HURRICANE CHANGES: EXAMINING ENHANCED MOTIVATION TO CHANGE DRUG USING BEHAVIORS AMONG KATRINA EVACUEES

Abstract

Substance use disorders are credited with greater amounts of death and illness than all other preventable health problems. Billions of dollars are spent on efforts to control drug supplies and fund various treatment approaches, but relatively little resources have been directed towards investigating how environmental conditions can contribute to or detract from substance user’s individual motivation to change behavior. Hurricane Katrina caused untold property damage and upheaval, in addition to the vast numbers of people whose lives it drastically affected. This article examines how surviving this ordeal, subsequent evacuation, and eventual resettlement in New Orleans or re-location to a different city (in this case, Houston) impacted individuals’ motivation to change their substance use patterns and behaviors. This article’s approach is grounded in the values of the social work profession and examines: 1) the role of life events in motivating change of substance using behaviors in the absence of formal treatment interventions; and 2) participant resilience in overcoming the adversities inherent to this disaster.

INTRODUCTION

The city of New Orleans plays host to millions of visitors each year. People come from far and wide to soak in the rich cultural assets of a unique city. Few of these pleasure-seekers are likely to leave the city before consuming one of the area’s signature delicacies- gumbo. The dish has been a fixture in the city for at least 250 years (1). The spicy stew has no fixed composition: it can include sausage, chicken, shrimp, and crawfish, in addition to other proteins. Two defining elements, however, are rice and roux. Roux has been used to thicken a variety of soups, stews and other dishes for more than 500 years, but has been elevated to new heights with its use in gumbo (2). In gumbo, the roux is cooked until dark brown, transcending its role as a mere thickening agent and taking on the flavor of the stews assorted ingredients.

“Gumbo” has also been used to describe the composition of New Orleans (1). Caribbean, European, African, and Native American influences have collided at the juncture of the Mississippi River and the Gulf of Mexico for hundreds of years, yielding a truly unique cultural “stew.” However, Jazz and gumbo are not the only legacies to arise from this crossroads of culture and commerce. The city has garnered a reputation as a center of less wholesome aspects as well From the infamous brothels of the city’s Storyville section to the centuries-old tradition of Mardi Gras, the city’s identity is arguably associated as much with hedonistic tendencies as it is with its honored cultural aspects. The latter half of the 20th and first years of the 21st centuries saw the erosion of the city’s industrial revenues, which has been associated with a decline in public services and increases in poverty, crime and drug use (3, 4, 5).

In the last days of August in 2005, the bontemps came to abrupt, if temporary conclusion. The city of New Orleans began what has amounted to a battle for its very existence. Warnings that a powerful storm from the Gulf would lay the reality of New Orleans’ lack of planning and infrastructure bare had gone unheeded and the “Big Easy’s” residents paid with their lives and homes (6). When the wind and rain cleared, the sun shone mercilessly on a city that was more than 80% underwater (7). Nearly all of New Orleans’ citizens were eventually forced to evacuate, but not before many (often impoverished minority residents) endured periods in flooded locations, the Superdome, and other harrowing situations.

This article examines how surviving this ordeal, subsequent evacuation, and eventual resettlement in New Orleans or re-location to a different city (in this case, Houston), impacted individuals’ motivation to change their substance use patterns and behaviors. This investigation is grounded in “attention to the environmental forces that create, contribute to, and address problems in living” (8), in this case, how interaction with changing environments can contribute to motivation to change patterns of substance abuse on the individual level. Guidance is drawn from Bronfenbrenner’s ecology of human development framework, which posits that structures within the developing individual’s environment interact with each other and the person, shaping his or her growth (9).

The connection between traumatic events and adverse mental health outcomes has been well documented in the literature, both as pertains to popular media (10) as well as academic research (11). Individual personal growth stemming from disaster situations has been less studied, but is a nascent research topic (12, 13, 14). This article examines the experiences reported by a group of substance users within a framework of post-disaster resilience and documents their reports of recovery from substance use, in the absence of formal therapeutic interventions. Many argue that natural recovery from substance use disorders is possible. Though this idea remains somewhat controversial among many addiction treatment practitioners and researchers, there is little contention that those with substance use issues rarely actually seek formal treatment, yet many are able to reduce or discontinue their substance use (15).

Substance use disorders are credited with greater amounts of death and illness than all other preventable health problems (16). Billions of dollars are spent on efforts to control drug supplies and fund various treatment approaches (17), but relatively little resources have been directed towards investigating how environmental conditions can contribute to or detract from substance user’s motivation to change behavior. This article’s approach is grounded in the values of the social work profession and examines: 1) the role of life events in motivating change of substance using behaviors in the absence of formal treatment interventions; and 2) participant resilience in overcoming the adversities inherent to this disaster.

Tedeschi, Park, and Calhoun argue that social science researchers must focus on themes of growth among survivors of traumatic experiences (14). Their book “Posttraumatic Growth” asserts that this phenomenon has been the basis for key stories in human history, such as that of the Phoenix in Ancient Egypt, as well as in the Christian, Buddhist and Hindu traditions. This notion of the positive change potential for disaster survivors is central to this study, which focuses on recovery from substance dependence.

This article is divided into three main sections: 1) a discussion of the ecological configuration of substance use disorders; 2) the role of key phases of interactivity between the substance user and his or her environment in catalyzing motivation to reduce or discontinue substance use; 3) the contextual interpretation of the respondents’ as they encountered their many experiences.

Viewing Substance Use in an Ecological Context: The Dynamic Individual and Environmental Relationship Catalyzing Motivation to Change

Prior to Jellinick’s conception of the substance use disorder as a disease, those who became dependent on substances were thought merely to be intemperate and without sufficient desire to function (18, 19). The idea that alcoholism and other substance use disorders are medical conditions gave rise to the Alcoholics Anonymous (AA) model and reduced stigmatization of those suffering from addiction (20). Johnson articulates this view in his book “I’ll Quit Tomorrow.” The author argues: ”Alcoholism is a fatal disease. 100 percent fatal. Nobody, survives alcoholism that remains unchecked” (21). However, a view of substance use disorders as manageable, chronic diseases lacks appreciation for the potential role of other dynamic, often reciprocal, forces within the individual, and in his or her environment. Unfortunately, this focus has retained primacy in the search for an etiology of substance use disorders (22). This is not to say that research investigating the roles of both biology and psychology have been fruitless. Neuroscientists continue to advance the understanding of neurological mechanisms within the brain that are associated with the use of a wide range of substances (23). Further, it has been shown how the use of substances ultimately modifies the user’s nervous system when taken repeatedly (24). Corresponding with these developments, a growing variety of biologically centered interventions have been utilized in the past four decades (25, 26, 27). The role of the substance using individual’s psychological state has also been established as a component of substance abuse etiology (20). An expansive literature exists establishing the ability of psychotherapy to assist individuals in changing problem behaviors, including, but not limited to, substance use disorders (28). The ecological model calls for acknowledgement of the ever-changing relationship between the substance user and the environment in which the behavior takes place (9, 29). Treatment approaches have evolved towards this notion in the past two decades, demonstrating the success of interventions that combine biological, psychological, and environmental components (30, 31, 32). When viewing drug use systematically, it is essential to make use of literature that evaluates sources of motivation for recovery from addiction, outside of formal interventions. The ability to achieve sustained abstinence from nicotine addiction without formal treatment is widely accepted (33). Studies documenting recovery in this context among users of alcohol and illicit substances have been far outnumbered by those of the varieties described above for a range of political and methodological reasons (15, 33, 34, 35). Some reject the idea of addiction that can be overcome without treatment on a definitional level, arguing that the ability to stop usage outside of this context renders the individual a non-addict (35). It is estimated that less than ten percent of alcohol and other substance users interface with professional help (36). Thus, it must be acknowledged that the sequence of life events serving to motivate those who evolve out of substance use disorders need not include formal rehabilitation. The course of the substance user’s life can lead to the individual relinquishing chemical dependency, just as the interaction of individual and environmental factors have led to the onset of the substance use disorder.

Motivation Generated from Substance Users’ Reaction to Changes in Their Environment

A large amount of research has focused on life events in the causation and exacerbation of substance use disorders (20, 37). However, a growing body of work has examined the role of a range of themes in relation to enhanced motivation to reduce or discontinue use of substances (15, 34, 35, 59). Here we present background information for seven of the most articulated themes as emerging from the data. Although by no means all encompassing, the themes reveal what the majority of the respondents reported experiencing during their Katrina travails.

“Rock-Bottom.”

The dominant theme relating life events to motivation to change substance using behaviors in literature, as well as popular culture is the concept of hitting “rock bottom,” which Klingemann describes as the sudden realization of “physical, interactional and psychological collapse” (15, 38). The user’s arrival at this point is treated by many who study and treat those with substance use disorders as necessary for true motivation to change. It entails the user’s recognition that the collapse is attributable to his or her use of substances as a prerequisite to engaging in meaningful steps to overcome the problem. The value of this concept to addiction recovery literature and practice should not be diminished. However, studies have demonstrated the plurality of routes to motivation. These key themes and how they inform extant literature sources are summarized below.

Maturation

An initial theme to appear in literature suggesting the existence of natural recovery was maturation. This phenomenon was first discussed relative to heroin use (39), but was also evaluated relative to alcoholism twelve years later (40). These studies suggested that substance use disorders correspond with young adulthood for some individuals, and that the emergence of new responsibilities and other role changes motivated behavior change. Later studies, while articulating themes for natural recovery beyond the concept of maturation, continued to include maturation among their schema (15, 41). Klingeman referred to these as “cross roads” cases: these participants stated that they were not willing to forgo new opportunities for the sake of continuing substance using behavior. White and colleagues describe the routes to motivation as going “with the flow” away from substance use, as opposed to the user making a drastic decision to discontinue use (42).

Increased Self-Efficacy

Enhanced self-efficacy has been shown to be a predictor of behavior change (43). Globally elevated self-efficacy translates into elevated motivation to make healthier choices, including actions relative to substance use. A study of smoking cessation found that participants who were able to successfully remain in the maintenance phase of the stages of change model had significantly higher self-efficacy scores than those who returned to smoking (44). Self-efficacy measures and their ability to positively predict outcomes relative to substance use behaviors have been used in relation to a range of substances over the past ten years (45).

“Spiritual Awakening.”

Recent studies have attempted to advance the understanding of how spirituality and motivation to make health-oriented choices are related. Spirituality has long been accepted as a crucial component of the Minnesota model, typified by the AA 12-step recovery process (18). The role of spirituality in recovery is now well-established (42). The impact of dramatic spiritual changes in the context of natural recovery has also been documented (46). This theme in motivation enhancement is noted for the rapidity with which it propels the user into the later stages of change, as well with what is referred to as “quantum change” (42), in which individuals experience a radical change in perception that leads them to take immediate, dramatic action regarding their substance use.

Threat to Physiological Survival

Substance users can be motivated to change their behavior through a dramatic health emergency. (15, 42); life-threatening emergencies in particular (15). The incident is triggered by the individual’s declining health (often substance use related). This is distinguished from the “rock bottom” concept discussed above in that the physiological issues are not necessarily experienced in tandem with collapse in psychological, social or other domains.

Removal from a Stressful Environment

A common understanding of substance use disorder etiology centers on the role of substances in providing relief from a variety of stressors, often a particularly stressful environment (47, 48). The use of drugs to escape the psychological and physiological horrors of modern warfare has been extensively documented. Many soldiers were administered morphine during the Civil War and a significant number emerged from the conflict as addicts (49). More recent is the experience of U.S. soldiers who engaged in the use of substances, most notably heroin, while serving in Vietnam. These found that while many soldiers used heroin regularly while in Vietnam, a relatively small number used upon return to the states (59); and only a small percentage of the returning soldiers entered formal rehabilitation.

Methodological Issues

Despite the acknowledgement by the Institute of Medicine and the American Psychiatric Association regarding the legitimacy of natural recovery (33), many researchers and practitioners argue that individuals who are able to change their behavior without intervention are not, by definition, addicted (35). Beyond this philosophical issue, the phenomenon of unassisted recovery is more difficult to study because it occurs outside the clinical context. A limited number of studies on natural recovery have generated findings from more than one interview with participants (15). Further, the absence of control groups and longitudinal data complicates these interpretations; some studies have relied on retrospective recall of individuals admittedly “under the influence” (37). Studies, such as Klingemann’s mitigated the issues surrounding data collection through the use of multiple and collateral interviews (15).

As with several of the themes involving trauma described above, a majority of the literature has viewed the relationship between catastrophic events and substance use outcomes unidirectional, such as the work of Cerda et al (50) that looked at binge drinking trajectories in the wake of the September 11th attacks in New York. Other studies have found, however, that this relationship is sometimes more ambiguous, such as that found among survivors of the Three Mile Island Disaster (51). An analysis of alcohol sales following a major earthquake in Japan suggested that the disaster led to decreased consumption of the substance (13).

The present study uses transcripts from interviews with participants to draw out emergent themes (52).

The tumult experienced by the participants may have included any one or combination of the above-described themes related to previous natural recovery literature or others undocumented in previous studies. Although the self-efficacy literature reviewed is comprised of more conventional, intervention-based studies, it still presents a relevant theme. Survival in the Katrina, evacuation and resettlement environments involved the performance of difficult tasks, the completion of which may have had an elevating effect on participants’ self-efficacy. Bronfenbrenner’s ecology of human development emphasizes the role of the individual’s environment in shaping his or her growth (9). The author asserts that all levels of the environment are interactive and that all of this interactivity has an effect at the individual level: “The ecological environment is conceived topologically as a nested environment of structures, each contained within the next.” The theory is an apt tool for achieving an understanding of people according to the social work profession’s emphasis on working with the person in his or her environment (29).

New Orleans has been known as a seat of indulgence from days of its inception, taking its name from an infamous aristocratic French libertine (1). The city has also struggled to generate enough revenue to adequately fund its schools, police forces, and other institutions (3, 4). These factors contributed to the existence of the city’s vital drug markets prior to Katrina (5). Survival during the initial flooding followed by removal (temporary in some cases) from this environment and then resettlement in Houston or return to New Orleans all involved significant interaction with and adaptation to changing environment at all levels put forth in Bronfenbrenner’s framework.

Summary of Study Rationale

Substance use disorders play a role in many of the United States’ health and social problems (53). Experts in various disciplines continue to seek greater understanding of how recovery from substance use disorders can best be facilitated and maintained. Nevertheless, no study has been able to demonstrate that any intervention is consistently effective for a large proportion of those who have participated (54). There is limited consensus among professionals about which particular approach constitutes the best direction for treatment (15).

METHODS

Sample

The principal Katrina study consists of a sample of 107 individuals who self-reported as both drug users and evacuees from New Orleans as a result of Hurricane Katrina. Study participants were located in New Orleans and Houston, the primary evacuee relocation destination (55). Trained ethnographers utilized “snowball sampling” techniques to recruit subjects. In addition, individuals meeting the study criteria were asked to inform others about the study. The resulting sample included more males (n= 67) than females (n=39)0. The vast majority of the participants were African-American (n=91), with the next most populous group in the sample being Whites (n=10). The remainder of the sample was composed of Hispanies (n=3), one American Indian (n=1), and two individuals who did not give a response pertaining to their ethnicity.

The information gathered from participants is not representative of drug users nationally, or even those in New Orleans before or after Hurricane Katrina. However, the richness of the qualitative data generated from the sample provides an invaluable view of the nearly impenetrable subculture of drug users and the disaster’s effect on its function. The current analysis is comprised of 24 study participants who explicitly stated motivation to change substance use because of their experiences relative to the hurricane. A further component of the criteria for selection was the participant stating a relationship with illicit substances that includes sufficient grouping of symptoms described in the DSM-IV TR (2000) to qualify them as being Substance Dependent (56). These individuals reported use of illicit substances at a minimum rate of multiple times per week, in most cases one or more times daily. All participants were administered an informed consent document approved by the institutional review board of National Development and Research Institutes, Inc. (NDRI), an organization with more than forty years’ experience in substance abuse research. The NIDA funded study is housed at the Institute for Special Populations Research (Eloise Dunlap, PhD, Director) one of eleven institutes within NDRI. In order to ensure the confidentiality of all participants, individuals were referred to by codenames of their choice, and no details pertaining to legal identity were recorded. In addition, a certificate of confidentiality was obtained by NDRI to further protect respondents. Participants were paid 30 dollars for their time and reimbursed for interview related expenses.

Measures

A semi-structured, in-depth qualitative interview protocol was used to elicit a narrative recollection of the participants’ experiences prior, during and after the Hurricane’s landfall and the subsequent evacuation, relocation, and (in some cases) return to New Orleans. The majority of the questions reflected information about their consumption and/or general availability of illicit substances during this process. The use of the FileMaker Pro database management program facilitated data analyses.

Data Collection Procedures

The interview protocol was administered to participants by four trained ethnographers, two African-Americans and two Caucasian. Interview administration times ranged from two to five hours; interview length was a function of the detail in which participants reconstructed the time period and interviews were generally administered in multiple sessions. This article focuses primarily on the responses provided by participants that expressed a desire to reduce or abstain from substance use in the time window following evacuation (defined in the principal study as the 30-day period prior to the interview). The aim is on understanding how individuals reacted to their changing environments, whereas the principal study sought information related to the response of illicit drug markets to the hurricane.

Analysis Strategy

The data for this project was generated using a 100-question in-depth interview protocol. The project team administered the interview protocol between June 2006 and December 2007. Though the focus of the protocol was participants’ involvement in drug markets, both as sellers and users, questions explored the contexts in which this involvement took place: interviewees were asked about housing, employment, and other factors. Recordings of the interviews were then transcribed and loaded into the Filemaker Pro database management system. The program organized the interviews into four “window periods” (55): “Before Katrina,” “During Katrina,” “At Evacuation Site,” and “Present Time.” The program renders the data searchable, allowing for “string searches,” which are conducted by typing a desired word into a given field. “String searches” can also be conducted “globally,” a method in which a given word or combination of words is searched for throughout the database. The data analysis consisted of multiple phases of transcript review and interpretation. Initial reading was undertaken with the principal goal of determining whether participants reported reduction, intent to reduce or discontinued use of substances. Responses indicating such motivation were grouped according to general themes describing the various ways in which the Katrina experience provided this motivation. The next step in the analysis was a careful reading of all participant responses to questions regarding drug use in the time period leading up to the interview and whether experiences related to the “Katrina Disruption” had led them to consider discontinuing use, try to stop, or seek treatment. If participants to responded that the disaster had not led them to consider changes in the use of substances, they were deemed inappropriate for this analysis. It is understood that disqualifying participants in this manner may have led to the exclusion of some individuals whose drugs use changes at various stages covered by the interview could have been arguably linked to factors associated with the hurricane. A “profile” was created for each individual whose drug use was subsequently more thoroughly evaluated. These “profiles” consisted of some basic information about their use of drugs and the frequency with which they reported using these drugs before the storm and reported use at each time period. By following these individuals’ substance use trajectories across all time periods, the theme or themes each participant was associated with was reaffirmed and noted. The PI and the project team analyzed, coded and re-coded transcripts to identify emergent themes and develop subthemes. For example, several participants (n=7), stated that relationships with family members changed as a result of various activities related to the hurricane. The two salient sub-themes that emerged were that some individuals were motivated to change substance use patterns because of cohabitation with family members at various stages throughout the storm survival, evacuation, and resettlement processes. Other individuals stated that altered familial responsibilities and/or changed priorities motivated them to change use patterns.

The stages of change model (28) has been identified as a tool for recognizing individual’s motivation to engage in behavior change, even prior to that individual’s engagement in change-related action (57). The present analysis used this model to delineate participants’ progress from a state in which they were not considering any changes to drug using behavior, “pre-contemplation” (“No intention to change behavior in the foreseeable future,” (28), to stages further along the model’s continuum. For example, a participant who stated that Katrina-related experiences led him or her to consider necessary steps toward reduction in substance use, but had not begun implementing a plan to realize reductions, the individual would be seen to be in the framework’s “preparation” phase.

RESULTS

Respondents’ adjustments to substance use patterns are divided into four principal categories of change motivators: individual level, family, employment, and market disruptions. The resulting theme organization reflects a hierarchy that corresponds roughly with the individual, micro-, meso-, and macro-levels prescribed by Bronfenbrenner’s ecology of human development perspective (9). In nearly every case, respondents expressed motivation stemming from a combination of elements related to their Katrina experience and are included in the frequencies for multiple thematic categories, underscoring the interactivity between levels of the hierarchy prescribed by Bronfenbrenner.

Demographics

Sample

The majority of the participants of the larger study (from which the data for this secondary analysis was drawn) were African American (n = 91). The second largest group was composed of White respondents (n = 10). As seen in Table l, the sub-sample selected for the current study features a similar ethnic composition to the sample of the original study.

Table 1.

Selected Sample (N = 107) and Sub-Sample (N = 24) Demographics

	Sample		Sub-Sample
Demographic characteristic	(N = 107)		(N = 24)
Ethnicity
African American	85%	(N = 91)	84%	(N = 20)
White	9%	(N = 10)	8%	(N = 2)
Hispanic	3%	(N = 3)	4%	(N = 1)
Native American	1%	(N = 1)		-
Missing	2%	(N = 2)	4%	(N = 1)
Gender
Male	63%	(N = 67)	71%	(N = 17)
Female	36%	(N = 39)	29%	(N = 7)
Missing	1%	(N = 1)		-
Education Level Attained
Grade school	3%	(N = 3)		-
Some high school	51%	(N = 55)	33%	(N = 8)
High school graduate	22%	(N = 23)	33%	(N = 8)
Trade school	7%	(N = 7)	17%	(N = 4)
Some college	12%	(N = 13)	13%	(N = 3)
College graduate	4%	(N = 4)	4%	(N = 1)
Missing	1%	(N = 1)		-
Lawful Employment Before Katrina
Yes	64%	(N = 68)	75%	(N= 18)
No	32%	(N = 34)	21%	(N = 5)
Missing	1%	(N = 1)	4%	(N = 1)
Preferred Drug Before Katrina
Crack	34%	(N = 37)	54%	(N = 13)
Marijuana	27%	(N = 29)	17%	(N = 4)
Heroin	17%	(N = 18)	17%	(N = 4)
Cocaine Powder	4%	(N = 4)	8%	(N = 2)
Diverted Prescription Opiates	2%	(N = 2)	4%	(N = 1)
Other	15%	(N = 16)		-
Missing	1%	(N = 1)		-

The African American majority in both groups reflects the city's pre-Katrina ethnic profile, although the general population featured roughly 67% of these individuals (U.S. Bureau of Census, 2000) and, thus, was not as skewed towards African Americans as either sample. The original and sub-samples are comparable in regard to gender, as well. Both the sample and sub-sample feature approximately two thirds male participants (n = 67 and n = 17, respectively). This male majority in both samples runs contrary to the female majority of New Orleans pre-Katrina population (U.S. Bureau of Census, 2000). Regarding educational attainment, the sample and sub-sample are comparable. The statistics for the general population of pre-Katrina New Orleans featured greater numbers of individuals who reported college graduation, or higher level of educational attainment.

Crack was the dominant pre-Katrina reported preferred drug for both the larger as well as the sub-samples.

The majority of respondents were African American. Both the sample and sub-sample feature approximately two thirds male participants (n = 67 and n = 17, respectively). Regarding educational attainment, the sample and sub-sample are also comparable. The statistics for the general population of pre-Katrina New Orleans featured greater numbers of individuals who reported college graduation or higher level of educational attainment. Crack was the dominantly reported pre-Katrina drug of choice for both the larger sample and the sub-sample, followed by marijuana. As seen in Table 1, the percentage of those reporting cocaine powder as preferred drug prior to the storm was lower among the larger sample. Both samples contained small numbers of users whom diverted prescription opiates.

Changes at the Individual Level

Finances

A group of participants stated that differences in their individual (as distinguished from those related to family, which are discussed below) financial situations, both during (one participant) and at the time of interview (three participants), provided impetus to curtail drug use. These individuals stated that hurricane experience had interrupted income or altered their economic priorities.

During the hurricane

One respondent, Shermaine, a 32 year-old female African American, stated that she had a very limited amount of money during the evacuation phase (seven dollars) and “wasn’t gonna spend my last on no drugs.”

After the storm

Three participants reported that their individual financial situations at the time of interview presented the motivation to reduce or discontinue their use of substances. Respondents “Timothy,” “Tee,” and “Miss P” indicated the amount of money at their disposal at the time of interview did not leave them as much to acquire substances as their pre-Katrina monetary situation had allowed.

Realizations

Nearly half of the respondents reported that they had experienced “realizations” relative to their substance use at some point of the ordeal. This change in outlook at the individual level was often coupled with the changes in familial and employment situations that will be addressed below.

“New Life.”

Several (n= 12) respondents stated that the experiences that they endured through the course of the Katrina ordeal created motivation for them to change their relationships with substances because they desired a “new beginning” in their lives. This emerging theme was also called “New Life” by the project team, because respondents who voiced reactions of this category spoke of a general feeling that the ordeal had motivated them to reconsider their lives and make efforts to reduce or discontinue their substance use in order move into a new phase. Respondent “Buck”, a 63 year-old African American male who reported reduced use voiced this feeling:

“This is my, um, this is my chance to get away from all of this, you know, and make my new start. You know, and be the person I’m supposed to, I think I’m supposed to be.”

”Red”, a 37 year-old African American male, reported regular use of crack before the ordeal, but abstinence at the time of interview. He reported that the experiences undergone during and after the storm has altered the way in which he viewed the world:

“It was just so many changes that went on. And Katrina changed a lot of people’s lives.

It changed mines, so I just had a whole new out look on life after Katrina.”

“Nat”, a 54 year-old male African American daily heron user stated his experiences related to Katrina provided him with an enhanced appreciation to be alive. “Nat” reduced his heroin use pattern at a rate of once per month or less: “Katrina made me thought about a lot of things just to be here.”

Survival

Only one participant explicitly stated that her desire to use substances during the hurricane was squelched by more pressing concerns about her immediate survival. Shermaine stated that substance use was far from her mind because “it was like the world was comin’ to an end.” However, it is essential to point out that many of the themes discussed throughout these results relate closely to survival. Though participants who spoke about familial responsibilities or personal finances did not directly state that they were motivated to change use patterns in order to guarantee their own (or family members’) survival, it is likely that this was a primary if not secondary motivation. This is evidenced in “Chuck’s” statement below about his role in helping family members.

Chuck, a 28 year-old African-American male, stated that he was abstinent during the storm. He was not motivated to seek or use heroin (his pre-Katrina drug of choice), rather he was “just trying to protect my brother’s kids and my mom.” When interviewed later, Chuck stated that he had relapsed, but indicated that he was using less than he had been prior to his Katrina experience. Similarly, “Scanless,” stated that his role in protecting his family during this perilous time drastically reduced his inclination to acquire and use substances:

Scanless: “Because I had to get my family out. Had to get my family and my children out.”

“Congress,” a 43 year old Hispanic male and “N.O.,” a 40 year old African American male both from Houston, expressed variations on how familial responsibilities and relationships served to motivate changes in use patterns.

“Congress,” who was a daily user of crack and marijuana in combination (“Optimo”), stated that his spouse prevented him from participating in unfamiliar, and, thus, more perilous drug markets in Houston:

“Well, like I said before, I don’t go score. My fiancé refuse to let me go out there and score.”

“N.O.,” who reported using heroin multiple times daily before the storm, stated that he has taken action towards stopping, reporting substantially reduced intake at time of interview. He indicated that the additional familial responsibilities he assumed since relocating to Houston were a key component of his behavior change:

N.O.: “It’s by choice. Uh…you know, uh back at home I was a single man, so really once I paid my bills and stuff, you know what I’m saying, whatever, if I parlay it too much that’s on me. It was just, you know, me and-you know I look out for my little girl when her mama ask me. But I mean she didn’t pressure me or nothing like that there, you know, cause she was a working girl too.”

Fatigue

“Stevie B,” a 44 year-old African American male, expressed a significantly reduced motivation to continue his pre-Katrina substance use patterns due, in part, to the feeling of fatigue that the storm had left him with: “Yeah, it’s slow, it’s slowed me down…I, I’m really gettin’ tired of it. I'm just gettin’ tired. I really want to quit.” This respondent had not reached a point at which he was abstaining from his substances at the time of interview. However, he reported that his use has decreased to once or twice per week from using multiple times daily before the storm or as “Stevie B” put it, “Every time I could.”

“Cash” expressed a similar sentiment. In addition to his inability to safely acquire substances (see below), he expressed that his experiences relative to Katrina left him with a feeling of exhaustion relative to his use.:

“And I was gettin’ tired, you know. I was really burned. I mean, I stayed out there in my use for forty-seven years. So I was gettin’ really burned out. Plus I got liver problems, um, hepatitis B and C. So it was time to quit.”

Religion

One respondent, “Scanless,” a 27 year-old African American male, mentioned his feelings that a higher power had a role in the Katrina disaster:

“This was, this was like, well, what we went through, you know, it was like, it was like a sign. Yeah…God…Like he was cleansin’ the sins…Away from the city…With all that water.”

Family

United with family during hurricane, evacuation and post-evacuation situations. Several respondents reported co-habitation with family members for various periods during the storm, evacuation and resettlement periods. These participants stated that they were uncomfortable or unable to engage in use or pursuit of substances when in the presence of family members. One example was “Jassy,” a 44 year-old female who reported abstinence from crack use in the months following the storm, reported relapse at time of interview (though at a lower frequency of use than that which she reported before Katrina). “Jassy” reported that she had consistent access to substances but “just wasn’t into it because” she was in her “parents’ presence.

Employment

Several participants cited employment as a motivational factor to alter use patterns. Two themes emerged relative to the role of employment. The majority of these individuals, several of whom reported full-time employment before the storm, stated discontinued or very limited use due to anticipation of drug testing by prospective employers.

Staying clean to pursue employment

Five respondents stated explicit motivation to stop or significantly reduce substance use due to their employment pursuits. The common element among four of these respondents were statements pertaining to the use of drug screening by Houston businesses when considering new hires. Interestingly, these respondents stated they believed that they would have to submit not only a urine sample, but might also be subject to testing of hair samples.

“Tippy,” a 38 year-old African American female, reported. working part-time at a fast food restaurant before the storm, in addition to generating income from marijuana sales. “Tippy” reported smoking marijuana regularly and using pills occasionally before the storm. This respondent reported pursuit of employment, a process that he stated had motivated him to abstain from use over the course of the four months prior to the interview.

The fifth respondent who reported motivation to change substance use related to employment was “Buck,” a 62 year-old African American male, who stated that finding employment was his top priority. He indicated that finding drugs in Houston required more time and money than it had in New Orleans. In the following excerpt from his interview, “Buck” emphasized that his pursuit of employment required that he curtail pursuit of drugs and thus, use:

“Oh, not frequently. Not, not… Not that much at all now. Because I don’t have the, um, the resources. I don’t have the money, you know. And I know that, um, could be a test for myself, too, you know. Once I get some money, what would I do? Alright. Like I get a little money now, I can’t do it because I need gas. I gotta get around. I gotta find this job. So that’s my priority right now, finding a job”

Market Disruption

Several respondents cited changed illicit drug market conditions as a factor in their diminished motivation to use. These respondents are distinguishable from those who continued to pursue substances without success and used whenever they had access, because their responses indicated that market conditions played a part in a shift in their ongoing motivation to engage in drug use.

Greater perceived risk in acquiring substances after Katrina. Four participants expressed that removal from their New Orleans neighborhoods and accompanying networks of drug-related associates left them without associates with whom they felt safe engaging in drug transactions. Respondents “Money” and “Cash” both stated that lack of trusted associates at locations in the initial evacuation phase were key motivators of behavior change. “Cash,” a 67 year-old White male who reported heroin use at a frequency of three times per day prior to the storm, stated that this removal from his typical drug acquisition milieu played a part in his motivation to abstain from substances at the time of interview. His experiences during the storm led him to seek rehabilitation. In fact, the final portion of his interview was conducted at a rehabilitation center in New Orleans, where he talked about how “kicking” the Katrina experience was brought on by lack of access to heroin during the storm, evacuation and resettlement:

“Um, let me put it this way. I kicked real hard. But, um, when you don’t have it, you have to stop. Katrina probably had more to do with it than anything, you know, being displaced and not knowing anybody and not wanting to look around because I didn’t want to go back to prison.”

Several other participants in Houston cited their lack of knowledge relative to local drug dealers and markets motivated them to change their substance use behaviors.

Nat: “Yeah, I done slowed down a lot because it’s less people that I know who are using, you know and, like I said, to build trust and confidence in a person with stuff like drugs, you know, and you know the deal behind drugs and the penalty behind drugs you really got to have trust and confidence with people and that don’t come easy. That comes from years of dealing with people, getting credit from people, people that know that you’re going to come, they ain’t gonna hound you for your money, there and gonna be no stress and no frustration behind the little money, you know. They got people that will hound you for the little money. They will kill you behind the little money.”

“Congress,” stated that less flexibility on the part of dealers in Houston was a factor, in addition to his above-mentioned relationship with his fiancée, in his motivation to use less in Houston.

“Um, well, in New Orleans you can go with any, any type of money, I mean, two dollars and you can get served. But down here if you ain't got ten and above, they’re not messin’ with you. You know, they don’t, they don’t take nothin’ under ten dollars.”

DISCUSSION

This article examined changes experienced by a subset of substance using Hurricane Katrina survivors and whether these enhanced their motivation to decrease or discontinue their use of illicit drugs. The twenty-seven participants who qualified for the present analysis comprised more than one quarter of the total sample interviewed for the parent study, suggesting that individual and environmental changes enhance motivation to change substance-using behaviors. However, the low number of individuals that reported sustained abstinence at the time of interview indicates that the hurricane experience and related changes were not sufficient for the vast majority of the participants to sustain their efforts without any further intervention (i.e. Natural or Unassisted Recovery; 9, 41).

Social Work Implications

The findings of this analysis are of use to social workers and other health professionals who might come into contact with survivors of a disaster (like Katrina) or other similar catastrophic event. This subsample of individuals demonstrated that events such as Katrina have the potential not only to traumatize, but to also allow transformation in positive ways. The NASW Code of Ethics (8) states that those in the profession “seek to enhance the capacity of people to address their own needs.” This article demonstrates that a vulnerable group (drug dependent individuals) called upon inherent strengths in a life-threatening situation and emerged with motivation to engage in positive changes. Although these findings do not disprove the plethora of investigations that suggest connections between traumatic events and increased substance use, they illustrate that individuals (even those with substantial substance abuse issues) can face challenging situations and emerge in a changed state that is something other than pathological Although motivation generated by the experience at the attendant changes were not sufficient for the vast majority of those selected for the study to enter into the “maintenance” stage of behavior change, participants’ reports of actions taken to reduce use or intentions to do so, indicate that an appropriate intervention with those in post-disaster situations could be quite effective. Miller and Rollnick have developed the “Motivational Interviewing” style of counseling, which is guided by the idea of eliciting ambivalence in individuals regarding certain behaviors and building on this ambivalence using collaborative, conflict-avoidant strategies to build motivation (58). A “Motivational Interviewing” (MI-style) intervention would require a limited amount of time and would likely flesh out the ambivalence that these participants have developed about their substance use patterns. Additionally, MI provides an opportunity for motivated individuals to talk in greater detail about potential sources of motivation, allowing them to further crystallize change strategies.

CONCLUSION

Motivation stemming from individual interaction with changing environments has been detailed above. This division of participants’ accounts into the various categories, however, must not obscure the common elements. The two key themes expressed by these participants are that 1) negotiation of this event (through its various stages) resulted in changes in the broader outlook of participants and 2) adjustment to new environments, whether in an entirely new city (Houston) or drastically changed “home” (New Orleans) led to enhanced motivation to change substance use patterns. Those who expressed aspects of both key themes were often those who spoke at greater lengths and with what appeared to be greater conviction regarding their intentions to move beyond substance dependence.

Study Limitations

The interview protocol was not developed with investigation of specific reasons for use or non-use by particular individuals as a specific goal. Thus, participants were given relatively limited opportunity to discuss the effect of the experience on their use, or substitution patterns. Studies designed to elicit greater understandings of motivation to change behaviors, relative to substance use and beyond, have the potential to uncover the complex mechanisms through which adjustment to adversity and change circumstances can lead to positive change. Knowledge of motivation catalyzed by traumatic events will be furthered if research is undertaken that asks detailed questions about how motivation was generated during these situations and how this motivation impacts participants’ lives over time. Future studies should also look at the effects of triaging potentially motivated survivors into counseling interventions in a timely manner. These investigations would determine the efficacy of brief, “Motivational Interviewing”- style interventions described above.

The study findings suggest that survival of a catastrophic event and adaptation to changed environments in the wake of such an event can lead individuals to change in positive ways, that is, adversity can result in personal growth. This assumption extends to the specific issue discussed within: substance dependence. Although research on the adverse effects of traumatic experiences far outweighs that on these events as catalysts of positive change, at least some of these participants were motivated by experiences and environmental changes pursuant to the disaster to make different choices relative to substance use. Social workers and other helping professionals, working with those with substance abuse issues, should be mindful that these events present windows of opportunity. This study contributes to the natural recovery literature through its grounding in the core values of social work. Highlighting participant resilience is in line with social work’s strengths perspective, a view of clients that emphasizes the inherent strengths they possess and the role they can play in overcoming problems. Use of an ecological, environment-conscious approach to investigating recovery speaks to a call in the NASW Code of Ethics, for “attention to the environmental forces that create, contribute to, and address problems in living,” (8).