Running Toward Recovery: An Exercise and Psychosocial Intervention for Individuals Experiencing Homelessness and SUD

Background/Purpose: It is estimated over the course of a year nearly 1.5 million Americans will experience homelessness for at least one night (Padgett, Henwood, & Culhane, 2016).  Homelessness manifests the confluence of economic inequity, racial disparities, and biopsychosocial behavioral sequela. The National Survey of Drug Use (2014) reports 21.5 million American adults were suffering from a Substance Use Disorder which increases their risk for homelessness (Hedden, Kennet, Lipari, Medley, & Tice, 2014).  It is the intersection of these factors that can leave individuals vulnerable to many biopsychosocial issues, including: a lack of sober social networks, decreased self-efficacy and inability to maintain long-term substance use abstinence.  

Low self-esteem and self-efficacy are associated with continued drug use. Relapse rates remain high for individuals experiencing SUD and homelessness, creating a cycle of short term stabilization followed by periods of increased substance use and/or homeless episodes (Slesnick, Guo, Brakenhoff, & Feng, 2013). Research suggests physical exercise can significantly impact the abstinence rate for individuals seeking treatment for SUD, with subjects engaging in regular physical exercise reporting lower level of SUD (Wang, Wang, Wang, Li, & Zhou, 2014). However, homelessness and SUD treatment programs in the United States rarely allocate time for organized exercise (Linke & Ussher, 2015). The study’s purpose was to examine the psychosocial outcomes resulting from participation in an organized running group by measuring changes in self-efficacy, self-esteem, and substance craving intensity for individuals with a SUD and experiencing homelessness.

Methods: The study utilized a pre-experimental design with pretest and posttest measures to study the effect of an organized running group on self-efficacy, self-esteem, and substance craving intensity for individuals experiencing homelessness with a co-occurring SUD (n=41). All participants were residents of a local homeless shelter and participated in the program in 2018.  Participants mean age was 38.34 (10.07), 57% of the participants were Hispanic, and 44% were female. These participants were members of a treatment program, which focused on recovery from substance abuse and mental health stabilization. Participants were assessed at the start of the study and again after four weeks of practice.

Substance craving was measure using the Brief Substance Craving Scale, perceived self-esteem was measured using the Rosenberg Self-Esteem Scale, and perceived self-efficacy was measured using the General Self-Efficacy Scale. 

Results: The comparison of the means demonstrated that psychosocial variables significantly improved for all three measures. Results of a paired t-test representing psychosocial changes after 4-weeks of running group participation found  a statistically significant increase in perceived self-esteem t(40) =5.76, p<0.001.  Similarly, results of perceived self-efficacy significantly improved from a mean score of 28.81 to 32.43;  t(41)=6.06,p<.001. Substance use craving decreased from a mean score of 3.15 to 0.58 t(40)=5.7, p<.001.

Implications: These results suggest organized exercise is both a feasible and potentially efficacious adjunct to traditional rehabilitation treatment programs, offering promise to improve outcomes for individuals experiencing homelessness and SUD.  Study limitations include a small sample size and potential sampling bias as participation in the running group was voluntary for treatment program’s residents.