A History of Foster Care and Substance Abuse Among Newly Homeless Young Adults in New York City

Background and Purpose: The prevalence of substance use disorders among homeless young adults is three to four times higher than that of their never-homeless counterparts, with about half having a history of alcohol abuse and approximately one third having a history of drug abuse. One risk factor for their substance abuse that has received little attention is a history of foster care, which is reported by a disproportionate number of homeless young adults. Most of the over 500,000 children and adolescents currently placed in the U.S. foster care system were removed from their homes as a result of neglect, caretaker absence, physical abuse, and/or sexual abuse. The long-term consequences of childhood maltreatment in terms of risk for later substance use have been documented extensively. Among the estimated 25,000 adolescents and young adults age 15 years and older who exit foster care each year, substance abuse and homelessness have been consistently reported at high rates. The present study examined the substance abuse of homeless young adults seeking crisis shelter with and without histories of foster care to evaluate whether: (1) a history of foster care would be associated with the risk for substance abuse; and (2) foster care would remain related to the risk for substance abuse, controlling for demographics and childhood abuse.

Methods: A sample of 424 young adults (18 to 21 years) who entered crisis shelter in New York City between October 1, 2007 and February 29, 2008 were asked if they used alcohol, marijuana, cigarettes, and other substances, ever received treatment for alcohol or drug problems, and were emotionally, physically, or sexually abused during childhood. To examine the association of foster care with each substance use variable, unadjusted odds ratios were computed. To determine whether associations remained after accounting for the influence of demographics and childhood abuse, multiple logistic regression analyses were conducted, adjusted for controls.

Results: A history of foster care was reported by 34.7% of the sample. Forty-two percent (n=179) reported childhood emotional abuse, 37.1% (n=157) physical abuse, and 19.6% (n=83) sexual abuse. Alcohol (21.3%, n=81), marijuana (16.3%, n=66), and cigarettes (39.9%, n=166) were the most frequently used substances. Eleven percent (n=46) of the sample had received prior drug treatment. After adjusting for demographics and childhood abuse, homeless young adults with histories of foster care were more than twice as likely to use marijuana (AOR=2.32; CI=1.29, 4.16), almost twice as likely to smoke cigarettes (AOR=1.91; CI=1.20, 3.07), and more than three times as likely to have been in drug treatment (AOR=3.35; CI=1.65, 6.82) than counterparts.

Conclusions and Implications: The foster care system should increase its efforts to help those in its care better begin the process of resolving their substance use problems prior to discharge and tailor risk reduction interventions to their individual needs. Organizations that provide services to homeless young adults should target those with histories of foster care, screen them for substance use, and accordingly tailor prevention and treatment services.