Abstract

Objective: There has long been concern that public support payments are used to support addictive behaviors. This study examined the amount of money homeless veterans spend on alcohol and drugs and the association between public support income, including VA disability compensation, and expenditures on alcohol and drugs.

Methods: Data were from 1,160 veterans from 19 sites on entry into the Housing and Urban Development–Veterans Affairs Supportive Housing program. Descriptive statistics and nonparametric analyses were conducted.

Results: About 33% of veterans reported spending money on alcohol and 22% reported spending money on drugs in the past month. No significant association was found between public support income, VA disability compensation, and money spent on alcohol and drugs.

Conclusions: A substantial proportion of homeless veterans spend some income on alcohol and drugs, but disability income, including VA compensation, does not seem to be related to substance use or money spent on addictive substances.

Implications

For Practice

Homeless veterans who are using substances and alcohol should speak with their medical provider about ways to safely stop using. The veteran and the provider should also discuss healthy alternatives to substances and alcohol, such as exercising and arts and crafts activities. Additionally, homeless veterans on disability compensation should consider enrolling in courses to learn useful life skills, such as money management and coping skills. Medical providers serving homeless veterans who are using substances and alcohol should recommend services to help their patient identify reasons behind their substance and alcohol use and how to stop using. There are several services practitioners should consider recommending, including counseling and social support groups. Practitioners should also consider referring their veteran to a case worker to help address immediate issues, such as homelessness. Counselors or mental health therapists serving homeless veterans with substance abuse problems should recommend healthy, feasible detox measures. Family members of a homeless veteran who is struggling with substance abuse should encourage their veteran to seek help.

For Policy

Given that there is no association between VA disability compensation and the purchasing of substances among homeless veterans, the VA might continue disability compensation for homeless veterans with a substance abuse problem. The VA might continue its current substance and alcohol abuse intervention programs for homeless veterans. The VA might offer additional programs for homeless veterans with a disability who are struggling with substances and alcohol. Specific interventions for disabled veterans might target the underlining reason(s) for their substance and alcohol use. The VA might offer social support groups for homeless veterans who have substance use issues. Additionally, the VA might continue offering assistance to rural veterans who are homeless and residing in a rural location.

For Future Research

Despite this study having several strengths, including a large sample of homeless veterans and specific information about money spent on alcohol and drugs, it is not without its limitations. A limitation of this study is that it was observational, cross-sectional data. Thus, the authors were unable to infer causality of any associations. Future researchers should consider using verifiable forms of data, e.g. medical records. To allow for causality of associations to be inferred, future researchers should analyze longitudinal data. Another limitation of this study is that the data were based on self-reported income and substance use in the past month. Self-reporting and the time frame could have introduced potential biases, including self-reporting and recall. Future researchers should collect income information through more reliable sources, such as the previous year’s tax filings. Ninety-five percent of the respondents sampled in this study were male. Future studies on this topic should include more women veterans. Including more women veterans might help researchers better understand the relationship between disability compensation, homelessness, and substance abuse among women veterans. Including more women veterans will also improve generalizability to women veterans. Since a majority of the veterans included in this sample served before the Persian Gulf War era, generalizability to veterans from more recent conflicts is unclear. Future researchers should analyze data that includes veterans from more recent military conflicts, particularly the post-9/11 war. Only veterans referred to the HUD-VASH program were included in this study’s sample. Future research should include veterans who are not enrolled in the HUD-VASH program, including veterans residing in a rural location. Future researchers should continue evaluating the effectiveness of various services aimed at helping homeless veterans struggling with substance abuse. Researchers should continue evaluating services offered to disabled veterans who are homeless, including financial counseling, medical services, and shelter care.