Longitudinal Substance Abuse Patterns Among Transition-Age Youth in the Foster Care System and Their Subsequent Adulthood Outcomes

Background and Purpose: Adolescent substance abuse is recognized as a risk factor for adult homelessness and incarceration, with youth and alumni of foster care disproportionately affected. Given their unique challenges in transitioning to adulthood, substance abuse may exacerbate negative outcomes for foster care youth. This study, focusing on transition-age foster care youth, utilizes longitudinal data to (1) track changes in substance abuse from age 17 to 21 and (2) explore the connection between these patterns and experiences of homelessness and incarceration.

Methods: Data from the National Youth in Transition Database and the Adoption and Foster Care Analysis and Reporting System were utilized. A cohort of youth (N=5,852, 58.49% female) completed baseline surveys at age 17 (2017) and follow-up surveys at ages 19 and 21. Latent Class Growth Analysis (LCGA) and Multinomial Regression Analysis were conducted. LCGA identified latent classes of substance abuse across the three waves using a substance use referral questionnaire, which assessed self-referral and referrals by other figures (e.g., social worker, physician, foster parent). This questionnaire served as an indicator of substance abuse, as youths were referred for additional assessment if they showed signs of substance abuse. Logistic regression analysis examined the relationship between latent classes and adulthood outcomes, controlling for demographic characteristics, placement instability, and maltreatment history.

Results: The study identified three distinct groups based on the trajectory of substance abuse over three waves: (1) a group with decreasing likelihoods of substance abuse (9.82%), (2) a group showing increasing substance abuse (3.72%), and (3) a group not experiencing substance abuse (86.45%). Comparing these groups, those in Group 1 (decreasing substance abuse) had significantly higher odds of experiencing incarceration (OR=4.68, p<.001) and homelessness (OR=2.71, p<.001) compared to the reference group (Group 3, not experiencing substance abuse). Similarly, adolescents in Group 2 (increasing substance abuse) exhibited higher odds of both incarceration (OR=5.18, p<.001) and homelessness (OR=3.76, p<.001) compared to the reference group. Additionally, when comparing Group 1 and Group 2, the latter showed higher odds of homelessness. (OR=1.39, p=.045)

Conclusions and Implications: This study sheds light on the evolving dynamics of substance abuse among foster care youths as they transition into late adolescence. The findings underscore a concerning trend: regardless of the specific trajectory of substance abuse, youths with a history of such behavior face heightened risks of homelessness and incarceration in early adulthood. Given these challenges' enduring and costly nature, the study highlights the imperative for increased intervention and resource allocation targeted at this vulnerable demographic. Given the enduring and costly nature of homelessness and incarceration, our results underscore the urgent need for targeted interventions aimed at addressing substance abuse among youth in foster care. The findings suggest that early identification and intervention strategies tailored to address substance abuse issues could yield significant benefits in mitigating long-term adverse outcomes. For future practices, screening adolescents for substance abuse and implementing proactive referral and intervention measures can yield significant benefits.