What, how and who? Perspectives of problem substance use treatment from those experiencing homelessness and precarious housing: Key components and methodological observations

First published: 13 March 2019 | Last updated: 28 March 2019


Dr Hannah Carver

Knowledge Exchange Fellow

I am a Knowledge Exchange Fellow at the Salvation Army Centre for Addiction Services and Research, University of Stirling. I am a qualitative researcher with interests in families, young people, women and homelessness. Current projects include research and knowledge exchange activities in health, homelessness and substance use, including a NIHR funded study, SHARPS, a feasibility study of a peer-delivered relational intervention for people experiencing homelessness and problem substance use. I completed a PhD in 2017 at Edinburgh Napier University, conducting a qualitative study to explore substance use communication between looked after young people and their carers.

Aims: There is limited evidence regarding how treatment for problem substance use should be delivered to those experiencing homelessness. Synthesising qualitative studies enables both deep understanding of a subject, as well as generation of new theory, to inform future research. A meta-ethnography was conducted to develop a deeper understanding of effective problem substance use treatment from the perspective of those experiencing homelessness and precarious housing.

Methods: Electronic databases, websites and reference lists were searched for primary qualitative research published from 2000. Eighteen papers were included in the synthesis. First and second order data were extracted and coded thematically using NVivo. Reciprocal and refutational analysis identified similarities and differences between studies. The final line of argument synthesis identified key components of effective treatment which informed model development.

Results: The findings related in three key ways: ‘what treatment works’, ‘how treatment works’, and ‘barriers’. Particular interventions, service environment, treatment philosophy, and the importance of choices were all central features of ‘what works’. In terms of ‘how’, the need for support, compassion, time, stability and help to ‘(re)learn how to live’, were common elements. Stigma, shame and lack of trust were identified as major barriers. The line of argument synthesis highlighted methodological observations related to missing voices within published studies.

Conclusions: Our findings highlight key components of effective substance use treatment for those experiencing homelessness and precarious housing. It extends understanding of the particular needs of this group of men and women in new ways, with important implications for policy, practice and research.


Hannah Carver