Social relationships, homelessness, and substance use among emergency department patients

Amanda Jurewicz, Deborah K. Padgett, Ziwei Ran, Donna G. Castelblanco, Ryan P. McCormack, Lillian Gelberg, Donna Shelley, Kelly M. Doran

Research output: Contribution to journalArticlepeer-review


Background: Emergency department (ED) patients commonly experience both substance use and homelessness, and social relationships impact each in varied ways not fully captured by existing quantitative research. This qualitative study examines how social relationships can precipitate or ameliorate homelessness and the connection (if any) between substance use and social relationships among ED patients experiencing homelessness. Methods: As part of a broader study to develop ED-based homelessness prevention interventions, we conducted in-depth interviews with 25 ED patients who used alcohol or drugs and had recently become homeless. We asked patients about the relationship between their substance use and homelessness. Interviews were recorded, transcribed, and coded line-by-line by investigators. Final codes formed the basis for thematic analysis through consensus discussions. Results: Social relationships emerged as focal points for understanding the four major themes related to the intersection of homelessness and substance use: (1) Substance use can create strain in relationships; (2) Help is there until it’s not; (3) Social relationships can create challenges contributing to substance use; and (4) Reciprocal relationship of substance use and isolation. Sub-themes were also identified and described. Conclusions: The association between substance use and homelessness is multifaceted and social relationships are a complex factor linking the two. Social relationships are often critical for homelessness prevention, but they are impacted by and reciprocally affect substance use. ED-based substance use interventions should consider the high prevalence of homelessness and the impact of social relationships on the interaction between homelessness and substance use.

Original languageEnglish (US)
Pages (from-to)573-580
Number of pages8
JournalSubstance Abuse
Issue number1
StatePublished - 2022


  • Substance use
  • emergency department
  • homelessness
  • social relationships

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health


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