Adapting Homelessness Interventions for People Who Use Drugs or Alcohol in Montreal, Quebec: Service User Perspectives

Background: Under a housing affordability crisis, Montreal, Canada, is host to a growing homeless population. While people who use drugs or alcohol make up a large part of this group, homeless resources in the city continue to exclude them through sobriety rules or by not adapting programming to their specific needs. This systematic exclusion, and the conditions of these resources, can often be retraumatizing for individuals seeking help. Applying a trauma-informed spaces of care framework, this research asks what are the needs of homeless individuals who use substances to exit homelessness? What are the current limits within homeless resources in Montreal to actualize these needs? How can they change to meet these needs?

Methods: In 2023, 30 semistructured interviews were conducted, with follow-up at 3 months, with individuals who use drugs or alcohol currently experiencing homelessness. Transcribed interviews were analyzed in Nvivo.

Results: Findings called for serious reforms to homeless service provision, with an emphasis on more forms of harm reduction-based programming, integrated occupational activities, improved psychosocial accompaniment, better division of service users, and alternative and adapted housing interventions for substance users. Most participants disclosed potentially traumatic life experiences, highlighting the need for trauma-informed programming.

Conclusion: Allowing individuals to articulate their needs and desires for programming demonstrates that this group recognizes the inadequacy of services and identifies the homeless resource as a site of potential traumatization. While the recommendations of people with living experience of homelessness and substance use articulate promising practices in substance use recovery, as well as homelessness service provision, homeless service providers are slow to adapt their programming accordingly.