Interpersonal relationships and drug use over time among homeless people: a qualitative study
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RESEARCH ARTICLE
Open Access
Interpersonal relationships and drug use over time among homeless people: a qualitative study Marília Ignácio de Espíndola1,2* , André Bedendo1,2, Eroy Aparecida da Silva1,2 and Ana Regina Noto1,2
Abstract Background: Homelessness is one of the most severe forms of social exclusion and is an important public health issue. It is characterized by processes of weakening of interpersonal bonds. The objective of this study was, therefore, to elucidate how interpersonal relationships change over the life cycle of homeless drug and alcohol users. Method: We used a qualitative methodology. The participants were adults who had a history of homelessness and use of alcohol and other drugs. The interviews were semi structured and used a timeline instrument. All interview were audio recorded, transcribed, and submitted to thematic analysis. Results: Twenty individuals participated in the study. Reports on social exclusion over time stood out in respect of four main themes and their respective subthemes: Theme 1 – Childhood: instability upbringing, abuse, violence, and an absent or not very present father figure; Theme 2 – Adolescence: school dropout and failure; acceptance of gender and sexual orientation; birth of first child, living with a partner or getting married: Theme 3 – Adulthood: estrangement or conflicting relationship with family; health problems; drug trafficking and prostitution; Theme 4 – Cross-cutting factors: death of relatives and substance use. Conclusion: The results suggest that interpersonal relationships are permeated by successive breakups, conflicts and other events that start in childhood and can have a cumulative effect in later stages of life, and cross the subsequent phases. Substance abuse and dependence are mentioned as cross-cutting factors that intensify social exclusion in all stages of life. Keywords: Homeless person, Interpersonal relationship, Social marginality, Social determinant of health, Substancerelated disorders, Life cycle
Background Even though housing is a basic human need [1–3], the number of homeless people (HP) around the world is significant. Data from the Organization for Economic Co-operation and Development (OECD) show that Canada, Germany and the United States have the largest
* Correspondence: [email protected] 1 NEPSIS - Research Center on Health and Substance Use, Sao Paulo, Brazil 2 Department of Psychobiology, Universidade Federal de São Paulo – UNIFESP, Rua Botucatu, 862 – 1° Andar, Vila Clementino, SP 04023062 Sao Paulo, Brazil
homeless population when compared with other countries in the organization [4]. Brazilian data about homeless populations are scarce and incomplete [5, 6]. There has been only one national study about this population, and it was carried out in 2008 [7] with an estimate of homelessness being calculated using statistical models [5]. The total number of homeless people in Brazil was estimated to be 101,854 individuals [5]. However, with regard to the municipal level, São Paulo, unlike most cities, does have
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