The Influence of Alcohol and Drug Use on the Subsistence Adaptation of Homeless Mentally Ill Persons

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Abstract
While epidemiological research has offered much valuable information about substance use among homeless persons in general and homeless mentally ill persons in particular it has lacked information about the context in which substance use occurs, patterns of use, how use influences subsistence adaptation, and factors that mediate its effects. The Adaptation of the Homeless Mentally Ill (AHMI) research was able to address these gaps in our knowledge through long-term ethnographic field work with 50 homeless mentally ill individuals in the Skid Row area of Los Angeles. Most importantly, we found variation in the extent to which alcohol and drug use dominated the lives of sample members. Where some individuals organized their lives completely around the pursuit and use of drugs and alcohol, others were able to precariously balance their substance use with the tasks of meeting their basic needs. We then examine several of the possible factors that shape the relationship between substance use and subsistence adaptation, looking specifically at: (1) Skid Row; (2) psychopathology; (3) institutional affiliations; (4) values and beliefs, and; (5) the role of eventfulness. We conclude by summarizing our findings and their implications for social policy.