Motivation to Change?

Homelessness Effects on Alcohol and Drug Use

To Change or Not to Change?

There are many paths our lives can take either from decisions we make or those that are out of control. There are numerous factors that influence the people that we become. Many women are born into situations that direct them down the road of addiction and eventually homelessness. The question what factors contribute to a woman’s motivation to change needs to be further researched.


A group of study researchers (Upshur & Weinreb et al., 2014) examined the association between experiencing homelessness and motivation to change drug or alcohol use. Women enrolled in the AHEAD (Addiction Health Evaluation and Disease management) study considered the effectiveness of a disease management intervention in primary care for alcohol or drug-dependent adults. The AHEAD study enrolled 154 women, 69 reported homelessness and 85 reported being housed. There were no significant differences in demographic characteristics.


Data was collected at study entry and 3, 6, and 12 months later. Physical and mental health status were measured by the 12-item short form health survey (SF-12) and summarized by Physical and Mental Component Summary scores (PCS, MCS). Medical comorbidty was assessed by the Katz questionnaire; mental health used the Patient Health Questionnaire (PHQ-9) and Mini International Neuropsychiatric Interview for post-traumatic stress disorder. Lifetime consequences for substance use were measured using the Short Inventory of Problems (SIP) for alcohol and one for other drugs.


The study resulted in the study researchers finding no significant differences in demographic characteristics, intervention condition, or participation in motivational engagement treatment sessions. In both groups three quarters expressed high importance and readiness to change alcohol use and approximately 90 % expressed high importance to change drug use. There were no significant associations found between the groups for any of the outcome variables. Only one motivation variable was significantly different between women with more versus fewer days homeless. Women that were with >15 days homeless more often endorsed high importance to change drug use compared to women with fewer than 15 days homeless.


The study researchers concluded that these findings suggest that clinicians should not make assumptions that homeless women have low motivation to change their substance use. The same opportunities for addiction treatment should be provided to homeless women as to housed women. Regardless of outside factors the motivation to change comes from within. In each of us lie the will and the desire to live a better life.


Upshur, C., Weinreb, L., Cheng, D., Kim, T., Samet, J., & Saitz, R. (2014). Does experiencing homelessness affect women's motivation to change alcohol or drug use?. American Journal On Addictions, 23(1), 76-83. doi:10.1111/j.1521-0391.2013.12066.x