Coping Strategies for Substance-users and the Homeless Population 1

Coping Strategies for Substance Use Disorders and the Homeless Population

Jen Trinh

University of Utah Department of Occupational Therapy

 2

Jen Trinh
Literature Review

Drug addiction and substance abuse have become a huge global issue affecting people’s

health and increasing economic costs in American society. As stated in the 2012 National Survey

on Drug Use and Health, about 22.2 million people in the US were dependent or have abused

substances in the past year, especially with those in the homeless population (SAMHSA, 2013).

Embedded within this population includes addictive substances such as cocaine,

psychostimulants, and other forms of prescription drugs, like opioid pain medications, which has

led Utah to become one of the most addicted states in the nation (Lakeview Health, 2019). Every

week 6 Utahans die from an opioid overdose, and 80% of heroin users in Utah began with the

misuse of prescription drugs. Rothermel (2019) indicated that Utah is the 5th highest state in the

nation for prescription drug overdose deaths. With an increase-alarming rate of substance abuse

continuing to rise in America, only 1 in 10 people with substance abuse disorder receives

treatment (Rothermel, 2019).

Long-term use of drugs and alcohol has been reported to cause chemical changes in the

brain, affecting functions such as learning, judgment, decision-making, stress, memory, and

behavior (NIH, 2018). Those who seek treatment options are often faced with homelessness, a

lack of family support, PTSD, and a high frequency of relapse after discharge. Boden et al.

(2011) found that 35% to 50% of individuals diagnosed with PTSD also meet the criteria for

substance use disorders. With that being said, those who have co-occurring symptoms of

substance abuse and PTSD are more likely to participate in substances that are more harmful,

resulting in poorer treatment outcomes than do individuals with PTSD or substance abuse

disorders alone (Boden et al., 2011). Therefore, suggesting that counselors, including
Coping Strategies for Substance-users and the Homeless Population 3

caseworkers, peer supporters, and therapists should consider implementing Seeking Safety

programs to treat the complexity of PTSD and substance use (Lenz, Henesy, & Callender, 2016).

Often the despairing cycle between drug addiction and homelessness is ongoing. Those with

substance use are more likely to be homeless as compared to the general public. Mohaqeqi

Kamal, Sajadi, Ghaedamini Harouni, Basakha, and Noroozi (2019) suggests that protective

factors such as marriage and having a reliable social support system will often prevent and

improve the consequences of substance abuse for homeless men. The National Substance Abuse

and Mental Health Services Administration (2003) reports, 38% of homeless people were

dependent on alcohol, and 26% abused other drugs. The constant struggle between relapsing and

withdrawing can significantly impact one’s health, mental abilities, and daily activities.

Holloway (2018) indicates that without proper professional assistance and intervention to guide

people with substance abuse and mental illnesses, users will often never recover on their own.

The most common substance dependence treatment settings are self-help groups,

followed by inpatient and outpatient rehabilitation facilities (SAMHSA, 2013).

Pharmacotherapy, including detoxification and aversion therapy, are widely used treatment

options for individuals with alcohol dependence and substance use disorders (Fisher & Harrison,

2013). The process of slowly removing harmful substances from a person’s system can often

have severe consequences due to complications of withdrawal effects. In addition to

detoxification, aversion therapy is a behavioral treatment approach used to treat unfavorable

effects and psychiatric symptoms associated with an individual’s drug of choice. Other forms of

non-medicated treatment methods involve the Minnesota Model, management programs,

therapeutic motivational interviewing, seeking safety, cognitive-behavioral therapy (CBT), and

outcome interventions (Sipple, Weiss, Ramsey, Drymon, & Patterson 2015). From the treatment
 4

programs mentioned, the Minnesota Model or twelve-step programs, such as Alcoholics

Anonymous (AA) and Narcotics Anonymous (NA), are considered the most effective and widely

used therapy approaches in the US. These programs help clients refrain from using addictive

substances as compared with CBT and motivational enhancement therapy.

The Minnesota Model emphasizes that substance users have the potential to change their

attitudes, thoughts, and behaviors during the recovery process. Furthermore, addiction is viewed

as a disease rather than a choice, and substance users need to remain sober from any mood-

changing drug during the healing process (Sipple et al., 2015). Unfortunately, even with the

many treatment options available at most facilities, there continues to be a large gap between

individuals who require AOD treatment and those who are willing to attend therapy groups.

Therefore, health professionals such as occupational therapists, onsite nurses, and social workers

should strive to develop fun and creative intervention programs for clients with substance use

disorders. These programs will offer more opportunities for clients to pursue new activity

interests, practice life skills, and apply self-coping strategies via art therapy, mindfulness

approaches, and physical activity to redirect substance users from participating in previous

addictive habits.

Emerging research now shows the importance of implementing a holistic approach to

treat substance use disorders with the focus on emotional, physical, and social well-being to ease

the mind, body connection to promote a healthy lifestyle (Adedoyin et al., 2014; Atkinson, 2009;

Breslin et al., 2003; Golden, 2017). Different forms of holistic practice in substance abuse

treatment programs include expressive & art therapy, and osteopathic philosophy -connecting the

mind and body for healing (Adedoyin et al., 2014; Golden, 2017). These areas are not often apart

of traditional treatment programs like the 12-step and the Minnesota Model. Breshears, Yeh, and
Coping Strategies for Substance-users and the Homeless Population 5

Young (2004) indicate that at least 60% of treatment admissions for drug abuse are a reoccurring

episode, which implies that conventional treatment options might have an insignificant effect on

a client’s recovery process. Therefore, therapists and counselors should implement holistic

approaches when developing fun and creative treatment through mindfulness approaches, art

therapy, and physical activity in combination with traditional substance programs; all in which

have been proven to be useful to treat those with addiction (Adedoyin et al., 2014; Atkinson,

2009; Bayles, 2014; Bowen, 2014; Breslin et al., 2003; Matto, 2002; Sullens, 2012; Williams &

Strean, 2004).

Significant amounts of research have shown the importance of incorporating

mindfulness-based practice for people with substance use disorders to prevent recurring relapse

episodes (Bayles, 2014; Bowen, 2014; Brewer, 2010; Chiesa & Serretti, 2014; Li et al., 2017;

Montero, 2017). Meditation allows clients to be in the present moment, it promotes positive

cognitive changes, helps with emotional regulation, ease the mind and body via relaxation

techniques, and allows client’s to have nonjudgmental attitudes towards their addictive behaviors

(Bowen, 2014; Brewer, 2010; Li et al., 2017; Montero, 2017). Mindfulness programs that have

shown to be successful are Mindfulness-oriented recovery enhancement (MORE), which

combines training with cognitive-behavioral therapy that consists of 10 weekly, 2-hour group

sessions followed with assigned homework. In addition to Mindfulness-based relapse prevention

(MBRP), which integrates meditation and breathing exercises along with cognitive therapy. The

latter consists of 8 weekly, 2-hour group sessions followed by home exercises (Li, Howard,

Garland, McGovern, & Lazar, 2017). Also, with acceptance and commitment therapy (ACT), the

focus is on acknowledging thoughts as they come and go and dialectical behavior therapy

(DBT), which emphasis on Zen and emotional regulation in conjunction with mindfulness
 6

approaches (Chiesa & Serretti, 2014; Perroud et al., 2012). Limitations most often associated

with these mindfulness approaches were the length of the program and their small sample size,

which makes it harder to generalize its findings.

In hopes of bridging the current gap between those who need AOD treatment and the

number of individuals who receive it, providers and counselors should implement creative,

unconventional treatment options that appeal to a broader population of substance use disorders.

Another consideration that shows promising results involves integrating parenting classes for

fathers in an all-male substance use treatment facility. Studies show that little attention is paid to

the importance of fatherhood in substance use disorder facilities, although the significant effects

such treatment programs have for women with similar diagnoses (McMahon, 2013; Niccols et

al., 2012; Stover et al., 2018). The Fathers for Change (FFC) intervention program consists of

hour-long treatment sessions held once per week for12 weeks with treatment focus on emotional

regulation, hostile thinking, and anger. The goal of FFC is to motivate fathers on a one to one

basis to change their maladaptive behaviors, which have led to violent actions and the control of

substances (Stover, Carlson, Patel & Manalich, 2018). A few downsides of the Fathers for

Change intervention program that participants complained about were treatment sessions were

too short, and there was not enough offered each week. Other participants also mentioned that

they wished the program was provided in a group session rather than on an individual basis to

learn from others’ perspective, in addition to continuing similar interventions into their aftercare

phases following discharge from the facility (Stover et al. 2018).

Coping Strategies for Substance-users and the Homeless Population 7

Reference

Adedoyin, C., Burns, N., Jackson, H. M., & Franklin, S. (2014). Revisiting holistic
interventions in substance abuse treatment. Journal of Human Behavior in the Social
Environment, 24(5), 538–546. https://doi.org/10.1080/10911359.2014.914718

Atkinson, M. (2009, May/June). The best prognosis: Integrated, holistic approach to addictive
disorders. Addiction Today. Retrieved from
http://www.allianceforaddictionsolutions.org/images/pdfs/integrated-holistic-
approach.pdf

Bayles, C. (2014). Using mindfulness in a harm reduction approach to substance abuse

treatment: A literature review. International Journal of Behavioral Consultation &
Therapy, 9(2), 22–25. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103980396&sit
e=ehost-live

Boden, M. T., Kimerling, R., Jacobs-Lentz, J., Bowman, D.,Weaver, C., Carney, D., . . .
Trafton, J. A. (2011). Seeking safety treatment for male veterans with a substance use
disorder and post-traumatic stress disorder symptomatology. Addiction Research Report,
107, 578–586. doi:10.1111/j.1360-0443.2011.03658.x

Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., … Larimer, M. E.
(2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse
prevention, and treatment as usual for substance use disorders: A randomized clinical
trial. JAMA Psychiatry, 71(5), 547–556. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103958173&sit
e=ehost-live

Breshears, E. M., Yeh, S., & Young, N. K. (2004). Understanding substance abuse and
facilitating recovery: A guide for child welfare workers. Rockville, MD: U.S. Department
of Health and Human Services, Substance Abuse and Mental Health Services
Administration.

Breslin, K. T., Reed, M. R., & Malone, S. B. (2003). An holistic approach to substance abuse
treatment. Journal of Psychoactive Drugs, 35(2), 247–251.

Brewer JA, Bowen S, Smith JT, Marlatt GA, & Potenza MN. (2010). Mindfulness-based
treatments for co-occurring depression and substance use disorders: What can we learn
from the brain? Addiction, 105(10), 1698–1706. https://doi.org/10.1111/j.1360-
0443.2009.02890.x

Chiesa, A., & Serretti, A. (2014). Are mindfulness-based interventions effective for
substance use disorders? A systematic review of the evidence. Substance Use and
 8

Misuse, 49, 492–512. doi:10.3109/10826084.2013.770027

Fisher, G. L., & Harrison, T. C. (2013). Substance abuse: Information for school counselors,
social workers, therapists, and counselors (5th ed.). Boston, MA: Pearson.

Golden, B. (2017). Healthy anger: A mind and body approach. Counselor: The Magazine for
Addiction Professionals, 18(4), 25–38. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=124467952&sit
e=ehost-live

Holloway, H. (2018, July 18). How drug addition and homelessness are intertwined.
Retrieved from https://utahstories.com/2018/07/how-drug-addiction-and-homelessness-
are-intertwined/

Lakeview Health (2019). Utah substance abuse statistics. Retrieved from

https://www.recoveryconnection.com/substance-abuse-statistics-by-state/utah/

Lenz, A. S., Henesy, R., & Callender, K. (2016). Effectiveness of seeking safety for co-occurring
posttraumatic stress disorder and substance use. Journal of Counseling &
Development, 94(1), 51–61. https://doi.org/10.1002/jcad.12061

Li, W., Howard, M. O., Garland, E. L., McGovern, P., & Lazar, M. (2017). Mindfulness
treatment for substance misuse: A systematic review and meta-analysis. Journal
of Substance Abuse Treatment ,75, 62– 96. doi:10.1016/j.jsat.2017.01.008

Matto H. C. (2002). Integrating art therapy methodology in brief inpatient substance abuse
treatment for adults. Journal of Social Work Practice in the Addictions, 2(2), 69–83.
Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106822700&sit
e=ehost-live

McMahon TJ. 2013. Fathers too! Building parent intervention for substance-abusing men. In
parenting and substance addiction: Developmental approaches to intervention, Suchman
NE, Pajulo M, Mayes LC (eds). Oxford University Press: New York; 447–468.

Mohaqeqi Kamal, S. H., Sajadi, S., Ghaedamini Harouni, G., Basakha, M., & Noroozi, M.
2019). Prevalence, risk and protective factors for substance abuse among homeless
males living in tehran. Journal of Substance Use, 24(3), 240–244.
https://doi.org/10.1080/14659891.2018.1552727

Montero, R. (2017). The value of mindfulness practice for people with substance use
problems. Journal of Social Work Practice in the Addictions, 17(4), 433–441.
https://doi.org/10.1080/1533256X.2017.1358993
Coping Strategies for Substance-users and the Homeless Population 9

National Institute on Drug Abuse (2018). Understanding drug use and addiction. Retrieved from
https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-
addition

Niccols A, Milligan K, Sword W, Thabane L, Henderson J, Smith A. 2012. Integrated

programs for mothers with substance abuse issues: A systematic review of studies
reporting on parenting outcomes. Harm Reduction Journal 9:1–14.
https://doi.org/10.1186/1477-7517-9-14.

Perroud, N., Nicastro, R., Jermann, F., & Huguelet, P. (2012). Mindfulness skills in borderline
personality disorder patients during dialectical behavior therapy: Preliminary results.
International Journal of Psychiatry in Clinical Practice, 16(3), 189–196.
https://doi.org/10.3109/13651501.2012.674531

Rothermel, A. (2019, June 18). 4 Utah drug abuse statistics you didn’t know. Retrieved from
https://www.alpinerecoverylodge.com/utah-drug-abuse-statistics/

Sipple, S., Weiss, D., Ramsey, A., Drymon, C., & Patterson, D. A. (2015). Most common and
effective treatment practices for substance use disorders. Counselor: The Magazine for
Addiction Professionals, 16(6), 32–37. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110786920&site=eho
st-live

Stover, C. S., Carlson, M., Patel, S., & Manalich, R. (2018). Where’s dad? The importance of
integrating fatherhood and parenting programming into substance use treatment for men.
Child Abuse Review, 27(4), 280–300. https://doi.org/10.1002/car.2528

Substance Abuse and Mental Health Services Administration (SAMHSA).

(2013). Results from the 2012 national survey on drug use and health:
Summary of national findings. Retrieved from http://www.samhsa.gov/data/
NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm

Substance Abuse and Mental Health Services Administration. (2003). Homelessness–

Provision of mental health and substance abuse services. Retrieved from
http://mentalhealth.samhsa.gov/publications/allpubs/homelessness/.

Sullens, C. (2012). What is art therapy? Retrieved from

http://carlysullens.hubpages.com/hub/What-Is-Art-Therapy

Williams DJ, & Strean WB. (2004). Physical activity as a helpful adjunct to substance abuse
treatment. Journal of Social Work Practice in the Addictions, 4(3), 83–100. Retrieved
from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106594464&sit
e=ehost-live