Alcohol use and support receipt among people experiencing homelessness in England: a cross-sectional analysis with comparison to private household populations

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Introduction: Alcohol-related harm is more prevalent among people experiencing homelessness, but national data often overlook this group. This study examined alcohol use and receipt of support and compared this group with the general population. Methods: We analysed data from the Homeless Health Needs Audit (2015-2021; cross-sectional survey of a convenience sample of people experiencing homelessness in England), and for general population estimates, from the nationally representative Health Survey for England (2022). Outcomes included any alcohol use, exceeding drinking guidelines (>14 units per week), possible alcohol use disorder (men: >50 units per week; women: >35 units per week), self-identified alcohol problem and receipt of support for their drinking. We estimated the prevalence for each of the outcomes and odds of receiving support and type of support by age, gender and type of homelessness. Results: Among people experiencing homelessness (n=2652), 78.4% (95% CI 76.5% to 80.2%) consumed alcohol, 31.1% (95% CI 29.3% to 33.3%) exceeded drinking guidelines and 19.2% (95% CI 17.4% to 20.9%) had possible alcohol use disorder, compared with 83.4% (95% CI 82.4% to 84.4%), 23.9% (95% CI 22.7% to 25.1%) and 4.8% (95% CI 4.2% to 5.5%) in the general population, respectively. For the latter two outcomes, prevalence was highest among people sleeping rough (47.4% (95% CI 40.8% to 54.1) and 37.8% (95% CI 31.4% to 44.2%), respectively). Overall, 28.3% (95% CI 26.5% to 30.0%) self-identified ever having an alcohol problem; of these, 58.4% (95% CI 54.7% to 62.1%) received support. People sleeping rough had lower odds of receiving support than those in their own tenancy at risk of homelessness (OR adjusted for age and gender: 0.26 (95% CI 0.12 to 0.54)). Conclusions: Similar proportions of people experiencing homelessness and those in private households reported drinking alcohol in the past year. However, people experiencing homelessness were more likely to exceed drinking guidelines and had approximately fourfold higher prevalence of alcohol use disorder. Although nearly two in three individuals self-identifying as having had an alcohol problem received support, access was unequal, with substantially lower odds of support among people sleeping rough.

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