Findings indicate that homeless women’s social context is important to understanding substance use, consistent with an ecological model that health-related behaviors can be most productively understood when levels of influence in addition to intrapersonal characteristics are investigated (Sallis et al., 2006
; Stokols, 1992
). Women who reported greater proportions of drug using alters in their networks reported a greater probability of marijuana, crack, cocaine, and methamphetamine or other amphetamine use during the past 6 months. This finding is consistent with research conducted among other urban drug users (Williams and Latkin, 2007
) and suggests that the drug users in homeless women’s networks may have communicated norms supportive of drug use (Pilowsky et al., 2007
). With the exception of cocaine use, these findings were replicated with drug using alters who were specifically primary sex partners, reinforcing the potentially important influence of these partners in homeless women’s drug use (Amaro and Hardy-Fanta, 1995
). Further research may be useful to understand why primary partners’ drug use did not appear to affect women’s cocaine use.
Binge drinking was predicted by alters’ heavy alcohol use, a finding replicated when we examined the potential influence of alcohol using primary sex partners specifically. Alcohol use may be affected by drinking behaviors of peers through social normative influences (Borsari and Carey, 2001
; Maddock and Glanz, 2005
). Our findings similarly suggest the importance of an influential social environment that encourages or provides opportunities for homeless women’s alcohol use. Binge drinking was not predicted by alters’ use of drugs. As a legal substance, alcohol may be more readily obtained when desired than illicit drugs, thus perhaps rendering the behaviors of drug-using peers less influential in affecting women’s use of alcohol.
Alters’ alcohol use to intoxication was important to women’s crack use, in that women reported fewer days of crack use when they had a greater proportion of alcohol users in their networks. This result, and that women’s drinking was not predicted by alters’ drug use, suggest differences in the social contexts of alcohol and drug use. That an alcohol using network predicted a lower probability of crack use whereas a drug using network predicted a higher probability of crack use, for example, may suggest differences in the “culture” of heavy alcohol use as opposed to drug use that is reflected in social normative influences. Crack use in particular has been closely linked to women’s street-based survival activities such as prostitution (Wechsberg, Dennis and Stevens, 1998
). Although studies have shown that crack use is often accompanied by alcohol use (Zule et al., 2002
), our data do not permit identification of the drugs used by women’s alters.
The notion of a difference between heavy alcohol using and drug using networks is further supported by the finding that women with a greater percentage of alters met through the criminal justice system experienced significantly fewer days of binge drinking. Incarceration experiences of indigent persons, particularly ethnic minorities, is often due to drug-related activities (Human Rights Watch, 2000
; Iguchi et al., 2002
; Moore and Elkavich, 2008
). More research is needed to clarify the influence of the social context on homeless women’s alcohol use, and the influence of their alcohol-involved networks on drug use.. Further investigation is also warranted to understand how network alters with incarceration experiences influence homeless women’s substance use. Network density does not appear to carry significant potential for normative influence on the substance use of homeless women.
The composition of homeless women’s networks appears to confer both risk and protection. Results indicate that disassociation from alcohol-involved networks might be beneficial for homeless women with alcohol problems, and disassociation from drug-involved networks might be beneficial for women with drug problems. Homeless women with networks having greater proportions of persons met through school and employment had a reduced probability of marijuana, crack, and cocaine use. Connections with such individuals may have a protective influence on risk for substance use. Our findings suggest the importance of structural solutions that include stable housing and enhanced employment and educational opportunities. Support for housing and opportunities for employment have been found to be important in maintaining sobriety among homeless persons in drug treatment (Milby et al., 2004
). Housing can provide a stable base away from risky members of the network; employment and education can enhance exposure to pro-social influences and healthy behaviors of others (Nyamathi et al., 2000
; Williams and Latkin, 2007
). As noted by Padgett et al. (2008)
, the standard warning in treatment and recovery to maintain distance from people associated with substance use (Sun, 2007
) may be especially challenging for a homeless person without housing and support services, Homeless persons tend to live in impoverished neighborhoods burdened by disproportionate rates of substance use, crime, and other social ills. Homeless persons lack economic resources and may also lack skills that facilitate reciprocal, prosocial, and health-promoting relationships (Padgett et al., 2008
). The combination of housing, education, and employment may enhance the capacity of women to develop healthier affiliations.
There was limited evidence of the importance of relationship quality in protecting against women’s alcohol and drug use. Tangible or informational support was associated only with significantly fewer days of marijuana use, consistent with a previous, longitudinal study of homeless women (Tucker, D’Amico et al., 2005
). Absence of a significant association between social support and use of other drugs may reflect the addictive properties of crack, cocaine, and methamphetamine – support is likely not sufficient to help a woman overcome abuse or dependence but can serve as an important adjunct to treatment and recovery.
The current study also emphasizes the importance of individual characteristics of homeless women in association with drug use. Findings support the need to address comorbidity of mental health problems (Bassuk et al., 1998
; Tucker, D’Amico et al., 2005
). Depression affected more than half of the women in this study and significantly predicted women’s binge drinking. For homeless women with substance use problems and depression, housing as well as educational and employment opportunities should be linked with treatment for substance abuse and depression.
A number of limitations should be noted. Data are cross-sectional and thus it cannot be definitively argued that women’s networks influenced their substance use during the past 6 months. It is possible that expectations or policies regarding abstinence in the shelters from which we sampled the women may have impacted the level of substance use we observed. Our focus on reporting of substance use during the past 6 months rather than a shorter, past-30 day timeframe, for example, may have reduced the extent that substance use reporting was influenced by expectations of the particular shelter in which a woman was interviewed. Despite shelters’ stated expectations for abstinence, substance use may nevertheless occur within them (Padget et al., 2008
). Additionally, the study relied on self-reports of substance use, as have other studies involving homeless persons (e.g., Nyamathi, Leake and Gelberg, 2000
; Tucker, Wenzel et al., 2005
). While there is concern about bias in self-report of sensitive information, self-report data on substance use have been highly correlated with objective measures (Nyamathi, Leake, Longshore et al., 2001
). Another limitation is that behaviors of alters were not solicited directly from alters but rather reflected the perceptions of the respondent. Responses gathered in this way may be biased toward the respondents’ expectations (Buchanan and Latkin, 2008
); however, research has shown that perceptions of others’ behaviors have an important influence on one’s own cognitions and behaviors (Bronfenbrenner, 1979
; Kelly and Kalichman, 2002
; Wingood et al., 2001
). Also regarding the alters, it may be that by limiting the number each woman name to 20, peripheral yet influential social ties were omitted from consideration. Despite these limitations, this study has succeeded in furthering our understanding of homeless women’s alcohol and drug use through an investigation of the social context, thus providing needed direction for future research and interventions involving this vulnerable population.