Drink and Drugs News DDN February 2019 | Page 17

More conference pictures at: www.drinkanddrugsnews.com NO HELP FOR SMOKERS Dr Lynne Dawkins of London South Bank University (LSBU) explained the strong link between homelessness and tobacco use and looked at opportunities for harm reduction. Smoking killed around 200 people a day in England and was responsible for more than a quarter of cancer deaths – and with the average pack price almost £10, it was expensive. ‘You’d expect people on the lowest incomes to be the most sensitive to price changes, but that’s not what the evidence shows,’ said Dawkins. ‘Those who smoke can least afford it.’ While there was a slow but steady decline in smoking in the population as a whole, there were widening health inequalities in people who smoked. It was estimated that 77 per cent of homeless people smoked, which could exacerbate the onset of psychosis. ‘The desire to quit is no less in the homeless population, but attempts are often unaided,’ she said. ‘In some cases, smoking cessation is discouraged as it’s felt they can’t deal with it – that it’s “the only pleasure they have”.’ Evidence had shown e-cigarettes to be 95 per cent less harmful to health than smoking, eliminating the tar and the exposure to 4,000 chemicals, including 60 carcinogens. They gave much faster delivery of nicotine than patches, could replace the all-important hand-to-mouth activity, and didn’t feel like a ‘quit attempt’ to many that tried them. So why aren’t we considering e-cigs for the homeless, an extremely nicotine-dependent population, she asked. NOTHING TO LOSE Another problem that disproportionately affected homeless people was gambling, and Dr Steve Sharman of the University of East London who had looked at whether gambling was a cause or a consequence of homelessness. ‘Most gamblers have problems before becoming homeless, but also a smaller proportion took it up afterwards – so it’s more complex than we thought,’ he said. He shared case studies which showed the gradual onset of a gambling habit. Dean’s gambling had started when he was 14 and used to go with his father to collect his mother from the bingo hall. Playing on the slot machines while they were waiting became the start of a habit that led to stealing from friends and family, spending all his wages, becoming homeless when his landlady evicted him for not paying the rent, and two suicide attempts. Tom was abused from a young age and in care at ten, discovering drugs and alcohol as a way of escaping the negativity he was feeling. He and his girlfriend had a baby at 15, when his gambling career started with interactive tv games; before long he was spending their child benefit in the bookmaker’s, committing burglary, street robbery and violent crime to fund the habit, and became homeless after a spell in prison. Using the information from personal stories, Sharman was developing a series of tools including a resource sheet with immediate tips and safeguarding measures (freely available at www.begambleaware.org). Fewer people were aware www.drinkanddrugsnews.com of treatment services for gambling than for drug problems, so the challenge was to find those in need of help, particularly if they were ‘lost’ to the system. BODY AND MIND ‘The problem is not lack of evidence, but lack of compassion. It’s a class attempt to write people off and not think of them as fully human.’ One of the other key areas for review was effective treatment for dual diagnosis, where poor mental (and physical) health overlapped with substance misuse – a situation all too common in homeless people. Using qualitative research, Dr Hannah Carver of the University of Stirling had looked at what could be effective for people in this situation. As well as long-term, tailored treatment that looked at underlying conditions, it was found that peer support and compassionate non- judgemental staff were important to outcomes. The right environment and the right intervention needed to be paired with stability and structure, and opportunities to learn life skills. ‘Services should be facilitative and friendly, treating people “where they’re at”,’ she said. CARE PATHWAYS Across every facet of healthcare there was evidence-based information that could go a long way to improving the lives of people experiencing homelessness. But as Dr Michelle Cornes of King’s College London demonstrated, the theory came to nothing if multi-professional teams did not work as a unit around the person needing help. ‘The picture is very fragmented,’ she said. ‘We often talk of the need to get physical health better before mental health.’ But pathway teams, including nurses, GPs, housing workers, social workers and occupational therapists, needed to be part of the care team – demonstrated in the case of hospital discharge. The recuperation, rehab, resettlement and recovery were all part of intermediate care that ‘has been shown to give enormous benefits’, she said. She introduced Darren and Jo, experts by experience, who explained what happens when the care pathway breaks down. February 2019 | drinkanddrugsnews | 17