Visual Ethnography: Decriminalization and Stable Housing Equals Motivation, Stability, and Recovery Among Latinx Populations

Un lugar seguro: A safe place. Photo courtesy of the Boston University-Casa Esperaza Photovoice Group. Printed with permission.

Photograph by Nemá Etebar; printed with permission.

Despite recent reductions in overdose fatalities overall, the death toll among Latinx individuals continue to increase.¹ Moreover, Latinx populations experience significant access and retention barriers to substance use disorder (SUD) treatment services as well as treatment delays.^2–4 In an effort to better understand the recovery experiences of Latinx individuals in Massachusetts, researchers from the Boston University School of Social Work, working in partnership with staff from Casa Esperanza, used Photovoice (Fotovoz), a form of visual ethnography.⁵ Participants had a mean lifetime substance use of 16.6 years, with a range from 1 to 30 years, and were in recovery for 2 months to 3.25 years. Not surprisingly, as seen in the image shown here, selected by the group, housing emerged as a motivator for sobriety and a beacon of security, stability, strength, progress, and hope.

Es un lugar seguro, donde tiene su cosa personal donde puede ir a descansar, ahí pensar… Y eso entonces nadie lo puede botar de allí. Si. Tiene toda su esperanza ahí.

(It is a safe place, where you have your personal things—where you can rest, think. … So, nobody could throw you out. Yes. You have all your hope there.)

Housing stability is an important piece of the SUD recovery puzzle, yet the wait times for housing units at our partner organization range anywhere from one year to a decade.⁵

“e cojió casi tres años para llegar . . . a coger tan siquiera mi propio lugar. . . . Me trae recuerdos de estar durmiendo en los carros . . . , detrás de un “building” en la calle. . . . Cada vez que miro . . . es una fuerza que me da porque no quiero volver a donde estaba.

(It took me almost three years to get there . . . to have at least my own place. . . . It brings back memories when I was sleeping in cars . . . , behind a building, in the street . . . every time I look . . . it gives me strength because I don’t want to go back to that place.)

Porque cuando estas en la calle, tu ganas y pierde... Antes no me importaba nada. Yo miro eso [referring to his own place, the room in the photo] y digo, antes los sitios que yo vivía era como . . . un “shooting gallery” voy a decir yo . . . cervezas, cenizas por todos lados, todos lo hacían en la cama…eso es algo, que yo digo, yo no puedo perder. Me cogió casi tres años para lograr ésto . . . y . . . no lo voy a perder.

(Because when you are in the streets, you win and lose. . . . I didn’t care about a thing before. I look at that [referring to his own room] and say, the places where I used to live at were like . . . shooting galleries . . . beers, cigar’s ashes everywhere, we did everything on the bed . . . that is something [referring to the room again] that I cannot lose. It took me three years to achieve this . . . and . . . I am not going to lose it.)

Significant progress has been made in recent years to shift the narrative around SUD from an illicit behavior to a disease, to a biological, psychological, and social health condition with multiple risk factors.^6–8 Unfortunately, policy has not kept pace with health research. People with SUDs remain excluded from a number of social services, including housing. This is particularly concerning because access to housing is a critical determinant of health.⁹

For example, among the participants in the Photovoice (Fotovoz) project, over 65% reported being homeless, over 60% were unemployed, and 80% had spent time in jail or prison. The criminalization of SUD disproportionately affects communities of color, including the Latinx population (who comprise 18% of the US population and “38% of those incarcerated in federal prisons for drug offenses”).^10(p1) Thus, criminalization of SUD presents a structural barrier to housing, leaving individuals to live in circumstances that do not support recovery.

Desde que salí de la cárcel,. . . he estado ahí en casa ajena. You know . . . yo siempre he estado enfocado en los mismos líos, ‘cause it’s been hard . . . believe me it’s a struggle man . . . viendo gente puyándose [inyectándose] y fumando crack y eso. . . . It’s not easy, believe me . . . every day a struggle. . . .

(Since I got out of prison, . . . I’ve been living in other people’s places. You know? I’ve always been focused on the same issues, ‘cause it’s been hard . . . believe me it’s a struggle man . . . watching people shoot up and smoking crack and all that. . . . It’s not easy, believe me . . . every day a struggle. . . .)

Stable housing can serve as both a motivator for maintaining recovery and a refuge from potential triggers of relapse. This Photovoice project demonstrates participants’ deep understanding of the structural barriers they experience, providing an important voice to inform and shape research, practice, and policy. Participants highlighted structural barriers (e.g., housing, incarceration) that impede the recovery process for Latinx populations as well as the need for culturally relevant programs that support individuals’ basic needs to enhance SUD-related outcomes on multiple levels (e.g., individual, community).¹¹ This project emphasizes the importance of the voices from Latinx community driving dialogue and informing research, practice, and policy.