a deterrent just pretty vulnerable person. Then they just started feeding me Heroin and got me addicted to, addicted Deterrence to criminality as a broader concept has to Heroin, and that’s basically what started my steam- been described as either “general deterrence” or rolling. Then steamed me onto like a criminal career “specific deterrence” (Chalfin & McCrary, 2017). Gen- type of thing.” eral deterrence refers to when the threat of punish- 2. P. 13 “I was ill at home, couldn’t get a job because of ment acts as the deterrent, and specific deterrence is my drug use. Not much money, got involved with a when the experience of the punishment acts as the lot of people through my drug use. They used to deterrent for future actions (Loeffler & Nagin, 2022). come round in the day, started dealing drugs. I was Research exploring prison as a deterrent focusses on dealing the drugs that led to me dealing harder drugs. Which then took the frame of a prison how the different mechanisms function to prevent 8 H. S. PROTTS ET AL. crime. However, interestingly, one common theme in prison, which were more negative. Although, a review this study is that prison did not deter these partici- of the prison system in 2020 reported a significant pants from committing crime. This became apparent increase in overcrowding, unsuitable living con- through the way participants expressed their opinions ditions, violence, and self-harm in prisons between and experiences of prison, making both the positive the period of 2010 and 2020 (House of Commons and negative comments. Public Accounts Committee, 2020), suggesting the During interviews, six out of ten participants gave prison experience has worsened over time, as opposed of positive comments about their prison experience, to improved. It is plausible that due to the length of which were generally related to basic survival needs. time out of prison, these participants’ memory of prison may be less accurate than other participants. 1. P. 6 “You’ve got a roof over your head, you’ve got Nonetheless, as their experiences of prison are more your meals, you’ve got a job if you want it, you’ve got historical, they are comparably less applicable when a tele, you can sit in bed all day if you want, it’s far more normal than being out here to be honest.” looking to explore the current issues around the topic. In relation to the two participants who have been 2. P. 12 “You get three meals a day and then if you homeless for the shortest amount of time, it could can’t go down, they get the food bought to ya.” be assumed their more recent and lengthy experience Despite the positive comments, nine of the ten partici- of stable accommodation compared with the other pants still referred to negative aspects of prison, participants may have impacted their views. For describing it as “depressing,”“dangerous” and “mental example, the basic amenities provided in custody are torture.” viewed less positively by these participants due to their comparative of a stable accommodation, even 1. P. 1 “It’s like torture, mental torture, they put me in though it may not be their current housing situation. the worst cell for a month” In general, the findings support the notion that P.6 “it’s not an easy environment, it’s far from, it’s prison not being a deterrent is exclusive to those dangerous.” who find themselves in the entrenching cycle of home- lessness, offending, and substance use. There appeared A few participants even disclosed that they had/would to be no difference in responses when comparing reoffend to return to prison, an observation also those in the night shelter with those rough sleeping. shared by Gunner et al. (2019), Reeve (2011), and This study’s findings challenge the inferences made Rowlands (2011). from quantitative studies, such as Greenberg and P.10 “To the point I have got myself recalled on pur- Rosenheck (2008), Snow et al. (1989), and Willis pose because I have known someone has been in (2004), who reported the motives behind crimes are there. I will just get my TV time for two weeks.” mainly for tangible survival needs, due to their nature. From the participants, who made negative comments, Instead, suggesting that homeless individuals may also five also made positive comments. Generally, the posi- have an ulterior motive to return to prison. tive aspects of participants’ prison experiences focus on In either regard, it does not seem that prison is a basic amenities, which the layperson may take for deterrent to committing a crime. In fact, the concept granted, including food, shelter, warmth, and edu- that prison may be a better option than homelessness cation. It seems that a lack of these basic amenities for these participants, suggests that prison can even be for individuals who are homeless or rough sleeping, a motivation to commit a crime. This supports the ear- with substance use disorders, means prison may pro- lier idea that the type of offending committed by vide a preferable environment and not be viewed as a homeless individuals with substance use disorders punishment. By removing the punitive element, both differs from other forms of offending, raising the ques- the general and specific deterrents, as described by tion as to whether prison is the right solution for Chalfinand McCrary (2017), are no longer functional. attempting to reduce crime within this particular Interestingly, of the four participants who only group of individuals. made negative comments about prison, two (P. 2 and P. 13) had not been to prison in over ten years Stigmatization and marginalization but had still had recent experience with the criminal justice system, and two (P. 1 and P. 11) had only In this study nine of the ten participants disclosed feel- been homeless for a year after spending the vast ings of marginalization and separation from main- majority of their life in stable accommodation. These stream society. account for the only two participants who with more P.3 “I am just so far away from society, people can’t historical prison sentences, and the two participants sort of reach out and grab me kinda thing.” with the shortest amount of time being homeless. It may be that, due to the historical prison sen- P.5 “So it’s a tier system, you know, and we are the tences, two participants had different experiences of bottom tier.” JOURNAL OF SOCIAL DISTRESS AND HOMELESSNESS 9 Marginalization of homeless individuals is a phenom- suggestions on what might make support services enon which has existed for decades, characterized by more effective, a strong theme of being supported by an individual’s lack of personal residence, setting someone who has experienced their situation was them apart from the rest of society and making it evident. more challenging for them to ever regain access to P.1 “At certain times you sit down and you talk to mainstream society (Fitzpatrick et al., 2013; Goetz & them and most people that actually help them are Schmiege, 1996; Melnitzer, 2007). people that have actually had it themselves.” Nine of the ten participants also disclosed feelings 1. P. 11 “Yeah, and I think it should be someone who of stigmatization (stigma), stereotyping, and judge- has been there themselves really.” ment, which seemed to serve as a barrier to rehabilita- tion and reintegration into mainstream society. This seems to be related to a desire to be felt under- stood by support services. P.1 “It’s been because of what’s written down and my records. See, people seem to read them and they go off 1. P. 4 “So, there needs to be a bit more understanding them, rather than not take someone at face value.” in why people commit offence. Why people shoplift. Why people do this, why people do that.” P.4 “When you come out of jail, look, people do look at you like you are scum, because you have got a crim- 2. P. 13 P: “Well, you can walk in here [day centre], inal record.” you get a friendly face, ‘who are you? We’d like to know who you are,’ they talk to you a little bit, you Considering research has identified that those who are can get a free cup of tea, you know.” homeless do suffer from stigma when using services (Gunner et al., 2019; Lloyd, 2010; Martineau & Man- Whilst these findings are important to consider, thorpe, 2020), it is unsurprising that this study has there have been positive developments to improve yielded findings of stigma and judgement toward par- services, and the outcomes for service users. These ticipants. Pauly (2014) reported that those who are include introductions of specialized primary health- homeless are often perceived as the “underclass,” care centers for individuals facing homelessness highlighting that, as a society, they are seen as “differ- (Gunner et al., 2019), and an adaptation of the ent” or “threatening,” in turn viewing them as outsi- “Chronic Care Model” to better support homeless ders (Becker & O’keefe, 2002). Due to these individuals with substance use disorders by provid- marginalizing views, homelessness services seem to ing integrated care and “wrap-around services” (Sta- have focussed on subsistence alone, providing support blein et al., 2021). However, despite the only for basic survival (Pauly, 2014). However, mini- implementation of new services, it does not directly mal support does not provide a realistic chance for address the attitudes of a society or continued feel- homeless individuals to escape marginalization and ings of marginalization and stigma. stigma and reintegrate with mainstream society (Tsemberis, 2010). This should make us question cur- Marginalization and social exclusion rent societal attitudes toward those who are margina- Whilst exploring the topic of marginalization during lized, as it could be argued that, as a society, we hold interviews, it became apparent that the participant’s oppressing views toward those with criminal records, experiences of marginalization differed from the per- substance use disorders, and those who are homeless. ceived meaning of marginalization in today’s society. Participants also identified perceived negative atti- Many research papers on homelessness describe tudes toward them from service providers as a barrier marginalization using terms such as “social exclusion” to receiving good support from services. and “social isolation” (Fitzpatrick et al., 2013; Fitzpa- P.1 “They [probation on release] didn’t care about me trick & Stephens, 2007; Gunner et al., 2019; Martineau anyway.” & Manthorpe, 2020), and the phrases seem to be gen- These viewpoints appeared to be driven by feelings of erally accepted as interchangeable. However, many continuous failures of support services to meet their participants in this study did not display social iso- needs. lation/exclusion but were affected by marginalization, thereby, highlighting “marginalisation” and “social P.4 “you are so used to getting push down, pushed exclusion” as two dichotomous concepts. down, so what’s the point of fucking engaging? You Despite identifying feelings of stigma and exclusion know you are going to get nowhere.” from mainstream society, six participants expressed P.5 “It’s the authorities, and my probation officer said feelings of inclusion and belonging within their own couldn’thelp mewith housing, couldn’t help me with marginalized group. Participants also expressed often clothing myself, couldn’t help me with a food voucher.” relying on those within this group for support with Interestingly, when participants were discussing when shared issues including substance use, homelessness, support services had been effective or given and/or offending. 10 H. S. PROTTS ET AL. P.1 “I mean I’d understand, I’d be able to detox some- This study used opportunistic sampling, whereby body. If I knew how/what their intake is I know I participants volunteered themselves, potentially could detox someone much more comfortable than resulting in a selection bias, as participants may not they [support services] actually do.” be representative of those who did not volunteer. As P.13 “Which I found it very difficult communicate an example, perspectives of those who are currently with normal people, um, I call normal people, people in prison, or perspectives of those who are not actively who don’t use drugs. So, I started dealing the drugs to engaging with the services, would not be included in find the people who were on drugs.” this study. This highlights a potential barrier to successful out- Furthermore, all participants were sourced from comes through the unrealistic view that marginaliza- the same location, which can result in geographical tion also means social exclusion, and that recovery bias, as the views may not be representative of individ- is, in part, measured by an individual’s ability to uals experiencing homelessness in other locations. reintegrate into a mainstream society that does not Especially, considering support services in different reflect their social experience. These findings evidence locations will differ to some degree (Johnsen & that social inclusion exists within marginalized Jones, 2015). Ten interviews were used in this study, groups, challenging the assumption that the meaning a relatively small sample size, and may make the of society is common to all people, regardless of study less generalizable (Thomson, 2011). Although, their social background. It is self-evident that “main- it is worth noting that the population of homeless stream society,” and its views therewith, coexists individuals, with substance use disorder and offending with other societies, whose views, beliefs, and societal histories, is much smaller than the general population, expectations will vary. and Guest et al. (2020) would suggest that a smaller With this in mind, it could be argued that the goal sample size would still be enough for saturation to of reintegration with mainstream society placed on be reached. support services may be restrictive to recovery. Work- The interviews for this study were conducted over a ing with individuals in their own societal constructs large time frame (six interviews in 2018, and four in and aiding them to lead a life within the realms of 2020). During this time, The Homelessness Reduction their capabilities so they can coexist with mainstream Act (HRA) 2017 was introduced, an extension of part society, may be more effective. An example of an VII of the Housing Act 1996, and placed new legal approach of this kind is the introduction of specialist duties on English local authorities to ensure all those primary healthcare centers for individuals facing who are homeless or at risk of homelessness have homelessness, which provide a multitude of healthcare access to an appropriate support (The National services under one roof (Gunner et al., 2019). These Archives, n.d.). The 2017 Act came into force April centers are known for their appointment flexibility 2018 and would have applied to four of the ten partici- compared with mainstream services, addressing mul- pants in this study. The HRA 2017 was not directly tiple issues in one session and a greater tolerance for discussed in the interviews, yet participant’s experi- working with antisocial behavior, and have yielded ences of homelessness services may have been positive outcomes (Gunner et al., 2019). However, impacted by the HRA 2017 in the later interviews. the reality of the negative influences within an individ- However, the HRA 2017 does not fully address the ual’s current social or societal circles may impede complexity of issues often faced by rough sleepers recovery, such as antisocial peers and harmful family including offending behavior and substance issues relations (Andrews & Bonta, 2014; Pratt et al., 2010). (Fitzpatrick et al., 2018). To overcome these barriers, current support services are also showing an increased initiative to employ those with “lived-experience,” which has shown to Conclusion benefit building relationships between service provi- der and service user (Fox, 2022; Welford et al., 2021). The findings of this study are generally consistent with previous literature in evidencing the complex, and often bidirectional relationships between homeless- ness, offending behavior, and substance use disorders. Limitations However, the use of qualitative analysis allowed for This study provides a unique insight into the experi- more detailed findings, which highlight that substance ences of homeless individuals, but nonetheless, limit- use disorders serve as the dominant function in the ations must be considered when interpreting the onset and continuation of the relationship between all findings. Most pertinent to this research would be three. With this in mind, the effectiveness of recovery the consideration of biases, being anything that may be improved if overcoming substance use dis- might influence or distort the study’s findings (Polit orders is central to the care plan, whilst also addressing & Beck, 2014). homelessness and offending simultaneously. JOURNALOFSOCIALDISTRESS AND HOMELESSNESS 11 District Council, Health and Care Research Wales, Public Furthermore, this study’s results are consistent with Health Lincoln, Santander. Steve Sharman is currently literature that reports those who are homeless with funded by an MRC / UKRI Future Leaders Fellowship. He substance use disorders are more likely to commit has previously received funding from the King’s Prize acquisitive offenses, crimes for survival purposes, Fund, the Society for the Study of Addiction Academic Fel- and/or to fund an addiction. However, this study lowship Scheme, Gambling Research Exchange Ontario also highlights that the motives behind the offenses (GREO) and Honoria from Taylor Francis Publishing. may be specific to those who are homeless with a sub- stance use disorder, raising the question as to whether Notes on Contributors prison is an effective form of rehabilitation for these individuals. This study would suggest otherwise, Honor Sibthorp Protts has a Master’s Degree in Forensic Psychology from The University of Lincoln, UK, and has with participants not only describing that prison was worked with vulnerable individuals facing homelessness not a deterrent, but that it often provides respite and and housing issues for a number of years. She currently basic needs, motivating further crime. For those com- works as Forensic Mental Health Practitioner within the mitting crime for this reason, prison sentences may criminal justice system and hopes to continue working to not be effective at reducing crime. Instead, a focus improve the support services available to vulnerability on support for overcoming the needs behind the individuals. motives may yield greater results. Amanda Roberts is a Professor of Psychology at the Univer- Considering there is a foundation of literature sity of Lincoln, UK, with a PhD in Behavioural Neuro- science from Cardiff University and previous research and which links prison sentences, homelessness, and hous- lectureship positions at UK academic institutions including ing instability, further research exploring how prison Kings College London, The Institute of Psychiatry, Queen sentences impact housing stability and homelessness Mary University London, The Wolfson Institute, and for those who have substance use disorders would be UEL. She has numerous multidisciplinary national and beneficial. international collaborations including an honorary research contract at the National Problem Gambling Clinic and a Lastly, when discussing support services, it was Research Fellowship at the Gambling Addictions Research apparent that participants experienced feelings of Centre, AUT, NZ. Amanda’s research interests include the stigma and marginalization. However, many did not evaluation of gambling addiction treatment programs both experience social exclusion, a term commonly used in the community and in UK prisons, and additional inter- interchangeably with marginalization. Instead, partici- ests extend across topics that relate to gambling comorbid- pants described social inclusion within their own ity, gambling in vulnerable populations, homelessness, women and gambling, and gambling and interpersonal social group. These findings suggest “marginalisation” violence. and “social exclusion” are two separate concepts, and Steve Sharman is a Research Fellow at King’s College individuals with shared experiences of homelessness, London and the first behavioral addictions focused Research substance use disorders, and offending behavior have Fellow within the National Addiction Centre. He has held their own “society” in which they do not experience previous post-doctoral positions at the University of East marginalization. Therefore, suggesting that the aim London, and the University of Lincoln. Steve completed to reintegrate individuals back into mainstream his PhD in Experimental Psychology at the University of Cambridge, and his MSc in Cognitive Neuroscience at society is restrictive to recovery, due to the notion UCL. He is a current recipient of a UKRI Future Leaders and experience of “society” varying for each individ- Fellowship, and has previously been awarded the King’s ual. The focus should instead be on how to help Prize Fellowship, and the Society for the Study of Addic- them recover within their “society.” tion’s Griffith Edwards Academic Fellowship. His research interest’s include gambling behavior, gambling in virtual reality, and problem gambling in specific vulnerable popu- Acknowledgements lations. Steve is a member of The National UK Research Network for Behavioural Addictions (NUK-BA) and is The authors would like to thank the individuals who partici- part of the organizing committee for the Current Advances pated in this research and for their willingness to share their in Gambling Research Conference. He also supervises final- personal experiences. We would also like to thank the ser- year undergraduate and post-graduate dissertations and tea- vices which supported us with recruiting participants. ches undergraduate and post-graduate psychology. Disclosure statement References No potential conflict of interest was reported by the authors. 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Journal

Journal of Social Distress and the HomelessTaylor & Francis

Published: Apr 27, 2023

Keywords: Homeless; substance; offending; rough sleeping; marginalized

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