Substance Use and Victimization: Street-involved Youths’ Perspectives and Service Implications

Research shows that homeless youth engage in substance use and abuse at high rates, with results from one national study (N=11,000) indicating lifetime use rates among homeless youth to be 99% for marijuana, 78% for cigarettes, and 76% for alcohol.¹ Rates of recent use are similarly high; one study found 84% of homeless youths had used one or more substances in the past three months.² This substance use is associated with street victimization; those who meet criteria for alcohol abuse are three times more likely to have experienced a traumatic event and five times more likely to meet PTSD criteria.⁴ Though using substances is related to experiencing trauma and PTSD,^4,5 explanations for this relationship vary. Some scholarship indicates substance use is a risk factor or precursor to trauma.^6-8  Still other scholarship places substance use among homeless youth as a type of self-medication strategy used to relieve trauma or PTSD symptoms.⁹ In the present study, the authors rely on qualitative inquiry to determine 1) how substance use places homeless youth at risk for trauma and 2) how substance use acts as a coping mechanism.

The Sample

A purposive sample of 50 youth participated in individual interviews, responding to open-ended questions regarding coping methods, substance use, and victimization.

• Age: M=20 (SD=1.1)
• Gender: 54% male, 46% female
• Race/ethnicity: 40% Black, 26% Latino, 20% White, 14% other
• Living situation: 66% street or temporary shelter; 34% with friends, family, or in foster or criminal justice systems
• 82% experienced a traumatic event, 22% met PTSD criteria, 68% met drug abuse or dependence criteria, 42% met alcohol abuse or dependence criteria

The Results

The authors used template analysis¹⁰ based on existing literature. The authors discuss themes in the data within two categories: substance use leads to negative consequences and substance use as coping for victimization or distress. These themes are briefly summarized below.

Substance Use Leads to Negative Consequences

• Physical health problems from substance use (e.g., sexually transmitted illnesses, withdrawal symptoms, substance overdose, addiction)
• Emotional consequence of substance use (e.g., anger, irritability, depressive symptoms, guilt, pain, sadness)
• Loss of relationships and support systems (e.g., broken trust, feelings of abandonment and isolation)
• Decreased motivation to leave the streets (e.g., laziness, not showing up for obligations, disruption of service-seeking behaviors, sacrificing money for substances)
• Lack of awareness (e.g., reducing inhibitions and awareness of potential victimization)
• Participation in illegal or violent activities to support need for substances (e.g., robbing, mugging, prostituting)

Substance Use as Coping for Victimization or Distress

• Substance use to deal with uncomfortable emotions/moods (e.g., to improve mood, deal with loss, reduce traumatic flashbacks)
• Substance use to relax (e.g., deal with current life circumstances, to avoid anger and violence in social interactions)
• Substance use to escape and avoid thoughts (e.g., forget trauma and avoid thoughts of homelessness and related living conditions)
• Substance use to socialize and find support (e.g., having fun, help open up to homeless peers for support)
• Substance use as a temporary fix (i.e., fixes current emotional pain, but often leads to long-term consequences)

The Implications

Overall, homeless youth described substance use as a temporary solution, while still recognizing ways in which it places them at risk for victimization. Despite limitations (e.g., single city sample, potential for social desirability bias), the authors offer several implications for research and practice:

• Many programs offer substance use prevention curricula for homeless youth. This study suggests trauma-related material should be integrated and the interconnectedness of substance use and victimization explicitly discussed with youth.
• Intervention to improve contextual factors in the lives of homeless youth may be necessary to reduce substance use and victimization. Social service providers can help by connecting youth to stable housing, education, and employment opportunities; aid youth in disengaging from street culture; and encourage prosocial connections.

For More Information

To learn more about Dr. Bender’s work with street-involved youth, visit her faculty page or DU portfolio.

Citation

Bender, K., Thompson, S.J., Ferguson, K., Komlo, C., Taylor, C., & Yoder, J. (2012). Substance use and victimization: Street-involved youths’ perspectives and service implications. Children and Youth Services Review, 34(12), 2392-2399. doi: 10.1016/j.childyouth.2012.09.008

References

¹ Thompson, S.J., Maguin, E., & Pollio, D.E. (2003). National and regional differences among runaway youth using federally funded crisis shelters. Journal of Social Service Research, 30(1), 1-17. doi: 10.1300/J079v30n01_01

² Bousman, C.A., Blumberg, E.J., Shillington, A.M., Hovell, M.F., Ji, M., Lehman, S., & Clapp, J. (2005). Predictors of substance abuse among homeless youth in San Diego. Addictive Behavior, 30, 1100-1110. doi:10.1016/j.addbeh.2004.10.006

³ Stewart, A.J., Steiman, M., Cauce, A.M., Cochran, B.N., Whitbeck, L.B., & Hoyt, D.R. (2004). Victimization and posttraumatic stress disorder among homeless adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43(3), 325-331. doi: 10.1097/00004583-200403000-00015

⁴ Bender, K., Ferguson, K., Thompson, S., Komlo, C., & Pollio, D. (2010). Factors associated with trauma and posttraumatic stress disorder among homeless youth in three U.S. cities: The importance of transience. Journal of Traumatic Stress, 23(1), 161-168. doi: 10.1002/jts.20501

⁵ Ginzler, J.O., Garrett, S.B., Baer, J.S., & Peterson, P.L. (2007). Measurement of negative consequences of substance use in street youth: An expanded use of the Rutgers Alcohol Problem Index. Addictive Behaviors, 32(7), 1519-1525. doi: 10.1016/j.addbeh.2006.11.004

⁶ Wenzel, S.L., Leake, B.D., & Gelberg, L. (2001). Risk factors for major violence among homeless women. Journal of Interpersonal Violence, 16(8), 739-752. doi: 10.1177/088626001016008001

⁷ Baron, S.W. (1999). Street youths and substance use: The role of background, street lifestyle, and economic factors. Youth & Society, 31(1), 3-26. doi: 10.1177/0044118X99031001001

⁸ Thompson, S., Barczyk, A.N., Gomez, R., Dryer, L., & Popham, A. (2010). Homeless, street-involved emerging adults: Attitudes toward substance use. Journal of Adolescent Research, 25(2), 231-257. doi: 10.1177/0743558409350502

⁹ Nymanthi, A., Hudson, A., Greengold, B., Slagle, A., Marfisee, M., Khalilifard, F., & Leake, B. (2010). Correlates of substance use severity among homeless youth. Journal of Child and Adolescent Psychiatric Nursing, 23(4), 214-222. doi: 10.1111/j.1744-6171.2010.00247.x

¹⁰ King, N. (1998). Template analysis. In G. Symon, & C. Cassell (Eds.). Qualitative methods and analysis in organizational research: A practical guide (pp.118-134). Thousand Oaks, CA: Sage Publications.