Author's School

Brown School of Social Work

Author's Department/Program

Social Work


English (en)

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Peter Hovmand


This dissertation study examined what role substance abuse plays in the marginalized status of homeless adults and how the combined effects of marginalization and substance abuse impact service use and housing status changes over time. The concept of marginalization is used to describe how isolated an individual is from basic needs such as supportive social contact, a safe environment, and legal income options. Thus, the specific aims of this project were to 1) describe longitudinal patterns of substance abuse and marginalization in a homeless population, 2) examine the combined effects of substance abuse and marginalization on housing status changes over time, and 3) investigate how marginalization and substance abuse impact service use over time. This dissertation used secondary data collected as part of a NIDA funded longitudinal study of urban homelessness called SUNCODA: DA 10713, PI-Carol North). Four hundred adults in the Saint Louis, Missouri metropolitan area were recruited from shelters and street locations: 1999-2001) and interviewed at baseline, then at 1 and 2 year follow ups. Subject-matched service data: including shelter use and contacts with health, substance abuse, and mental health sectors of care) were collected from regional providers over the same time period. These data provided a unique opportunity to explore longitudinal changes in substance abuse, mental health, social contacts, victimization, criminal activity, housing status, service use, and employment among homeless adults. To understand these complex relationships, a flexible Bayesian framework was adopted to develop Markov transition models of housing state changes and zero inflated Poisson regression models of routine and emergency service counts over two time intervals. Key findings include consistent relationships between living on the streets, alcohol use, and increased marginalization, notably legal problems, shadow work, and victimization. Additionally, at several points, there were distinctions between street based homeless and those who found housing at some point or were episodically in shelters. These results underscore the importance of addressing legal problems and local environments in intervention design, specifically in how we might enhance the most basic aspects of well-being for homeless adults such as safety and housing.


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