The “high cost of low living”: Substance use recovery among older formerly homeless adults

Abstract

Background

The population of older homeless substance-using adults is growing considerably, and we sought to understand how such individuals gain control of problematic substance use amidst other life problems.

Methods: Data were collected in an NIMH-funded study in which four in-depth interviews were conducted over 18 months with formerly homeless adults living in permanent supportive housing. The study subsample was comprised of 15 predominantly African American individuals over age 45 who were in recovery for at least six months. Cross-case analyses used a template approach followed by inductive sub-theme analyses.

Results: Three themes drawn from the literature yielded seven sub-themes as follows. Theme #1: Acute life stressors: (a) “substance use as primary”; (b) “acute life events and substance use”; (c) “incarceration as turning point.” Theme #2: Attributions of recovery: (a) “quitting as personal decision”; (b) “I just got to stay on top of it”; Theme #3: Social relationships: (a) “I have associates, not friends”; (b) “taking a cautious approach.”

Conclusion: Participants viewed substance use as the primary problem in their lives despite other adversity. Recovery was viewed as a personal decision, but maintaining recovery involved positive social relationships. Policies and practices related to recovery should address the complexities of lives-as-lived.

Keywords:

• Substance use recovery
• serious mental illness
• homelessness

Acknowledgments

The authors wish to express their appreciation to the study participants for sharing their life stories.

Author contributions

Deborah Padgett: Conceptualized the study, conducted data analysis, and wrote the manuscript. Kristen Gurdak and Lynden Bond: Conducted data analysis, produced tables and references, contributed to the study’s findings, and edited the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was made possible by funding from the National Institute of Mental Health [Grant R01 MH#84903]. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.