Paper under discussion:

Sleeping at the margins qualitative study of homeless drug users who stay in emergency hostels and shelters

Sarah Nettleton, Joanne Neale, & Caral Stevenson. (2012). Critical Public Health, 22(3), 319-328.

This month’s article by Nettleton et al. provides novel insight into a seemingly unremarkable daily phenomenon among homeless people who use drugs: sleep. It is an excellent demonstration of the ways in which qualitative research can be used to illuminate seemingly ordinary phenomena and open up consideration of the socio-political factors that are interwoven into everyday practices. It also helpfully reminds us that while research in the alcohol and other drugs field is so often focused on ‘risk’ practices associated with drug use, people who use drugs live full (and sometimes complicated) lives.

The study’s authors interviewed 29 men and 11 women in England to better understand when and where homeless populations utilise emergency hostels and night shelters, the strategies they implement to guarantee a ‘good night’s sleep’, and the barriers and facilitators they encounter in their attempts to secure safe sleep environments. There are several facets of this intriguing article worthy of mention.

Nettleton et al. analysed the data thematically and applied a conceptually rich lens to push the discussion beyond homelessness and substance use. From a methodological perspective, both novice and experienced qualitative researchers should refer to the article’s innovative use of a ‘pen portrait’. While the methodological approach in the study involved interviews, the structure of this article momentarily gives focused attention to the experience of one participant. By focusing on the story and experiences of one individual, this approach allows the reader to gain a rich, in-depth understanding of the social and political complexities of finding ideal sleep spaces.  While the data used to develop this analysis is voiced by one individual, the authors use this data to tell a compelling story about the shared experiences of many in this population group. This analytic technique demonstrates that to be effective, good thematic analysis need not always operate by simply breaking down interviews into manageable quotes and thematic nodes across participant transcripts.

Importantly, the study’s findings trouble a few assumptions about homeless people who use drugs. A participant underscores that – in her case – the use of illicit drugs increased as a result of her homelessness. That is, the use of drugs was not the cause of her homeless but was rather a comforting factor while homeless (‘to get warm’). This finding has important implications in both the public health and addictions realms, and suggests that if individuals who use drugs are given assistance to meet life areas often defined as ‘competing priorities’, e.g. housing, employment, and food stability, this could help to reduce the frequency of their drug use. Of course, this is not a simplistic equation, and as outlined in the article, ‘recovery’ from illicit drugs will require ongoing support. The finding nonetheless illustrates an alternative (and less commonly discussed) narrative in the literature on the role of drug use among homeless populations and merits further exploration. Importantly, this is an example of the ways in which qualitative research can be used to destabilise and reconfigure assumptions about drugs and the people who use them, potentially opening up new lines of inquiry for the field.

Another major finding was that emergency centres and shelters, spaces typically sought by participants, were also identified as places that potentially increase the risk for intra-group violence. Consequently, some participants avoided these settings to explore a myriad of other spaces for sleep: under bridges, parks, buses, etc. There were constant negotiations around safe spaces for sleep, and for some participants this included weighing the risks of being exposed to the physical elements (e.g. cold temperatures) in exchange for physical protection. Although the article speaks to the multiple sleeping locations explored, further research is required on the transient nature of homelessness – the fluctuation between unstable and stable accommodation – for people who use drugs and its relationship to drug use. Again, the categories of ‘homeless’ or ‘in accommodation’ are frequently used in alcohol and other drug research, but rarely interrogated. This kind of qualitative research helps us see that these categories might be fluid and require more sensitivity when deployed in studies.

This article succeeds in imploring the reader to consider sleep as a public health right, one in which most of us are fortunate enough to take for granted. The ongoing challenge of ‘sleep safety’ warrants further attention in studies involving populations who use drugs.

The Sydney Reading Group: Alison Marshall, Kari Lancaster, Kev Dertadian, Kenneth Yates and Jake Rance
Further reading

Stevenson, C. & Neale, J. (2012). ‘We did more rough sleeping just to be together’ – Homeless drug users’ romantic relationships in hostel accommodation. Drugs: Education, Prevention and Policy, 19:3, 234-243.

Stevenson, C. (2014). A qualitative exploration of relations and interactions between people who are homeless and use drugs and staff in homeless hostel accommodation. Journal of Substance Use, 19(1-2), 134-140.


The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.

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