2S/LGBTQ+ YOUTH SUBSTANCE USE AND PATHWAYS TO HOMELESSNESS: A PHOTOVOICE STUDY

Abstract

Background

Studies have posited that substance use is associated with, or contributes to, homelessness for 2S/LGBTQ+ youth. However, interconnections between these issues are poorly articulated.

Methods

This community-based photovoice study describes the narratives used by 2S/LGBTQ+ youth about how substance use featured in their pathways to homelessness. Employing constructionist narrative analysis, two storylines were inductively derived from participant-produced photographs and photovoice interviews with 32 2S/LGBTQ+ youth in Vancouver, Canada.

Results

Taking refuge narratives centered on 2S/LGBTQ+ youths’ use of substances to cope with intersecting hardships and minority stressors they had faced growing up, and when transitioning to homelessness. From playing into precarity narratives focused on the shifting possibilities and tensions of what sexualized crystal methamphetamine use can surface for 2S/LGBTQ+ youth in terms of facilitating connection and release and simultaneously invoking discomforts, including eviction from their family home.

Conclusions

These narratives can usefully be anticipated and recognized to better understand and address the social contexts in which 2S/LGBTQ+ youth experience substance use and associated harms, especially homelessness. They affirm the need for tailored supports for 2S/LGBTQ+ youth who use drugs in the lead-up to and after becoming homeless, including the provision of care that better recognizes youths’ pursuits of becoming and belonging in the context of marginalization, and that takes a harm reduction approach to addressing the role of substance use in these pursuits.

INTRODUCTION

Pathways to homelessness for youth are complex and tied to factors operating across individual (e.g., mental illness, desire for greater independence), family (e.g., relationships, conflict), social (e.g., bullying, violence), and structural (e.g., poverty, housing unaffordability, discrimination) levels (Samuels et al., 2021; Schwan et al., 2018). By “youth experiencing homelessness,” we refer broadly to individuals under 30 years of age who live independently of parents/caregivers, yet are unable to secure safe, stable, and consistent housing (Canadian Observatory on Homelessness, 2016). Homelessness among youth populations can be thought of as distinct, given that youth are continuing to develop physically, mentally, socially, and emotionally, and therefore may benefit from tailored and age-appropriate supports that are responsive to their unique needs, strengths, and desires, which targeted research is well suited to inform (Providence Health Care Society d.b.a. Foundry, 2024).

Circumstances for becoming and being homeless among youth are diverse, yet it is well documented at a population level that Two-Spirit, lesbian, gay bisexual, transgender, queer, and other sexual and gender minority (2S/LGBTQ+) youth are disproportionately and unjustly affected by the upstream preventable constraints and relational problems that underpin youth homelessness (Ecker, 2016; Goodyear, Chayama, et al., 2024). There are also distinct factors associated with homelessness for 2S/LGBTQ+ youth. These include family strife and rejection related to one’s sexual and/or gender identity, minority stress (i.e., excess distress and social stigma among members of a minority group) and related responses (e.g., using substances to cope, fleeing non-affirming environments), and 2S/LGBTQ+ youths’ desires and pursuits of more queer-affirming and secure home and lives for themselves (Goodyear, Knight, et al., 2024; Matthews et al., 2019; Robinson, 2020). These issues and wider structural forces have led to inequities in homelessness for 2S/LGBTQ+ youth, who are estimated to comprise up to 40% of the total population of youth experiencing homelessness in Canada and the United States (Abramovich & Shelton, 2017; Ecker, 2016; Robinson, 2020). Importantly, determinants of homelessness for 2S/LGBTQ+ youth also increase risk for other health and social issues, including compromised mental health and substance use associated with harm (McCann & Brown, 2019).

There is great variation in the detail with which pathways to homelessness for 2S/LGBTQ+ youth are documented in the existing literature. Qualitative research has surged over the last two decades to elucidate some of the specifics surrounding how 2S/LGBTQ+ youth begin experiencing homelessness (Goodyear, Chayama, et al., 2024). Methodologically, this work has attended to the homelessness trajectories of 2S/LGBTQ+ youth with ethnography (Castellanos, 2016; Robinson, 2018a, b, 2021) and photovoice (Forge et al., 2018), alongside life-course and phenomenological in-depth interviews (Côté & Blais, 2021; Noor, 2022; Prendergast et al., 2001; Shelton & Bond, 2017). This work has directed considerable attention to specific determinants of homelessness – in particular, family rejection, which is an important yet frequently decontextualized explanation for homelessness among this population (Robinson, 2018b; Shelton & Bond, 2017). Other determinants, including youth mental health and substance use concerns, are less explored, and across published studies are only briefly discussed and with insufficient attention to contextual factors such as minority stress. This disparate focus represents an important knowledge gap given that 2S/LGBTQ+ youth face multiple forms of early-life hardship and precarity (beyond family rejection) that elevates their risk for homelessness. Moreover, addressing these complex issues necessitates in-depth understandings and responsive policy and practice initiatives, which targeted research can inform (McCann & Brown, 2019).

Substance use is a common noteworthy issue connected to homelessness for 2S/LGBTQ+ youth. Substance use in the family home, including intergenerational use, is indeed identified as a contributor to 2S/LGBTQ+ youths’ homelessness experiences (Alessi et al., 2021; Castellanos, 2016; Côté & Blais, 2021; McCann & Brown, 2019; Robinson, 2018b). The interconnections and processes behind these trajectories vis-à-vis substance use and homelessness are underexplored, though available research offers preliminary insights. For example, one study documented that transgender and gender-expansive youths’ use of substances was seen by their parents as a form of “acting out,” for which they were evicted from the family home (Shelton & Bond, 2017). More frequently, studies detail how 2S/LGBTQ+ youth use substances to cope with intersecting minority stressors, mental health hardships, peer and family conflict, violence, and poverty in the lead-up to, and after becoming homeless (Goodyear et al., 2023; Robinson, 2021; Shelton, 2016). Acknowledging the impacts of these issues, a literature review by Ecker (2016) found that 2S/LGBTQ+ youth experiencing homelessness are more likely than cisgender heterosexual youth to have used substances (including multiple substances), exhibit earlier onset of substance use, and be diagnosed with a substance use disorder. While important, these findings represent limited insight into the timing, motivations, and effects of 2S/LGBTQ+ youths’ substance use as it intersects with their pathways to homelessness.

In sum, studies have posited that substance use is associated with, or contributes to, homelessness for 2S/LGBTQ+ youth. However, interconnections between these issues are poorly articulated, particularly with respect to the temporal and contextual storylines for how drugs feature in 2S/LGBTQ+ youths’ transitions to homelessness. Addressing this literature gap can inform actions to better support 2S/LGBTQ+ youth at-risk for and experiencing substance use and homelessness – a priority in many settings, including ours in Vancouver, Canada, where youth are grappling with overlapping housing and overdose crises (Manson & Fast, 2023; Smith et al., 2023). Indeed, our Vancouver-based research with 2S/LGBTQ+ youth has begun to generate insights that contextualize the affective dimensions and role of substance use in experiences of homelessness and unstable housing (Fast, 2024; Goodyear et al., 2023; Goodyear, Jenkins, et al., 2024), and we advance these insights with the current investigation. Specifically, the aim of this study is to identify the narratives used by 2S/LGBTQ+ youth about how substance use featured in their pathways to homelessness.

METHODS

Study overview

Our authorship team comprises community-based health researchers with interdisciplinary backgrounds, including in nursing, public health, social work, anthropology, and sociology. We are invested in advancing equity in youth health and substance use and approach this work as 2S/LGBTQ+ people and allies with personal, family, clinical, and research experiences related to the topics under study. This article presents a focused narrative analysis and draws from a larger qualitative study, “Out on the street: A community-based study with homeless 2S/LGBTQ+ youth who use drugs.” For this study, we used a photovoice study approach (Hergenrather et al., 2009) that facilitated community engagement and research accessibility, and generated opportunities for youth to share their perspectives in ways that were decidedly participant-driven, creative, and not solely reliant on words. The utility of photovoice as an arts-based approach for producing contextualized visual representations of one’s identity and place in community is evidenced by previous work with 2S/LGBTQ+ youth experiencing homelessness and unstable housing (Forge et al., 2018; Goodyear et al., 2023), and was operationalized in this study with the aim of promoting youth agency in how they shared knowledge about their lives and social circumstances. To this point, we also engaged two youth advisory committees with whom the lead author (TG) has met monthly since September 2022 to steer this study, particularly regarding knowledge translation. Our work with one of these groups culminated in a community photovoice exhibit that we hosted together as part of Vancouver’s Queer Arts Festival (https://queerartsfestival.com/queer-eyes-queer-lives/), as we will detail in a future publication.

Data collection

We recruited participants using posters at the Vancouver-based At-Risk Youth Study downtown research office and nearby youth shelters and drop-ins, which TG visited regularly (with staff approval) to inform youth about the study. Eligible participants were 2S/LGBTQ+ people between 14 and 29 years-old, with current or past-year substance use and homelessness. Participation occurred between March and November 2023 and was renumerated with a $150 CDN honorarium, distributed over three payments. All participants provided informed consent. The University of British Columbia Behavioural Research Ethics Board approved the study (#H22-02910). Participants’ rights to privacy, confidentiality, and safety were of central concern in this research and promoted through several mechanisms. Of note, we enrolled participants under the age of majority as emancipated minors, informed participants that they could skip any interview questions they wanted and take breaks at any time, provided and reviewed with participants a youth resource sheet (e.g., for housing, mental health, substance use, and queer- and gender-affirming supports), and took a trauma- and violence-informed approach to interviewing, with all interviews conducted by TG, a registered nurse with clinical experience in youth mental health care. These ethical considerations and broader reflections about researcher ethics and positionality vis-à-vis this work are detailed at length elsewhere (Goodyear, 2024).

Data collection occurred in three stages. This process involved 61 in-depth individual interviews that lasted about one hour each and took place at our research office and in youth drop-ins. TG first met with participants for a brief sociodemographic survey and semi-structured interview exploring their substance use and homelessness trajectories and whether and how participants perceived these issues as being interrelated. Questions included, for example, “How did drugs first feature in your life, and what was going on in your life during this time?”; “How do you feel your substance use has influenced your living situation (past and present)?”; and “How do you think your gender, sexuality, or other identities and the experiences that can come with that relate to your substance use, and/or your experiences of becoming homeless?”. At the end of this interview, TG provided youth with disposable cameras and reviewed instructions and institutional ethical guidelines for taking their photographs. TG encouraged youth to take photographs depicting whatever was most important to them with respect to their substance use, homelessness/housing, and health more generally. TG also offered some prompts, asking youth to consider taking pictures depicting when and how they began using drugs and became homeless, and how their substance use featured in or alongside transitions to homelessness. Youth then spent approximately one to two weeks on the photovoice activity, after which they returned the cameras to TG. Once the photographs were developed, youth took part in a follow-up interview wherein they described their photographs, one at a time, while TG inquired into their underlying motivations and meaning. Here, TG asked youth how their photographs could be used in this research. The participants designated most of the photos as “public,” meaning they could feature in knowledge translation activities; all identifying photographs were kept private. TG also invited youth participants to title their photographs, and they did so about half the time. Interviews were transcribed, anonymized, and checked for accuracy. Data were managed using NVivo 14 software.

Participants

This study included 32 youth, aged 17 to 29 years (mean = 22.6). They reported first becoming homeless between the ages of 11 and 22 years (mean = 17.3) and, at the time of the interviews, were all experiencing homelessness or unstable housing. Youth often reported staying in a combination of settings, including shelters or safe houses (n = 13), single-room occupancy hotels and supportive and modular housing programs (n = 12), outside (n = 6), couch surfing (n = 4), apartments/dorms (n = 4), and on/off with family (n = 2). Importantly, even “semi-fixed” and supportive housing contexts could still be seen as constituting homelessness in the lived experiences of the youth, given the poor quality and precarious nature of much supportive housing in our study setting (Fast, 2024). Of participants, 21 were cisgender, eight were transgender, two were gender-questioning, and one preferred not to say. Youth reported a range of gender and sexual identities. Reported genders include man (n = 17), woman (n = 8), non-binary (n = 2), genderfluid (n = 1), feminine (n = 1), and androgynous (n = 1); one participant was unsure about their gender and another preferred not to say. Reported sexual orientations included bisexual (n = 14), lesbian (n = 4), gay (n = 3), queer (n = 3), pansexual (n = 3), bicurious (n = 1), semi-bisexual (n = 1), asexual (n = 1), and questioning/unsure (n = 3). Additionally, five Indigenous youth were Two-Spirit. Youth also reported diverse ethno-racial backgrounds, including white (n = 13), First Nations (n = 7), Latino (n = 2), Black (n = 2), Métis (n = 1), East Asian (n = 1), South Asian (n = 1), Southeast Asian (n = 1), and mixed (n = 4). Youth described wide-ranging substance use patterns, including polysubstance use. They reported primary (co-) use of stimulants such as crystal methamphetamine, cocaine, and/or crack (n = 23); heroin/fentanyl (n = 11); alcohol (n = 11); and cannabis (n = 11), plus other substances, including psychedelics and benzodiazepines. Four participants identified as recently sober, all of whom spoke to both the positive and negative impacts of their past substance use in relation to pathways to homelessness, in much the same was as participants who were currently using substances.

Data analysis

We analyzed the data using a constructionist narrative approach (Andrews et al., 2013; Esin et al., 2013) and Oliffe’s (2008) guide for analyzing participant-produced photographs together with interview data. TG began the analysis concurrently with interviewing, facilitating data immersion by writing interview summaries of each participant’s specific context and overarching storyline concerning substance use and housing/homelessness, while noting emergent ideas that would be used to inform subsequent interviews and lines of inquiry. Analysis progressed by focusing on shared meanings of events and points of emphasis in participant narratives to address our research question, how do 2S/LGBTQ+ youth position their substance use in relation to pathways to homelessness? TG treated each interview series as a unit of analysis and read them together and alongside other participants’ stories for predominant narratives responding to the research question. Concurrent with this approach, TG engaged with participants’ photographs by employing Oliffe’s (2008) preview and review stages of analysis, mapping basic social processes and determining illustrative photographs and quotations that could be shared as representative of emerging storylines. To inform and refine the analysis, we drew on Glynn’s (2021) theoretical framework for studying youth transitions through the lenses of recognition, precarity, and liminality. This theoretical scaffolding prompted careful consideration of how individual agency and pursuits of self-sufficiency and meaningful social inclusion (i.e., recognition) intersect with social and structural constraints on the lives of vulnerable populations (i.e., precarity) to shape youth transitions. This includes transitions with homelessness but also the self, including with respect to the in-between states and “constantly becoming” (i.e., liminality) we associate with youth substance use trajectories, sexual and gender identity development, and coming of age. We used this framework to examine and interpret participants’ experiences within their distinct social contexts, and to construct in-depth narratives for how substance use can map on to youths’ experiences of homelessness.

Beyond engaging with full interview transcripts and participants’ photographs, TG developed a coding framework that was used to organize the data set. Although coded data were not the focus of the current investigation, TG triangulated and contextualized the inductively derived narratives by integrating insights from the coded data, especially those coded to “Substance Use in Trajectories of Becoming Homeless.” Additionally, narrative findings were verified and further developed through regular (biweekly to monthly) meetings with the youth advisory committees and between the authorship team. Based on what predominated in our analysis of participants’ storylines and photographs, we developed two narratives: taking refuge and from playing into precarity. There was fluidity in these narratives, and they are not intended to reflect fixed scripted accounts of youths’ complex lived experiences of the study phenomena; however, there is also significant overlap and cohesion in the findings within each narrative. Because constructionist narrative analysis emphasizes the importance of exploring multiple constituent elements of stories in specific contexts and on various levels (Andrews et al., 2013; Esin et al., 2013), we made the pragmatic decision to focus on the storylines of a subset of participants whose homelessness and substance use trajectories were most illustrative of these two overarching narratives. “Zooming in” on their storylines and distinct narrative segments within them allowed us to develop detailed and compelling narratives representing the pathway between substance use and homelessness for 2S/LGBTQ+ youth. In what follows, we present these two narrative frames while integrating illustrative quotations and photographs. We also provide pertinent socio-demographic details about participants, including their age and self-reported gender and sexual orientation, to illustrate the ways in which some narrative elements may relate to these aspects of social location and participants’ wider social circumstances.

FINDINGS

Taking refuge: Substance use as survival in pathways to homelessness

Salient in this study was a Taking refuge narrative in which 2S/LGBTQ+ youth spoke to how substance use had been an agentic practice that they leveraged to cope with social and structural constraints on their lives, including the early-life hardships and intersecting minority stressors they had faced in the lead-up to becoming homeless. This narrative was particularly clear in the stories of Reginald, an 18-year-old cisgender bisexual man, Christopher, a 19-year-old transgender man questioning his sexual orientation, Billy, a 20-year-old gender-questioning bisexual person, and Lauren, a 23-year-old cisgender bisexual woman. These four participants shared how they had initially sought out and used substances – including cannabis then crystal methamphetamine (Reginald), cannabis (Billy), and alcohol and cannabis (Lauren and Christopher) – in early adolescence, as one way to achieve feelings of relief. They sought relief from diverse stressors, including sexual and gender identity-related stigma and shame, gender dysphoria (as described by Christopher and Billy, who were actively pursuing gender-affirming care), and queerphobia, intersecting with mental health challenges and family conflict and wider social inequities. Reginald summarized this nexus of marginalizing forces by reflecting that he had been “liv[ing] in a different world to people my age.” Reginald and other participants explained that substances could function as a sort of “crutch” to help them survive this precarious context and the tangled web of issues they had faced (and were still facing) as 2S/LGBTQ+ youth. In foregrounding and narrating these issues, Christopher characterized taking refuge in cannabis (and later, alcohol) to “numb out” the distress he wrestled with as a trans guy with gender dysphoria and with persistent barriers to accessing hormone replacement therapy. Christopher storylined his younger life and his pursuit of greater recognition while in a family environment where his parents did not accept his gender identity, nor his use of cannabis to “self-medicate,” in the absence of gender-affirming healthcare:

I found it [i.e., cannabis] really self-medicating. ’Cause, there are aspects of my life that I just would rather be able to numb out. […] [At home], it was just complete control, like surveillance. Wherever I went, they [i.e., my parents] were there. […] I found myself like daily consuming cannabis, that’s for sure. It’s just something I’ve used to soothe myself. […] And as a trans man, I don’t like living in my body. And when I’m like not stoned, I can really feel like everything that’s wrong with me. Everything that’s not right. And I sometimes it just gets way too much, and I can’t function with it some days. I- it’s a very different experience for everyone, but for me it’s intense. ’cause I intensely feel wrong, so I just gotta numb it out somehow. […] It was always to just take away the crushing feeling. […]. And [I] definitely wanted to numb it out and definitely wanted to have a better time on the daily, just… It’s easier, just to smile and have fun when you’re drunk or stoned.

Christopher narrated himself as an outsider in the family home, having taken refuge in substance use to ease that ill-fit and liminality and perhaps to delay his seemingly inevitable departure. In this way, Christopher’s taking refuge narrative positions his substance use as a deliberate resource for buying some time but one that ultimately also had the effect of hastening his exit from the home. Indeed, he explained how the pressure and control his parents exerted over his gender and intentional use of substances boiled to a point where “my parents didn’t want me in the home, and I could tell.” Christopher likewise did not want to be in this environment, as it was “just not something I could see myself continuing to live in.” Christopher positioned himself as a reluctantly “self-made” survivor, having ultimately decided to leave home at 17-years-old and turn to couch surfing ahead of staying at shelters before eventually securing rental housing.

Similar to Christopher, Billy encountered parental rejection based on their sexuality/gender and, later, substance use. Billy described grappling with gendered queerphobia growing up, summarizing that, “I was around a lot of homophobia,” including in school, where, “people would call my friends and I queers just for having dyed hair and hanging out [together] and, like, having shorter hair.” This othering of Billy’s gender expression and perceived queer sexuality contributed to internalized shame, identity struggles (i.e., “It’s hard to figure out yourself when you don’t have an accepting environment”), and a general “unhappiness” that they would intentionally “run away from” by using cannabis. Billy took Photograph 1 (Untitled), and explained how, growing up with non-affirming family members and peers, they had been “feeling like just a shadow of who I was.” Cannabis, as represented by the shadowed outline of the bong Billy is holding in the photograph, was one proactive means by which they eased identity-related shame invoked by others and worked to feel more comfortable in their own skin and social environment. This was an uphill battle, however, as, like Christopher, Billy’s parent’s upset over their queerness intersected with concerns about substance use. They recalled how the “friction” in their child-parent relationship was sparked by conflict over Billy’s cannabis use – aggravated by the fact that Billy’s older sibling had also used substances and died of overdose – and exploded after Billy disclosed their gender identity struggles. Seeking recognition through doing so, Billy was instead met with mutually reinforcing substance use stigma and queerphobia that peaked with their mother rejecting them in the immediate moment. This contributed to Billy attempting suicide, after which they were hospitalized then transitioned to a youth mental health recovery group home. Here, substance use stigma and policing further shaped Billy’s transition to homelessness, as group home staff asked them to stop using cannabis or move out. Positioning cannabis as key to their survival amid hardships faced, Billy chose to leave and build a new home for themselves, on their own terms. They began couch surfing at the age of 19.

Photograph 1.

Untitled (Billy_P24).

Parental rejection of youth’s identities and practices (with sexuality, gender, and substance use) was not a universal experience among participants who espoused a taking refuge narrative. Lauren and Reginald’s storying of their pathways into homelessness sheds further light on how family conflict related to substance use, structural poverty, and the local housing affordability crisis can come together to push youth to the margins of the city. Lauren, for example, had not disclosed her queer identity to her father and his girlfriend, whom she had been living with throughout adolescence. Still, like many participants, Lauren described experiencing abuse and generally feeling “unsafe” and “stressed” while growing up, adding that her caregivers were also using substances intensively, and summarizing, “It was just horrible.” Lauren positioned her family home as both norming and necessitating substance use. She intentionally used alcohol and cannabis to shelter herself from a precarious family and home situation, and to forge new avenues for security and survivability. Referring to this tumultuous context, Lauren took Photograph 2 (“Make Me Feel Alive”) of her art, resting atop a suitcase, and shared:

Photograph 2.

“Make me Feel Alive” (Lauren_P06).

I just felt really dead inside [as a teenager], and I was just always, like not, sober. […] I had a really bad home life. So, I was just trying to escape that. And yeah, I was just depressed, and I didn’t wanna like go to school or anything, and I was just always getting into trouble. […] It [using substances] was just like a distraction. It was just, like, having fun with my friends, and like not thinking about reality.

The contrasting imagery and colours in Lauren’s artwork encapsulates the burden of hardships she faced, together with her desires and active pursuits to sustain herself. The blunt in the skull’s mouth marks Lauren’s cannabis use as simultaneously damaging and therapeutic for easing the weight of ever-growing relational and structural pressures, while the bordering suitcase can be interpreted to reflect her narrative positioning as a temporary resident in her family home. Lauren ultimately left that home, escaping to what she referred to as a trap house – i.e., a place that is a hotspot for buying, selling, and using drugs. Laurens’ shelter in this house was short-lived, however, as she came to realize that it, too, “was just not safe or stable, so I had to leave.” Against a backdrop of strained family ties and her own financial precarity as a “runaway teen,” Lauren recounted how, after leaving the trap house, “I ended up being broke, so, I had nowhere to go.” She was promptly referred to a youth homelessness shelter by a social worker to whom she was already connected and had a brief stay there. Lauren then spent the next five years moving in and out of couch surfing arrangements and temporary stays with partners and family, before eventually securing social housing wherein she felt more stably “at home.” While Lauren had used alcohol and cannabis consistently throughout her homelessness trajectory, with this use intensifying as she sought to alleviate the stress of her life and socio-material circumstances, it subsided as she moved into quality independent housing.

Lauren and Reginald shared that substance use had been prevalent in their immediate families and intergenerationally and traced their own use directly to this context, in a manner that was distinct from other participants’ storylines. Reginald also tied his stimulant use to (indirect) experiences of queerphobia and the compounding effects thereof. Although Reginald had a relatively positive experience of coming out as bisexual in his early teens, he was nonetheless exposed to gendered queerphobia through his mother’s disapproval of his transgender sibling’s gender identity and expression. This caused arguments and strife in his family and his relationship with his mother, which were further exacerbated by conflict and child welfare system involvement related to Reginald’s mother’s substance use and, eventually, his own. Indeed, Reginald explained that his substance use preceded (and paved) his entry homelessness by nearly three years, as he had been using cannabis and crystal methamphetamine as one way to ground himself and “forget about all the bad things that were going on, all the problems.” The hardships affecting Reginald and his family were further complicated by entrenched poverty and Vancouver’s housing crisis, which led the family to move homes frequently and never fully settle while Reginald was a child and teenager. For Reginald and others, drugs were a buoy for staying afloat amid a protracted state of liminality, movement, and crisis tied to family instability and wider structural issues. It is no surprise, then, that Reginald’s use of substances intensified after his family’s most recent rental eviction, which left him on his own, with nowhere to go:

My mom got evicted, and I was staying with her. And once we left there, I was homeless. And you know, I’ve just been messing around places, safe houses, outside, [ever since]. […] In general, I like that it keeps me up, keeps me functioning. I feel like now I’m to the point where I can like function because I smoke side [i.e., crystal methamphetamine]. […] I keep on going. I don’t feel groggy or down as much. I feel a little bit more motivated to be more up, more proactive (emphasis in bold).

When asked how his experiences with substance use were connected to his homelessness, Reginald replied cautiously that, “substance use came first.” He contextualized this response by stating that becoming homeless was “something that was always gonna happen.” This inevitability of homelessness was entrenched in the vulnerability of his family circumstances and the normative use of substances to get by. Reginald’s narrative of taking refuge is thus congruous with those of Billy, Christopher, and Lauren in the sense that they were all purposely using substances to survive intersecting early-life hardships and minority stressors, inclusive of but not limited to queerphobia. Yet, it was also distinct in the sense that he was using substances to stay motivated and proactive. Thus, while the taking refuge narrative encompassed youth finding some solace in substance use, under the weight of everything they were going through, we emphasize that youth also used substances to different ends. In the next section, From playing into precarity, we continue our analysis by presenting a second narrative of 2S/LGBTQ+ youths’ substance use as it connects to their evolving social worlds and pathways to homelessness.

From playing into precarity: Stimulants, sex, and the shift to homelessness

For another group of participants, circumstances of becoming homeless were closely tied up in their use of crystal methamphetamine with sex (i.e., Party and Play, chemsex) in pursuit of new forms of recognition and becoming, the intensification of their use, and associated social and mental health sequelae. This included Edgar, a 19-year-old cisgender gay man, Morgan, a 21-year-old cisgender pansexual man, and Cole, a 24-year-old cisgender bisexual man. All three described initially using crystal methamphetamine for fun and excitement, in line with an extensive literature (e.g., Maxwell et al., 2019; Pienaar et al., 2020b) detailing the socio-cultural context of young queer men’s sexualized use of substances, including for enhancement and transformation purposes. In our study, these three young men gradually transitioned to more regular use in pursuit of the stimulants’ effects for garnering confidence and pleasure, especially (though not exclusively) with sexual activity. Edgar first used crystal methamphetamine with a friend, in a platonic context, whereas Morgan and Cole first used it with sexual partners they met on a queer hookup and dating app. Each of their decisions to use crystal methamphetamine were closely tied to their sexual identity puzzlements and an active desire to shift away from social precarity and the family conflicts they were having at home, with the youth reporting that they wanted new ways to experiment and enjoy themselves. Morgan referenced many of these overlapping issues and the feelings of uncertainty and misrecognition they could engender as he traced his initial foray into crystal methamphetamine use in his late teenage years:

I was kind of, I guess, operating on autopilot, as I like to say. I was kind of very disconnected. […] I just wasn’t getting the joy and fulfillment or satisfaction that I wanted out of life. So, I was seeking for it in a new form. And meth just so happened to be that form. […] It was kind of a spur of the moment decision [to try crystal methamphetamine]. I was deeply upset when I was met with the news that I would not be welcome to reside where I did [with my parents]. I say that because I think it did play some role… Because I’ve used the…. the app, Grindr, quite frequently in the past year… That’s where I met the person who I ended up trying crystal meth with for the first time. But then that’s also where I spent a lot of my time with hookups and various other kind of engagements with people. And [with] Grindr, and the time where I would be away from home and perhaps develop from, perhaps that was some of the disruptive behavior that my parents were referring to, when they asked me to leave [home]. […] It’s all kind of an interconnected picture.

Morgan, Edgar, and Cole continued using crystal methamphetamine, escalating their use in terms of amount and frequency, with much of their crystal methamphetamine consumption being coupled with sexual activity, both alone and with others. Each of these participants discussed finding pleasure from, yet becoming caught up in, sexualized substance use. Within the narrative of from playing into precarity, there was a sense that stimulants had initially served as a bridge to fun, pleasure, and respite with respect to youths’ life circumstances and identity struggles, yet that this use had simultaneously turned to engendering sense of lost control as it ceased being able to satiate the evolving challenges they faced. Indeed, Edgar spoke in detail about how crystal methamphetamine had become a “driving force” and “the only thing that gets me up and going.” At the same time, he shared that his use had intensified to a point where he felt as though it was becoming unchecked. He took a photograph of his bed in his family home and discussed becoming entangled in the liminality of sexualized crystal methamphetamine use:

This is where I would, like, I used to masturbate a lot. […] This is where I would spend my time, basically, like, for days and weeks. […] I would just be on Twitter, I would just be on Tumblr, I would just visit everything [online, for porn]. Just fucking masturbate, all day. All week, all month, all year. […] That’s where I would just spend my mostly days and I would miss work and I would also just be late for everything. […] I would just buy side [i.e., crystal methamphetamine] and then my plan would be that, and then just doing that for, like, that cycle, you know? I’m in that cycle.

Participants positioned their crystal methamphetamine use as tied to physical and sexual pleasure, at first, though they likewise narrated the ways in which could facilitate emotional connections as well as feelings of thrill, euphoria, and desire. These affective benefits were critical given the minority stress and isolation participants were experiencing as young queer people, as well as the conflict and rejection they faced with others. In this context, participants described actively seeking out feelings of excitement, (self-)discovery, and fulfillment, which crystal methamphetamine could garner. Cole reflected on the desire to “run free” when discussing Photograph 3 of his vintage Led Zeppelin sweater, which he took while homeless and spending the night at a local bathhouse. He titled this, “Sex, Drugs, and Rock and Roll.”

Photograph 3.

“Sex, Drugs, and Rock and Roll” (Cole_P02).

Sex, drugs and rock and roll all tie in with me, in terms of my party and play habits. This one, I took at, on one of the beds at [name – bathhouse]. [….] Speed [i.e., crystal methamphetamine] will kind of just sort of allow us, like, my sort of libido, to run free, and I just dive into that completely; so, it’s… It is an escape in a way, or a help with escape.

With their freeing effects, stimulants (and other substances) could even be grounding or stabilizing for youth. This was especially so as the participants were grappling with, and actively deviating from, the precarious minority stress and relational tensions they endured while growing up queer. They all discussed “constant friction” at home and in their teenage lives, oftentimes describing feeling lost and like they could not be their authentic selves, as their sexual identities and personhood were poorly recognized by family members and peers. Vulnerability and a desire for more were indeed central to participant narratives about their early lives, with the youth often positioning the marginalization they faced as something from which they sought to shift away. This was evident in Cole’s will to “dive into” and “run free” with crystal methamphetamine, as well as Edgar’s comments below about pursuing a truer and more secure sense of self while using stimulants. They both positioned themselves as getting release, finding pleasure, and even becoming more grounded as they experimented with disinhibiting desires and identity work. Edgar reflected:

People, like the LGBT, people like us, want to feel grounded, like, as important. I think it [i.e., substance use] has something to do with that, too, as well. Finding who, what you truly are, and what you like.

Youths’ learning and performing of identity through and while using substances occurred despite growing precarity at the nexus of housing insecurity, minority stress, and family strife. They narrated how drugs and the release and recognition secured through their consumption could become habit forming for knowing identity and related practices and effects (e.g., experimentation, sex; self-discovery, pleasure), with this tide turning as intensifying substance use began to “take over” and intensify the precarity of their life circumstances. Edgar, Morgan, and Cole all indicated that escalations in crystal methamphetamine use heightened the social stress and family conflicts they were experiencing. For example, being out of the family home past curfew and/or for longer periods of times, such as with binge stimulant use and prolonged hookups, exacerbated existing tensions with their parents. Concerns about youth bringing drugs back into the family home were also a problem. In this context, the youth positioned their intensifying use of stimulants in parallel with their families at a loss for what to do and eventually having to make hard decisions about them needing to leave home, because of this use. Indeed, Edgar explained that, although his mother had come to accept and support this queerness, she could not accept his stimulant use. Edgar emphasized that he “sympathize[s] with her struggles” and felt as though his mother was only trying to do what was best for him and to curb his burgeoning stimulant addiction. This involved her swaying back and forth between letting Edgar stay in the home and kicking him out, about which she was still at a crossroads. At the time of the interviews, Edgar’s mother was not allowing him to stay at home. Capturing their individual and collective struggles, Edgar took Photograph 4, titled with the response, “Nobody,” and reflected on the consequences of his intensifying stimulant use and their relationship breakdown:

Photograph 4.

“Nobody” (Edgar_P13).

[This represents] the stillness, I guess. Like, just the-, the isolation of drugs. Of how isolating it is, sometimes. For me. […] When you’re too deep into your addiction and like when you, and you see no problem with it, still. I think that’s… how it’ll turn out. Like, I’m just gonna be staying here [on the streets and in shelters].

Edgar’s comments about stillness and isolation speak to a marginal state and contrast participants’ descriptions of initially using crystal methamphetamine to spark fun, excitement, pleasure, and connection. Just as stimulant use was rife with possibility among youth, it could also precipitate (and potentiate) loss and dislocation. Edgar, Morgan, and Cole all shared how the financial and time demands of regular stimulant use as well as missed and lost paid-work tied to this use contributed to socioeconomic stress and material insecurity. Cole, for example, recalled feeling as though his parents had been discounting his autonomy and independence as a young bisexual man, and indicated this feeling had escalated when he got himself into credit card debt. Cole’s parents became concerned and ultimately demanded that he cancel his credit card and allow them to begin reviewing his financial statements, or else leave the home. Cole chose to leave and go to a shelter, feeling as though this fiscal and more general oversight was unjust and presented an insurmountable barrier to the freedom he desired. For Morgan, the intensifying use of stimulants began to take a toll on his mental health and culminated in the development of psychosis, then police involvement, forced hospitalization, and homelessness. He recounted this trajectory with a cascade of events, all of which began with his early experiences with sexualized substance use:

[We had] a continual relationship where we kind of engaged in some sexual activities and smoked crystal meth for about a couple months, few months, three months. And we’d meet up about every couple weeks, every week, or thereabouts. And then that kind of cascaded into me procuring my own meth from them. And then eventually just getting it from a dealer myself, and then smoking it more often daily, then progress progressively becoming more isolated and detached from people, suspicious of people, psychotic. And I- I fell into some troubled waters [while homeless], when I was arrested by police on… [details omitted] […] Taking drugs used to be a thrill, something novel, something exciting and new. Now, it’s just a habit, you know? It has kind of become kind of commonplace and normal for me to smoke meth. Well, as absurd as that sounds…

Morgan took Photograph 5 (“Malaise”) while sitting alone at a coffee shop. He contrasted the shadowy figures in the image with the bright lights dangling above to speak to how crystal methamphetamine had functioned as a tool for shifting away from the malaise he felt as a queer teenager, even as it turned to producing new forms of discomfort and precarity. As with Edgar and Cole, Morgan’s stimulant use had shifted in ways that extended well beyond his initial pursuits of sex, pleasure, and experimentation, eventually coming to precipitate and solidify his transition to homelessness. Although he first used stimulants “to get myself out of the depressive or kind of stuck funk I was in,” commenting that this had even worked for a time, his use had effectively “spiraled from there.” In this narrative lies a tension in that drugs served as both a release and risk for these young men, each of whom had already been wrestling with social and relational pressures tied to their sexual identity puzzlements and pursuits of greater recognition. Their initial use of drugs in this precarious context provokes a broader question about whether the youth still would have turned to sexualized crystal methamphetamine use, or engaged in it in the same way, had the social and structural constraints on their early lives been lifted.

Photograph 5.

“Malaise” (Morgan_P06).

DISCUSSION

This community-based study used photovoice to derive two narratives about how substance use features in pathways to homelessness for 2S/LGBTQ+ youth: taking refuge and from playing into precarity. Within the taking refuge narrative, participants’ storylines focused on how substance use had been an agentic practice they drew on to survive and shift away from the early-life hardships and intersecting minority stressors they had faced in the lead-up to homelessness. With regards to from playing into precarity, storylines of sexualized crystal methamphetamine use converged to illuminate the contrasts of what drugs can do for and to 2S/LGBTQ+ youth in terms of facilitating connection, release, and recognition, yet simultaneously invoking discomforts, including eviction from the family home. Although some experiences within these narratives are not unique to 2S/LGBTQ+ youth, our findings highlight that marginalization of gender and sexual orientation can add one more layer of disadvantage, and one more degree of exclusion, to the many that are oftentimes already weighing on vulnerable youth (Prendergast et al., 2001). This marginalization, the precarity it can garner, and youths’ related pursuits of becoming and belonging must be accounted for in interventions aimed at helping youth at-risk for and experiencing homelessness, above all for 2S/LGBTQ+ youth and others facing oppression shaped by intersecting aspects of social location. In what follows, we discuss some empirical and pragmatic implications of these narratives in connection with existing literature to make recommendations for future related research, policy, and practice.

Findings from this study detail how drugs featured in 2S/LGBTQ+ youths’ pathways to homelessness, as tools for bridging access to refuge and release from sexual identity puzzlements and family conflict. 2S/LGBTQ+ youth also used drugs to shift away from these issues and to precipitate fun, pleasure, connection, and experimentation. These findings build on prior work detailing how street-involved youth use crystal methamphetamine to “get going,” “be more normal,” and mediate exclusion (Fast et al., 2014), and that 2S/LGBTQ+ people use drugs to enhance or transform their experiences of gender and/or sexuality (Pienaar et al., 2020a, b), adding that 2S/LGBTQ+ youths’ substance use can even be a way of grounding oneself amid intersecting early-life hardships and as identity work unfolds. With the present study, we also emphasize the temporal dimensions of substance use in this population, tracing how it can evolve from a largely positive experience to become constraining for youth and exacerbate the precarity of their lives and material circumstances, such as by threatening mental health and financial and housing security, a finding also noted in a study by Matthews et al. (2019), with LGBT+ people in Scotland. The push-pull relationship between harms such as these and the physical, psychological, and emotional gains that substance use can garner for youth has been detailed in our study setting and elsewhere (Duff, 2015; Fast, 2024; Fast et al., 2014; Goodyear, Jenkins, et al., 2024) and is key to acknowledge among support persons for 2S/LGBTQ+ youth at-risk for and experiencing homelessness. This is especially so given how common substance use is among 2S/LGBTQ+ youth experiencing homelessness and unstable housing (Ecker, 2016; Hao et al., 2021; McCann & Brown, 2019), and the precarity that such issues and the wider social contexts of these youths’ lives can bring with respect to heightening substance use-related risk and harms. Whilst acknowledging this potential for harm, our work has shown how substance use can also be comforting for 2S/LGBTQ+ youth experiencing homelessness, including as youth seek to mediate interrelated experiences of social stress and mental health challenges (Goodyear et al., 2023; Goodyear, Jenkins, et al., 2024).

The narratives in this study hold value for informing substance use and harm reduction service delivery with 2S/LGBTQ+ youth experiencing homelessness, suggesting avenues for responding to particular contexts of substance use in ways that may both honour and shift these narratives. In effect, the taking refuge and from playing into precarity narratives accentuate what drugs are doing for 2S/LGBTQ+ youth grappling with early-life hardships and intersecting minority stressors, even as these issues collide to initiate or catalyze pathways into homelessness. In line with these findings, we draw from studies examining youth substance use intervention approaches (Duff, 2015; Fast, 2024; Jenkins et al., 2017) to suggest that programs grounded solely in prevention and abstinence paradigms and denying generative potentials (as well as the risk potential) of drugs may not be relatable, meaningful, or helpful for 2S/LGBTQ+ youth at-risk for and experiencing homelessness. What may be more impactful, in our view, is for policy makers and support persons to align care approaches conceptually with a substance use spectrum model (Government of Canada, 2022), together with the philosophy and practice of harm reduction (Canêdo et al., 2022; Jenkins et al., 2017; Munro et al., 2017; Pauly, 2008). A key part of this would involve recognizing that substance use changes across individuals, time, and contexts. Thus, it ought to be viewed along a continuum representing shifting degrees of benefit apportioned with harms (Government of Canada, 2022). Adopting such an approach can prompt support persons to help 2S/LGBTQ+ youth to identify and mitigate pertinent substance use harms, such as deteriorations in mental health, evictions, and the effects of stigma and violence, while still experiencing desired benefits. Here, it is also key to account for and act on the upstream factors (e.g., homelessness, intersecting minority stressors, family conflict) that contribute to harms associated with the context of 2S/LGBTQ+ youths’ substance use. Interventions within this frame could include services to assist families in accepting and reuniting with 2S/LGBTQ+ youth, tailored housing subsidies and programs, and 2S/LGBTQ+-affirming policies across communities, among other measures that attend to the root social and structural causes of inequities in substance use and homelessness for 2S/LGBTQ+ youth (Goodyear, Chayama, et al., 2024; McCann & Brown, 2019). Alongside such efforts is a need to work intersectionally to improve access to safe, affirming, and evidence-based substance use treatment for diverse 2S/LGBTQ+ youth, as detailed elsewhere (Dimova et al., 2022; Matthews et al., 2019; Paschen-Wolff et al., 2024), including through residential treatment and transitional housing programs.

Strengths of this study include the volume and depth of the data, the participatory qualitative methods and triangulated data sources (i.e., photographs, interviews), our recruitment of a locale-specific and diverse sample of 2S/LGBTQ+ youth with varied lived experiences, and our rich description of the social context of participants’ lives. These strengths can support transferability of the findings across different populations, contexts, and settings, including other urban centres. Limitations include the reliance on 2S/LGBTQ+ youths’ narratives for the findings, without the perspectives of family members, peers, and service providers. Additionally, we opted to focus on a subset of participant narratives for the analysis, with the aim of nuancing their storylines. This may have obscured important aspects of other participants’ stories, though we mitigated this issue by triangulating our narrative analysis with insights from pertinent coded data. Limitations in our research design and question hindered our capacity to conduct robust intersectional and comparative analyses, including to explore potential variation in participants’ accounts along axes of gender, sexual orientation, ethnocultural identity, and types and patterns of substance use. Likewise, we were unable to examine interconnections between family and intergenerational substance use and homelessness among 2S/LGBTQ+ youth, and the structural forces driving these issues, as surfaced elsewhere (Robinson, 2018b). Future work might address these limitations using intersectional and longitudinal approaches, as well as targeted and multi-pronged sampling and data collection approaches, including to support participation of younger youth. There is also opportunity to research the substance use and homelessness trajectories of 2S/LGBTQ+ people across the life span, from youth through to older adults.

CONCLUSIONS

The lives and stories of participants in this study provided powerful insights about how 2S/LGBTQ+ youths’ trajectories of substance use and homelessness can intersect, connecting and colliding with wider social and structural forces. The identified narratives (taking refuge, from playing into precarity) are critically important starting points for getting upstream of dire health and social hardships for 2S/LGBTQ+ youth, including substance use associated with harms, and experiencing and becoming caught in homelessness and unstable housing. To this end, these narratives might be usefully anticipated and recognized for their importance among support persons seeking to better understand, and ultimately address, the evolving social contexts in which 2S/LGBTQ+ youth experience homelessness, substance use, and associated harms. The study findings affirm the need for tailored supports for 2S/LGBTQ+ youth who use drugs in the lead up to and after becoming homeless, including the provision of care that is grounded in harm reduction and that views substance use and its benefits and harms along a continuum. Also needed is the championing of family, school, and social policy interventions to address the root causes of inequities in substance use and homelessness among 2S/LGBTQ+ youth.

HIGHLIGHTS.

• 2S/LGBTQ+ youth narrated their substance use and homelessness trajectories.

• They took refuge in drugs to survive early-life hardships and becoming homeless.

• 2S/LGBTQ+ youth also used drugs for release and to shift away from marginalization.

• Stimulants were used for pleasure, connection, and experimentation amid inequity.

• Drugs simultaneously invoked discomforts, including eviction from the family home.