Life Course Perspective on Substance Abuse Recovery Among Formerly Homeless Older Adults

Background and Purpose: Persons who experience multiple life crises--substance abuse, serious mental illness and chronic homelessness—may require years of working toward recovery and frequently experience accelerated aging. Little is known about the life course of ‘complex recovery’ among these individuals, particularly with respect to substance abuse. Our goal in this report is to use the life course perspective (LCP) to examine recovery in the lives of older formerly homeless adults living in permanent supportive housing. Of interest is the extent of abstinent (vs. non-abstinent) recovery and the role of life transitions, social relationships and personal agency.

Methods: The sample consisted of all participants over age 45 (n-=15) sampled from a larger NIMH-funded study of ‘dual recovery’. All were living in supportive housing, had histories of homelessness, mental illness and substance abuse and had recovered from the latter for at least 6 months. A qualitative cross-case study design was used to analyze in-depth interviews (60 total) to understand the contexts of each participant’s recovery. Content analysis was used to document histories of substance abuse, type of recovery (abstinent vs. non-abstinent), use of substance abuse treatment, and normative vs. non-normative life transitions. In the second analytic stage, three domains of the LCP—life transitions, social relationships and agency—were used to conduct thematic development within each domain. Three analysts independently read the transcript selections under each domain and used memos and consensus discussions to identity sub-themes within each.

Results: The sample was predominantly African-American (N=14) and male (n=12). Age of substance abuse onset ranged from 7 to 31 years; most (n=12) were poly-drug abusers. About one half (N=7) had formal substance abuse treatment. Time since recovery ranged from 8 months to 32 years; 8 were in abstinent recovery and 7 in non-abstinent recovery. Participants had few normative life transitions and experienced non-normative life events such as incarceration and teen pregnancy—none of those with children (n=10) had parented their children. Sub-themes for life transitions were: substance abuse as primary, severity and synergy, and incarceration as turning point. Sub-themes for social relationships include: "associates, not friends" and taking a cautious approach. Sub-themes for agency included: quitting as personal decision and “I just got to stay on top of it”.

Conclusions and Implications: Our findings show that participants resiliently recovered from substance abuse even while dealing with cumulative adversity in their lives. The role of formal treatment was negligible in their decision to quit but maintenance of recovery was assisted by social avoidance and selective use of support groups. Candid about the toll substance abuse had taken, participants sought a recovered life as they confronted depleted social networks and prior negative relationships. As the number of older formerly homeless adults grows rapidly in the U.S. (Culhane et al., 2019), services beyond housing are needed to help them maintain their recovery, seek out positive relationships and cope with the effects of premature aging.