International Journal of Drug Policy - 2014

Volume 25 Issue 3 May 2014

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Page 55 of 153

International Journal of Drug Policy 25 (2014) 556–561 Contents lists available at ScienceDirect International Journal of Drug Policy j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o Research paper Single room occupancy (SRO) hotels as mental health risk environments among impoverished women: The intersection of policy, drug use, trauma, and urban space Kelly R. Knight a,∗ , Andrea M. Lopez b,c , Megan Comfort c , Martha Shumway d , Jennifer Cohen e , Elise D. Riley b a Department of Anthropology, History and Social Medicine, University of California, San Francisco, United States b Department of Medicine, University of California, San Francisco, United States c Urban Health Program, Research Triangle Institute International, United States d Department of Psychiatry, Trauma Recovery Center, University of California, San Francisco, United States e Department of Clinical Pharmacy, University of California, San Francisco, United States a r t i c l e i n f o Article history: Received 8 May 2013 Received in revised form 28 September 2013 Accepted 30 October 2013 Keywords: Built environment SRO hotels Women Trauma Mental health Drug use Ethnography a b s t r a c t Background: Due to the significantly high levels of comorbid substance use and mental health diagnosis among urban poor populations, examining the intersection of drug policy and place requires a consid- eration of the role of housing in drug user mental health. In San Francisco, geographic boundedness and progressive health and housing polices have coalesced to make single room occupancy hotels (SROs) a key urban built environment used to house poor populations with co-occurring drug use and mental health issues. Unstably housed women who use illicit drugs have high rates of lifetime and current trauma, which manifests in disproportionately high rates of post-traumatic stress disorder (PTSD), anxiety, and depression when compared to stably housed women. Methods: We report data from a qualitative interview study (n = 30) and four years of ethnography conducted with housing policy makers and unstably housed women who use drugs and live in SROs. Results: Women in the study lived in a range of SRO built environments, from publicly funded, newly built SROs to privately owned, dilapidated buildings, which presented a rich opportunity for ethno- graphic comparison. Applying Rhodes et al.'s framework of socio-structural vulnerability, we explore how SROs can operate as "mental health risk environments" in which macro-structural factors (housing policies shaping the built environment) interact with meso-level factors (social relations within SROs) and micro-level, behavioral coping strategies to impact women's mental health. The degree to which SRO built environments were "trauma-sensitive" at the macro level significantly influenced women's mental health at meso- and micro-levels. Women who were living in SROs which exacerbated fear and anxiety attempted, with limited success, to deploy strategies on the meso- and micro-level to manage their mental health symptoms. Conclusion: Study findings underscore the importance of housing polices which consider substance use in the context of current and cumulative trauma experiences in order to improve quality of life and mental health for unstably housed women. © 2013 Elsevier B.V. All rights reserved. Introduction In the United States, the comorbidity of substance use and men- tal illness is a widely recognized phenomenon at a national level (Conway, Compton, Stinson, & Grant, 2006; NIDA, 2008; Volkow, 2004), specifically among the urban poor (Bassuk, Buckner, Perloff, ∗ Corresponding author at: Department of Anthropology, History and Social Medicine, University of California, San Francisco, 3333 California Street, Suite 485, San Francisco, CA 94143, United States. Tel.: +1 415 867 8405. E-mail address: (K.R. Knight). Shari, & Bassuk, 1998; Hien, Zimberg, Weisman, First, & Ackerman, 1997). Epidemiological studies underscore significant gender dif- ferences in the presentation of comorbidity, with women more likely than men to be diagnosed with affective and anxiety-related mental health disorders (Diflorio & Jones, 2010; NIDA, 2008). Esti- mates of depression and Post-Traumatic Stress Disorder (PTSD) are disproportionately higher among substance-using, unstably housed women than cohorts of housed women (Coughlin, 2011; El-Bassel, Gilbert, Vinocur, Chang, & Wu, 2011; Nyamathi, Leake, & Gelberg, 2000). While research has shown that access to hous- ing may contribute in a significant way to a number of individual mental health outcomes (Baker & Douglas, 1990; Earls & Nelson, 0955-3959/$ – see front matter © 2013 Elsevier B.V. All rights reserved.

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