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Health Literacy for Homeless Men Regarding Drugs and Alcohol Abuse

Health Literacy for Homeless Men Regarding Drugs and Alcohol Abuse

You are working as a registered nurse in an outreach service for homeless men in a large city. Issue: You want to promote health literacy and decision-making in relation to drugs and/or alcohol use.


Health literacy refers to a range of results and outcomes from health communication and health education activities. Hence, health education is directed at improving levels of health literacy. Health literacy can also be described as the skills, beliefs and knowledge which help one to recognize, prevent and manage substance abuse issues, as well as mental health disorders. This paper will explore the fundamentals of health literacy from the point of view of a nurse working on an outreach program informing homeless men of the elements of drug and alcohol.

There are various issues that will need to be covered with this population, including enabling these individuals so that they are able to recognize particular relevant issues such as mental health and addiction information, seeking appropriate professional help and self-management, reduction of stigma/ reduction, as well as knowledge of causes and risk factors (Kraybill & Zerger, 2003). It is essential to address mental health issues amongst homeless men since a greater percentage of them also suffer from affective disorders such as emotional disturbances, posttraumatic stress disorder and dementia. This is compounded by the fact that most of these homeless men are also elderly who have either been abandoned by their families or have none to speak of.

The context

The thought of someone being homeless in Australian streets conjures up the stereotypical image of an elderly man on the streets. Even though this is not a true representation of the nature of homelessness, it is true that males account for over 50% of the homeless population in the country. Men also make up a larger percentage of those staying in boarding houses and improvised dwelling totalling to about 72% and 60% respectively (Homelessness Australia, 2012). Homelessness of different men in Australia is caused by different issues. Some have lost their homes following breaking up resulting in the difficulty to re-access stable finance and housing (Blow & Distelberg, 2006). Others may experience financial difficulty resulting from unemployment and other series of adverse life experiences. Given that there has been a chronic shortage of affordable housing, homelessness following unemployment or economic downturn as well as the depletion of savings is not a surprise. The shortage of affordable housing in Sydney is among the most common causes of homelessness as it prevents rehousing when people become homeless.

Younger men are mostly homeless because of the arrival of step parents or relationship breakups (Zerger, 2002). Others are homeless because of problematic substance abuse (mostly alcohol), mental illness or gambling debts. It is estimated that about 20,000 Australians are homeless owing to gambling debts (Counting the Homeless, 2006). Being homeless in itself is an issue that may cause depression in these individuals which may result in subsequent substance abuse. The problems that led to the homeless, like unemployment, neglect, mistreatment, disagreements, breakups and gambling, also add to the depression that these individuals may feel which makes these individuals additionally vulnerable to substance abuse. Of the homeless individuals with substance abuse problems, two thirds of them have indicated developing it after they had become homeless (Homelessness Australia, 2012). This is compounded by the fact that some of these men are accompanied by children who are taken away from them following their being homeless.

Another aspect of homelessness in men is that they make up for the majority of the individuals who can be termed as being chronically homeless. These individuals make rounds in temporary housing facilities often ending up homeless at least twice or thrice in a year. Chronic homelessness is associated with an increased likelihood of developing mental illnesses and dependency on substances. Consequently, homelessness and substance abuse are linked inextricably. This is made worse by the fact that these individuals who are homeless with substance abuse also have mental disorders that they have developed or were suffering from before they became homeless (Castonguay & Beutler, 2006). Over half of homeless individuals are also abusing alcohol.

Common themes covered in substance abuse programs for homeless men

Rather than approach the issue from abstinence only perspective as most other intervention programs, this health literacy program will focus on motivating homeless individuals to live healthier lives. Addictions in homeless individuals should be viewed as illnesses that require support, treatment and counselling to overcome. It is a unique problem because it is a case as well as a result of homelessness. Health literacy for homeless individuals will include counselling them on where and why to seek help (Beutler, 2002). This will include letting them know where to seek constant help and counselling so that they can always know where to go for help. Homeless individuals often turn to alcohol and other drug substances to cope while this only makes it difficult for them to be accepted in the community of being trusted enough to be given jobs by others in the community. Hence, the health literacy program will also include letting them know about the benefits of being sober. This will also include reminding them of why it is important to be independent and working.

This is important because it will motivate them to move toward stopping substance abuse. The motivation to stop drinking and using drugs is poor because it is not among their priorities. For most of homeless men, their priority is to survive rather than development and personal growth. In addition, shelter and food are also a priority above going for drug counselling. It is also likely that a majority of these individuals has become estranged from their families and friends who might have provided support and a social network critical in recovering from alcohol and drug abuse (AFTA Newsletter, 1999/2000). Even when they recover, the rates of relapse are higher because of the lack of support and living on the streets where there are substances available to them.

Motivational interviewing

Motivational interviewing is a treatment strategy that was developed for use in substance abuse treatment. It involves the client centered directive counselling meant to elicit change in behavior by helping clients to resolve and explore ambivalence (Kraybill, Silver & Winarski, 2003). It is a unique approach because it is a collaborative and respective way of being with people which in turn motivates them to listen to what the individual is telling them and take it seriously. Consequently, it will also inspire individuals to elicit their personal motivation for change. This technique has proven effectiveness because it can run counter to other strategies, and it has been proven effective in such situations. While running another program such as helping the homeless learn about hygiene, it can be implemented along with these other programs as it does not take away attention from other programs, and it reinforces their commitment to fulfilling what the other programs wish to accomplish.

Apart from that, motivating interviews will also ensure that they patch up things with their families as it involves contacting them. This will ensure that they have a stable and ever present support system that is instrumental in ensuring they remain true to their being sober. This is especially important for the families of homeless war veterans because they can learn and understand what the men are going through and take this into consideration when dealing with their substance abuse (Miller & Rollnick, 2002). This strategy has also been proven effective when dealing with criminal justice settings that call for behaviour change of those with substance abuse issues. This is especially relevant in this case because those with substance abuse problems within the criminal justice system also struggle with mental health issues like homeless men. The best strategies are those that have been tested and proven effective in similar situations, and this indicates that motivational interviews will be effective.

It is the role of the nurse practitioner to make her clients thirsty for change rather than just telling them that they have to change or what the change is. In order to be effective in administering motivational change, it is essential to understand critical assumptions. For instance, motivation is a state, and it is not a trait, this means that it can be inspired in any individual using the right strategies and under the right conditions (Simon, 2006). Resistance should not be perceived as a force that needs to be overcome; hence, there should be no effort made toward making people feel bad for showing resistance (Kraybill et al, 2003). Resistance is part of motivation and counselling, and it should not be seen as a negative, but as a positive for it shows that the individual has some motivation. It is this motivation that should be directed at improving health outcomes. When the client shows ambivalence, it is also a positive sign because it tells of their struggle with change meaning that they are listening and paying heed to their health literacy lessons.

Motivational interviewing uses a number of strategies that make it appealing to the client. Homeless men have been battling with rejection, and some have even come to accept that they are not part of the society. Consequently, the first part of their health literacy should be creating a rapport with them by making them feel like they matter to the society and that they are contributory members of the society (Wampold, 2001). Their carefree attitude to life is detrimental even to their own wellbeing as they stop caring for everyone including themselves. Letting them know and feel that they matter is key to motivating their involvement in health literacy. Open ended questions are the most effective in bringing out care, counselling and health literacy. Much as the nurse is in charge of giving information to the client, they should keep the client involved in the sessions by asking questions such as ‘what would you like to do about your situation?’

Dealing with homeless men with substance abuse problems can be a challenge because they may not share information (McCollough, 2000). Being a neglected group, they band together and keep everyone else out of their circle as they go about their lives. Hence, coming in as a stranger – even one with good intentions – will be difficult. Among the best ways to beat, this is by using group sessions or group therapy when carrying put health literacy. Group sessions help them understand that they are not alone in their problems and that they can form a support group amongst themselves. They can also work together to keep drugs off the areas they live in.

Another strategy that may be a challenge to implement, but is equally effective is gaining knowledge about the homeless individuals. This needs to be done in groups, as well as individual sessions. This is not knowledge that pertains to their life and experiences, but rather to their personalities. Once aware of their strengths and weaknesses, it will be easier to give them affirmations. These are genuine statements about the strengths of these men, as well as the confidence one has in them to change. Being that it will be a health literacy program, it means that the clients will be listening a lot. As such, there should be opportunities when the client is also given opportunities to speak. At such times, the nurse should practice reflective listening, which is an active listening form where some of the clients’ feelings are mirrored.

Dealing with substance abuse problems in homeless individuals is not a linear effort, but a network of collective efforts from different parties in order to present a holistic intervention that will be effective in helping homeless individuals combat with their addictions. This is important because as mentioned in the context, everything around the individual contributes to their addiction. It is not enough that they are assisted in getting to rehabilitation programs; they need support groups and environments where they will be less susceptible to the allure of drug and alcohol abuse. Primary care is critical in helping homeless men reclaim their lives. One cannot just deal with medical conditions such as substance abuse without dealing with other problems that patients face. Homeless men who have suffered rejection may be using drugs to cope as a response to trauma. It is essential to change behaviors that are seen as resistant to effective coping strategies.


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