Substance abuse recovery after experiencing homelessness and mental illness: Case studies of change over time

Objective: This article addresses how consumers with dual diagnosis who were formerly homeless but are now living in supportive housing understand their recovery from substance abuse (i.e., substance abuse or dependence). Specifically, this study examined what can be learned about substance abuse recovery from consumers considered to be doing well; how past substance abuse fits into their present-day narratives; and how (if at all) policies of harm reduction versus abstinence are regarded as affecting recovery efforts. Methods: As part of a federally funded qualitative study, 38 individuals who met criteria for having achieved a measure of success in mental health recovery were purposively sampled from two supportive housing agencies, one using a harm reduction and the other an abstinence model. Researchers conducted in-depth interviews and used case study analysis, the latter including the development of case summaries and data matrices, to focus on substance abuse recovery in the larger context of participants lives. Results: Recovery from substance abuse was depicted as occurring either through discrete decisions or gradual processes; achieving recovery was distinct from maintaining recovery. Emergent themes related to achievement included (a) pivotal events and people, (b) maturation, and (c) institutionalization. Central themes to maintaining recovery were (a) housing, (b) self-help, and (c) the influence of significant others. Conclusions: These findings capture a complex picture of overcoming substance abuse that largely took place outside of formal treatment and was heavily dependent on broader contexts. Equally important is that consumers themselves did not necessarily view substance abuse recovery as a defining feature of their life story. Indeed, recovery from substance abuse was seen as overcoming one adversity among many others during their troubled life courses.