A new study finds homeless women are more likely to seek treatment for substance abuse if they have positive links in their social network.

Results published in the Journal of Substance Abuse Treatment reveal that having primarily street-based relationships has a deleterious effect on accessing substance abuse treatment, while having an intimate partner who offers support and information about treatment has a strong positive influence.

"Having partners or others around you who are not supportive of treatment and recovery can seriously interfere with treatment access and recovery," said Suzanne Wenzel, lead author of the study and professor with the USC School of Social Work. "Social workers might help women explore the sources of support and difficulties in their social networks, and make efforts to reconnect women with relatives or others who are helpful to them."

Wenzel and her colleagues at the RAND Corporation delved into the social circles of homeless women in shelters throughout Los Angeles County in an effort to identify factors that promote or inhibit seeking help for drug or alcohol dependence.

Using data from interviews with 273 homeless women who screened positive for substance abuse during the previous year, the researchers analyzed potential barriers and facilitators to treatment.

A critical component of developing positive social connections away from the streets is by providing safe, stable housing, Wenzel said.

"A major human need is for sustenance and safety, the freedom to not worry where one is going to sleep or whether one is going to be victimized on the street," she said. "When those fundamental needs are met, one can then pay more attention to self-care and healing."

She cited the case of one young woman who had been living with her sister and mother. When her sister had a baby, the apartment felt overcrowded and the woman moved out. She eventually wound up on Skid Row, a 50-square-block area of downtown Los Angeles with a large population of homeless people.

Wenzel said the woman felt too embarrassed to tell her family that she was living on the streets. Strategies designed to strengthen those family relationships could help the woman find a place to live, either with her family or in supportive housing.

Another important finding suggested that homeless women with substance abuse issues who have to care for children are less likely to pursue treatment. This is due in part to simple logistics—it can be difficult to seek help if there is no one else to care for the children—and there is a need for more treatment facilities that offer childcare services, Wenzel said. Only 6.5 percent of treatment providers nationwide offer such services, according to a national survey.

Lastly, the study revealed that women were less likely to access treatment for substance abuse if they had recently been treated for mental health issues. Wenzel said this may illustrate a lack of integration between mental health and substance abuse treatment services due to separate funding streams and administrative oversight.

"This seems very obvious but is critical: There must be firm and consistent recognition by agency and program directors and staff that providing care for co-occurring disorders is important, and that it is not appropriate to simply assume, for example, that once people stop using substances their mental health problems will subside," she said.

Additional training for treatment staff in both mental health and substance use disorders is one strategy to address this gap, along with increased efforts to provide multiple services under one roof.

In concluding the study, which was funded by the National Institute on Alcohol Abuse and Alcoholism, Wenzel and her colleagues called for additional research to begin developing interventions and strategies to help homeless women with substance use problems disconnect from their street lives and begin the path to recovery.

"We must nevertheless be respectful of each woman as an individual and work with her to understand her particular circumstances," she said, "and we must not assume that every community with challenges—such as Skid Row—can only harbor unhealthy relationships."