Substance Abuse and Adverse Childhood Experiences (ACEs) Among Older Adults Living in Public Housing

Background/Purpose: A growing body of research demonstrates that accumulated early adversity is strongly associated with substance abuse and other health problems. ACEs have been found to be more prevalent among homeless people and were associated with behavioral health service utilization prior to becoming homeless. Yet, limited information is available on the prevalence of ACEs and health problems among poor older adults at risk of homelessness. This study examines the relationships between a cumulative ACE score, substance abuse, and anxiety among older adults in public housing.

Methods: Using a cross-sectional design, data were collected via in-person interviews with a random sample of adults age 55 and older (N=49) living in public housing. The interview included ACE Study Questions and GAD7 as a measure for anxiety as well as socio-demographic measures. It also included a question on lifetime alcohol abuse and another question of lifetime drug abuse. These questions were combined as a binary measure of substance abuse. A question of lifetime homelessness was also included. Descriptive statistics, bivariate tests, and logistic regression were used to explore the relationship between substance use and anxiety.

Results: The mean sample age was 68, with a majority white (70%) and female (65%). More than one-third (37%) never finished high school. ACE prevalence was bifurcated: while more than one third reported no ACEs, another third had 4 or more ACEs. 18% of participants had experienced prior homelessness. Bivariate analyses indicate that older adults with 4 or more ACEs were significantly more likely to have experienced substance abuse issues (χ²=7.67), and total ACE scores were positively correlated with anxiety scores (r=.353). Furthermore, experiencing substance abuse issues was significantly associated with experiencing homelessness (χ²=21.99). Among those who had experienced homelessness, almost all (1 out of 9) had substance abuse issues. A multivariate model indicates that while taking into account race, homelessness background, and ACEs, substance abuse is significantly related with total anxiety score (p <.10).

Conclusions and Implications: The findings from this study suggest that compared to a middle class population, older adults living in public housing have a greater prevalence of 4 or more ACEs (17% vs. 31%).  Substance abuse background is significantly associated with ACEs and past experience of homelessness and predicts current anxiety level. Despite recruiting diverse participants from underserved populations, the biggest limitation of the study is small sample size. Yet, the current study sheds light on a vulnerable group and points to next steps in research analyzing data collected by providers and practice research on ACE-informed substance abuse services, including peer support, for older adults in public housing. We suggest access to ACE-informed substance abuse services for older adults living in poverty through 1) assessment of ACEs, substance abuse and anxiety by all providers, 2) policy action and resources to support inter-agency collaboration for on-site substance abuse consultation, coordinated services, and transportation to treatment, and 3) community development strengthening peer support for substance abuse recovery in public housing.