Alcoholism in homeless men in the mid-nineties: results from the Bavarian Public Health Study on homelessness

Parallel to structural economic changes homelessness has become publicly mo re visible and has received increased media attention in Western industrial ized countries. Most studies on mental illness and homelessness in recent y ears were carried out in North America but only few studies in Europe have dealt with these issues. The goals of the present study were (I) to assess alcohol abuse and dependence as well as other mental disorders in a represe ntative sample of homeless men in Munich using reliable methods of case ide ntification (Structured Clinical Interview for DSM-IV (SCID)), (2) to compa re homeless alcoholics with homeless non-alcoholics in our sample on releva nt variables, and (3) to compare our data from the Munich sample with data obtained by others. According to our results, the life-time prevalence of a ny SCID-DSM-IV Axis I diagnoses was 93.2% and the lifetime prevalence of su bstance use disorder was 79.6%. The single most prevalent diagnosis among h omeless males in Munich was alcohol dependence (life-time 72.7%); alcohol a buse (life-time 5.5%) and drug abuse/dependence were considerably lower in prevalence (life-time 19.1%) (weighted data). A higher rate of psychotic di sorders was found for non-alcoholic homeless men. Data show that alcoholism and its consequences were more severe in the Munich as compared to North A merican samples. Homeless alcohol dependent men showed a high comorbidity w ith other mental disorders (life-time) such as mood disorders (36.4%), anxi ety disorders (16.4%), drug abuse/dependence (18.9%) and psychotic disorder s (4.5%). Of those with alcohol dependence at some time during their life 5 9.1% had experienced at least one other life-time mental disorder. Alcohol- related behavioral patterns and symptoms as well as general social function ing are described. Considering the Very high prevalence of alcohol dependen ce (frequently in combination with other mental disorders), the participati on in alcohol rehabilitation and other services as well as self-help groups was rather low among Munich homeless alcoholics. Currently homeless men in Germany are adequately supplied with food, clothes, and shelter but psychi atrically (and medically) neglected. Existing concepts and programs for dea ling with these problems need to be implemented.