Problematic alcohol consumption in homeless Australians: A narrative review of the causes, barriers to receiving help and possible solutions

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Abstract
Issue addressed Problematic alcohol consumption (PAC) affects one‐third of homeless Australians, and it is expected that the rates will increase as the population ages. However current policy does not recognise the importance of this problem. The aim of this narrative review is to examine the social determinants and other risk factors contributing to PAC in homeless Australians, the barriers to receiving help, and possible solutions for the Australian context. Methods PubMed and PsycINFO databases and Australian government websites were examined for the keywords “alcohol” and “homeless”, and pertinent articles were selected for inclusion and for citation tracking of further relevant articles. Results The causes of PAC in homeless Australians are multifactorial, and multi‐directional, and include risk factors such as low socioeconomic status, mental illness, and having experienced trauma. There is significant stigma associated with both homelessness and PAC, which further isolates this group. Current policies to address PAC in the homeless are inadequate; however there are a range of possible programs to reduce PAC in this group, and international harm reduction strategies have also shown success in improving outcomes for this group. Conclusion there are numerous social risk factors that influence the development of PAC in the homeless. The introduction of harm reduction strategies, programs to enhance motivation and personal skills, as well as better mental health treatment, would all fill important gaps in services for homeless Australians with PAC. So what? Health professionals can be advised that there are many social determinants that influence PAC in homeless Australians. There are important structural barriers to providing this marginalised group with the services they require, however there is scope for the introduction of new programs, including harm reduction strategies, to meet the fundamental needs of this group.

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