The Relationship Between Trauma and Substance Use Among Street-Involved Young People

Introduction: Homeless youth experience traumatic events and meet criteria for posttraumatic stress disorder (PTSD) at higher rates than youth in the general population. Substance use is highly correlated with experiencing trauma and developing PTSD symptoms in homeless youth. Two potential explanations may elucidate this relationship: using substances may be a strategy for homeless youth to cope with past trauma or substance use may place youth at risk for subsequent trauma exposure. Although existing research identifies a relationship between trauma and substance use, the current study is among the first to approach homeless young people to elicit their perspectives regarding how their substance use and trauma experiences are interrelated. Methods: Youth respondents (N=50) were recruited from a drop-in center, shelter, and transitional housing sites associated with a homeless youth agency in a large western city. Inclusion criteria included being 18-24 years old, having spent at least 2 weeks away from home in the month before the interview, and providing informed consent. Respondents participated in qualitative, semi-structured, face-to-face interviews that queried youth on two broad topics: how substances are used as coping mechanisms and how substances place youth at risk. Audio-taped interviews were transcribed and analyzed using iterative content analysis. Inter-rater reliability was calculated among a team of three coders (range 80-96%). Results: Youth identified several ways in which substances temporarily helped them cope with past trauma (escaping difficult thoughts, improving negative moods, relaxing, and socializing with others). They also recognized many ways substance use placed them at further risk (decreasing awareness of potential danger, increasing physical risk through overdose or addiction, disconnecting youth from support systems, and increasing risk for violence and criminal behavior). Many youth (68%) described using substances as a “temporary fix” or “band-aid” to cope with memories of past trauma and difficult life circumstances. Although they feel initial relief, using substances placed them at higher risk for further victimization. Conclusions: Thematic findings are aligned with the concept of Social Estrangement that occurs as youth transition out of conventional home environments and become more entrenched in street culture where use of substances becomes normative. Youths' substance use places them at greater risk for estrangement from conventional institutions (school, jobs, services) and individuals (housed friends, relatives) and increases risk for experiencing traumatic events. Existing substance-use prevention programs for homeless youth should be adapted to address the interconnectedness between substance use and trauma. Adaptations might include helping youth to recognize when they use substances to deal with thoughts and feelings related to past traumas and aiding them in identifying healthier coping alternatives. Problem-solving activities may help youth anticipate how their substance use may increase their risk for dangerous and potentially traumatic situations, including victimization and violence. Such adaptations should be tested to determine whether they result in increased effectiveness in reducing high-risk behaviors among homeless youth. The specific examples described by street-involved youth in this study could enhance existing prevention programming by identifying practical ways substance use and high-risk behaviors are connected.