When a house is never a home: Housing instability among youth affected by parental drug abuse

Abstract

Background:

The negative consequences of parental substance abuse are significant and long-standing for children. Among other risks, these youth are more likely to experience housing instability. The most common predictor of a child not living with their biological parent is parental substance use. Research shows that these youth are at higher risks of housing instability; however, little is known about their housing experiences, from their perspective. This study explored the housing experiences of youth affected by parental substance abuse.

Participants and setting:

Fourteen African American young adults ages 18 to 24 years old who identified having at least one biological parent with a history of substance use participated in this study. The study is based in Baltimore, MD, USA; an urban city with one of the highest rates of drug overdose and substantial disadvantage.

Methods:

In-depth interviews were conducted among fourteen young adults (18–24) affected by parental drug use to discuss their housing experiences throughout childhood and adolescence. Five research team members developed a codebook, double coded all transcripts and analyzed inductively using a qualitative content analytic approach.

Results:

Three themes emerged to characterize housing experiences: frequent housing transitions, repeated trauma exposures related to housing instability, and the lasting effects of housing instability.

Conclusion:

The residual impacts of parental substance use have caused youth to experience the toxic stress and trauma associated with housing instability. It is important that young people have safe, stable and reliable housing to promote child health and normative development.

1. Introduction

Approximately nine million children in the United States have a parent suffering from a substance use disorder (American Academy of Pediatrics, 2018). For parents, the detrimental impact of drug abuse extends far beyond their individual usage and impacts the lives of those around them, especially their children (Adamson & Templeton, 2012; Barnard & McKeganey, 2004). Parental substance use has wide ranging impacts on the health and well-being of children. Adolescents with parents who use illicit drugs are more likely to have psychological issues, reduced academic performance, and poor coping strategies (Shearer et al., 2020). Specifically, youth affected by parental drug use are more likely to have mental and emotional problems such as depression, anxiety, and psychological attachment issues when compared to peers not experiencing parental substance use (Harwin et al., 2016; Velleman & Templeton, 2016). Youth exposed to parental substance use also have increased rates of early sexual relationships, difficulty establishing trusting relationships, and drug use during adolescence (Biederman et al., 2000).

Housing instability is often a central concern for families affected by parental substance use (Barnard & McKeganey, 2004; Velleman & Templeton, 2016). In fact, the most common predictor of a child not living with their biological parent is parental substance use (Powell et al., 2018). Parents who use drugs are more likely to experience high levels of instability due to homelessness, incarceration, domestic violence, and co-occurring mental illness (Barnard & McKeganey, 2004; Velleman & Templeton, 2016). As a result, parental substance abuse often causes children to experience housing instability, maltreatment, witness domestic violence, and experience family conflict (Barnard & McKeganey, 2004; Ronel & Levy-Cahana, 2011; Velleman & Templeton, 2016).

Housing instability refers to the lack of consistent, reliable and adequate residence (Hernandez Jozefowicz-Simbeni & Israel, 2006). It has been shown to have a range of negative long term effects on the health, well-being, and development of children (Gultekin et al., 2020). Research shows that the longer youth experience housing instability, the more likely they are to experience negative health and educational outcomes that hinder their ability to thrive as adults (Crumé et al., 2019; Evans et al., 2013). In a study comparing health outcomes of children housed in shelters to their stably housed peers, researchers found higher rates of respiratory infections, asthma, ear infections, and vision impairments among youth who were housed in shelters (Barnes et al., 2003; Cutuli et al., 2017; Gultekin et al., 2020). Unstably housed youth are also at increased risk for social isolation, sexual and physical victimization, drug abuse, involvement with the justice system, and stifled educational achievement (Brumley et al., 2015). Coker et al. (2009) found that children who had ever experienced homelessness were almost twice as likely to have emotional, behavioral, or developmental problems when compared to youth who were never homeless.

While much is known about the negative outcomes of housing instability on youth, few have ever asked young people about their experiences, which may limit our ability to best address the issues most important for their safety and well-being. Furthermore, very little is known about the compounded effects of these experiences from the perspective of the youth. The present study sought to fill this gap. The goal of this study was to describe the housing experiences of youth who are affected by parental substance use.

2. Methods

Data analyzed for this study were drawn from the Better Together Project, a multiphase project that takes a community approach to prevent early substance use and injury among African American adolescents in Baltimore, Maryland. This research is drawn from phase one of the project which explored the childhood experiences of young adults affected by parental drug use. Individual interviews were conducted between November 2018 and July 2019. Subsequent phases of the study will focus on the development and pilot testing of an intervention tailored for youth experiencing parental substance abuse. All research measures and procedures were approved by the university’s Institutional Review Board.

2.1. Participants and recruitment

Inclusion criteria for the sample were: aged 18–24 years, identify as Black/African American, and have a biological parent with a history of problematic opioid use. The study population consisted of fourteen young adults, the majority of which were age 21 or over. All participants identified as African American; one participant noted that they were biracial. The majority of the participants (57%) were male. Nearly all participants completed high school or received a General Educational Dipolma (GED) (86%). Table 1 lists detailed demographic information about participants.

Table 1.

Demographic characteristics of participants.

Variable	N (%)
Age (M, SD)
- 18–20	4 (28.6%)
- 21–24	10 (71.4%)
Race
- African American	13 (92.9%)
- White	0 (0.0%)
- More than one race	1 (7.1%)
Gender
- Female	6 (42.9%)
- Male	8 (57.1%)
Education
- Less than HS	2 (14.3%)
- HS diploma/GED	12 (85.7%)

The study team partnered with local organizations to recruit participants. Four recruitment strategies were used: (1) existing networks of the study team, (2) referrals from partner organizations, (3) participant referrals, and (4) flyers and information sheets posted in community organizations serving the target population. A screening tool was used to determine eligibility.

2.2. Measures

2.2.1. Demographic questionnaire

Participants completed a brief demographic questionnaire. The demographic questionnaire asked adolescent participants’ age, gender, race, and highest grade in school.

2.2.2. Interview guide

Participants talked through a semi-structured interview guide with 16 primary questions categorized into four sections (i.e., personal history, family relationships, health, and program recommendations). Sample items include, “Who did you live with growing up?” and “Tell me about your experiences living with other people besides your parents”. Follow-up probes were used to allow for completeness of participant responses.

2.3. Procedures

In-depth interviews were scheduled at a time, date, and location convenient for eligible and interested participants. After a review of the consent form, the interviewer answered participant questions about the project. Each participant was required to provide written, informed consent before participation. After providing consent, all participants completed the demographic questionnaire on a tablet provided by the study team. All interviews were conducted by a study team member trained in qualitative data collection. Participants were assigned a unique study identification number to protect their privacy. Because participants were recruited from local social service organizations, many already had access to mental health and social support networks. Still, given the sensitive nature of the discussion, each participant was offered information with resources for support services after the interview.

All interviews were digitally recorded and ranged from 42 to 91 min in duration. Upon completion of the demographic questionnaire and interview, participants were thanked for their participation and given information about the next steps of the broader research project. Round-trip transportation was offered to each participant. They were also given $25 for their time.

2.4. Data analysis

The digital recordings of the interviews were transcribed verbatim using an online transcription service. Study team members compared each of the digital recordings to the transcripts to verify the accuracy of the transcriptions. Transcripts were edited as needed by a study team member and then imported into the qualitative software program, Atlas.ti (version 8.0), to assist with data management and analysis. Transcripts were analyzed inductively using a qualitative content analytic approach (Hsieh & Shannon, 2005). Using this approach, the study team created a coding manual to identify the basic themes in the data. Initially, nine in-depth interview transcripts were independently read and coded by the study team. The codes were then discussed and refined as a group. There were 58 codes, categorized into seven groups, in the final codebook. This codebook was applied to the full data set.

Each transcript was coded by two study team members. To ensure consistent coding, team members met after coding each interview to discuss the coded material and address any discrepancies. Once all interviews were coded, comparisons were made across interviews to allow themes to emerge. Ultimately, the study team developed themes based on patterns and topics that persisted throughout the interviews. Peer debriefing and member checking were two techniques used to ensure the credibility of the data. Codes describing housing experiences were used in the current analyses. Demographic data was analyzed using STATA (version 15).

3. Results

Participants discussed a range of living arrangements; many fitting the description of housing instability. They noted that parental drug use strained parents’ abilities to pay for rent and basic household needs, which prompted repeated housing transitions. Respondents described staying with family members when they were younger; grandmothers and aunts were the most common caregivers during childhood. Approximately half of the participants spent some time in foster care, which reinforced family disconnection rather than reunification. Several participants reported running away from foster care because of poor treatment. Eight out of the fourteen (57%) participants recalled being homeless for a period of time, while others described long stints of at least a year living in vehicles or cycling through shelters. Three themes emerged to characterize their experiences: frequent and unpredictable housing transitions, repeated trauma exposures related to housing instability, and the lasting effects of housing instability. Each theme is described below in detail.

3.1. Frequent and unpredictable housing transitions

Participants described moving often and abruptly, with their initial move starting at very young ages and progressing unpredictably throughout adolescence. Fig. 1 shows the frequency of housing transitions among participants. More than half of the participants reported experiencing at least five housing transitions (i.e., relocating from one house to another) throughout their childhood and adolescence. At least 10 participants (71%) were in the care of someone other than their biological parents before the age of five. For example, one 22-year-old female participant shared that she was sent to live with her grandmother across the country at 16 months old. Another 21-year-old male participant described living with his great-aunt starting at 2 months of age.

Fig. 1.

Bar graph depicting frequency of housing transitions illustrates the number of residential transitions experienced by participants.

Several participants grew up in homes with their parent who used illicit drugs and other adults who took on the major parenting responsibilities. Those who grew up co-residing with other family members, likely a grandmother, usually experienced their first transition as a result of the unexpected death of the primary caregiver (not their parent). For those who did not initially live with their grandparents, grandmothers and aunts were usually the first stop for youth when housing transitions began. These women were described as the most used resource for family care. While the combinations of housing arrangements varied widely across the sample, almost all participants lived with a grandmother for an extended amount of time during their developmental years. Youth who co-resided with their parent and a grandparent described their grandparent as the primary caregiver while the parent was transient. Participants noted that parental drug use significantly impaired their mother’s ability to properly care for children. Often, the parent who used drugs recognized this as well and relied on others to care for their children. As noted by two participants:

My life growing up, my mom, she was on drugs. She realized that she wasn’t able to take care of me, so she signed her rights away. My grandmother ended up adopting me.

(Female, age 22)

The most I remember is me, my oldest sister and my brother, living with my mother and my grandmother. […] my mother was barely in the house, because she was out doing drugs

(Male, age 19)

Subsequent transitions were frequent and were described as unpredictable and confusing because adults rarely communicated the reasons for moving to youth. Some participants described learning of a move after returning from school; others described moves that were based on their parent’s relationships status. A participant described his frustration with not having a stable living arrangement:

He kicked us out. By this time, my mother was still pregnant or had my brother. […] It’s happened multiple times, [we get] kicked out, [then we] move to my aunts [house]. Then he got another house and we moved back with him again. She was like, “Don’t be mad at me.” [It] made me mad because she knew what she was doing and I had no control over sh**. […] Couple of months later, he kicked us out again and this time, I come home from school, mom like, “We going to a shelter.” I’m like, “What?”

(Male, age 21)

Housing transitions varied depending on the participant’s age at the time of the move. When youth experienced their initial move before age 10, most described moving with a parent to another location. New homes were often overcrowded; it was not uncommon for them to move into houses with other parents and children. For example, one participant described moving into a small house with eight other children, most of which were cousins and other fictive family members (Male, age 21). As they matured, participants more frequently mentioned moving without the parent. These independent moves seemed to give way to more frequent and less stable transitions. During adolescence, one participant described feeling exhausted from constantly moving from place to place (Female, age 22). Independent moves required the participants to manage their own relationships with their host, which proved difficult for many young people who had already experienced inconsistent relationships. One participant describes the fragility of his living arrangements:

I move with her [aunt]. Everything was sweet, but I got into a fight. When I got into a fight, she kicked me out. […] After that, I’m with my aunt or whatever, “I don’t want to do this no more. I want to move with my father.” I moved with my father. My father don’t got his own house. He lived with his girlfriend. It’s just chaos….

(Male, age 24)

Having a parent who used drugs prompted frequent housing transitions for study participants. Persistent housing transitions for these young people were overwhelming and they often lacked the emotional support of a stable adult caregiver. Youth had little control over when, where or with whom they moved. Although moving with parents who used drugs was challenging, moving alone as a teen seemed more stressful and less stable for youth.

3.2. Repeated trauma exposures related to housing instability

Several participants discussed experiencing traumatic events after having to move as a result of their parent’s drug use. For example, a 21-year-old male left his home because of his mother’s drug use only to be placed in homes with other family members who were also using drugs. Participants’ most traumatic memories stemmed from experiences in foster homes, which were described as being filled with physical, emotional, and sexual abuse. For example, one 21-year-old female described foster parents forcing her to eat cat food. Another 22-year-old male participant described being sexually abused while living in a foster home and then going on to sexually abuse other children in future foster homes. One participant described running away from her foster home around the age of 12 because of excessive abuse (Female, age 24).

In addition to maltreatment and abuse, neglect was also discussed in the context of housing transitions. Specifically, once participants arrived to a new location, it was usually unclear who was responsible for providing parental monitoring and supervision. This was described both when youth moved with their parents and when they did not. In the absence of a clear and consistent caregiver, participants were left to care for themselves at an early age.

I was eight. Living with my dad, he was on drugs. I was never in harm’s way, but he would leave me in the [apartment] overnight to run the streets. I knew how to cook. I knew how to take care of myself. I knew how to wash. I knew how to walk to school. Even though I was in kindergarten and first grade, I used to walk to school by myself because I had to, because my dad was out all day.

(Female, age 24)

Several participants described living with their grandmother, who provided basic needs such as food and shelter; but they often depended on other adults who lived in the house to provide day to day monitoring and supervision. These other adults would include aunts, uncles, significant others or the participant’s parent, all of whom may have been transient. The inconsistency in adult monitoring and supervision among families affected by parental drug use often left participants home alone or with other young children in potentially dangerous situations.

One time, my brother…he got school. I’m not in school yet. He’s in high school. Grandmother, she worked at a laundry mat. My mother, she was out doing her. Basically, I was home by myself… The next-door neighbor found me in the middle of the street… with no clothes on just running around.

(Male, age 19)

Up until I was 10, I was staying with my father for the most part. I wound up raising most of my nephews and nieces because my father was never there. I’d be the only one in there. So anything happened, I had to take responsibility for it because I’m the uncle. That’s big. I’m a kid still. I ain’t have no childhood.

(Male, age 21)

The move to a new place introduced additional traumatic experiences and inconsistent supervision for youth. Few efforts were made to address the previous trauma of living with a parent who used drugs or prevent re-traumatization. These experiences forced youth to quickly learn how to take care of themselves and others, who were often even younger than them.

3.3. The lasting effects of housing instability

Participants also felt that their housing instability negatively affected their school attendance, interest, and engagement. Moving from house to house often meant changing schools, which added another layer of inconsistency in their lives. Many reported externalizing behaviors such as misbehaving or fighting in school as a reaction to their unstable home lives. Across transitions, school attendance and engagement were often not prioritized or enforced. Two participants discuss their school experiences:

I was school hopping. Half the time, I wasn’t always in school. That’s why I say I was a dropout… I was never able to go to school.

I was always having to move here, move there, move there… School for me just had to get always put on the backburner.

(Female, age 22)

[The foster care system] sent me back with my mother. Wound up having to go back to hustling because I had no place to stay.

All my money was coming during the day. I couldn’t go to school, or if I did, I showed up once maybe a month. I was never no dummy, I just had no time for it.

(Male, age 21)

Persistent housing instability also contributed to participants’ lack of trust in others. Even when participants found a healthy and supportive housing environment, they often described behaviors of self-sabotage, which was often the case after numerous housing transitions. One participant described running away from foster homes, not because they were abusive, but because she felt she could not trust anyone as a result of the trauma she had experienced her whole life (Female, age 24). Other participants shared this sentiment, often citing that the lack of trust in people and systems stemmed from the neglect and instability they experienced during childhood.

Participants described their experiences of housing instability as traumatic. They articulated the connection between their lack of stable housing with their inability to trust others later in life. They also felt their experiences led to challenges in school and stifled their ability to grow and develop properly.

4. Discussion

The goal of this study was to describe the housing experiences of youth who are affected by parental substance use. Participants described numerous housing transitions, often starting in childhood and lasting throughout adolescence. Female relatives (e.g., grandmothers and aunts) were consistently described as reliable resources for youth affected by parental drug use as they experienced housing transitions. The more the participants moved, the more they experienced traumatic events. These findings are consistent with other studies that have found housing instability to have a compounded negative impact on the health and wellbeing of youth (Crumé et al., 2019). Regardless of when, where, or with whom they moved; it was evident that experiences of stress related to instability had a ripple effect on young people’s ability to establish healthy relationships with caregivers and supportive adults.

Family transitions describe events such as geographic moves, the introduction of a new household member, and the removal of an existing household member. Researchers generally focus on three core features of family transitions: frequency, nature and timing (Bengtson et al., 2005). Frequent transitions have been found to have negative impacts on the health and development of youth (Burton & Jayakody, 2001). Children who experienced more family transitions before the age of five were more likely to exhibit problem behaviors in school when compared to children with fewer transitions (Cavanagh & Huston, 2006). Frequent residential moves during adolescence predicted early onset of sexual activity and externalizing behaviors (Adam & Chase-Lansdale, 2002). Study participants described the disruptive nature of moving and how they felt that contributed to their poor mental and educational outcomes.

In addition to the frequency, the nature of the transitions has been found to heighten the risk for or protect against negative outcomes. Chaotic transitions, much like that of the participants interviewed, also lend to higher stress exposure with lower amounts of buffering support from caregivers (Bengtson et al., 2005; Sandstrom & Huerta, 2013). Family stress research suggests that when caregivers face highly stressful situations and are not able to cope properly, their ability to support their children is limited (McCubbin & Patterson, 1983). Consequently, children are left to navigate stressful events without the necessary resources to promote healthy adaptation This often requires them to develop a greater sense of autonomy and survival-based decision-making skills (McCubbin & Patterson, 1983; Sandstrom & Huerta, 2013).

Research has also shown that the timing of transitions is critically important, as experiences early in childhood tend to be more detrimental to normative development. Craigie et al. found that children born to cohabitating or married parents and who experience a divorce or separation before the age of five had higher rates of obesity, demonstrated more aggressive behaviors, and had lower vocabulary (Craigie et al., 2012). Over 70% of the participants in this study experienced a move before the age of five. Unlike normative transitions, participants’ frequent, unpredictable housing transitions introduced repeated experiences of abuse and neglect. Overall, the residential transitions are stressful. However, the frequency, nature, and timing determine whether the stress is toxic for healthy child and adolescent development.

Previous research has shown excessive exposure to adverse childhood experiences (ACEs), including neglect and abuse, to be strongly associated with sexual risk taking, poor mental health, as well as increased violence and drug use in adulthood (Hughes et al., 2017; Waehrer et al., 2020). Findings from this study suggest that ACE measurements be expanded to include measures of housing instability. Living with someone who uses illicit drugs is a common adverse childhood experience (ACE) that is often accompanied by one or more additional ACEs (Barnard & McKeganey, 2004; Powell et al., 2018; Velleman & Templeton, 2016). Adverse Childhood Experiences (ACEs) scales are useful in capturing toxic stress related to exposures of trauma (e.g., physical and emotional abuse, violence, family dysfunction, neglect, and household substance use). Toxic stress related to traumatic experiences can have lifelong impacts on the health and development of young children (Shern et al., 2014). Despite evidence provided by the current study and previous research (Dong et al., 2005; Finkelhor et al., 2015) of housing instability being a traumatic experience, none of the existing ACEs screening tools assess for housing instability. Not screening for housing instability may be a missed opportunity to develop and target interventions for the most vulnerable youth.

Several national surveys currently capture different aspects of residential instability such as number of moves, evictions, and overcrowding. However, none are based on the experiences of youth (Leopold et al., 2016). The Philadelphia ACE study expanded the original scale to include low-income inner-city youth and identified additional indicators that represented a more diverse range of lived experiences (Cronholm et al., 2015). This study included an indicator of ever living in foster care, which pertained to housing status, but misses the population of vulnerable youth who do not interface with the child welfare system (Cronholm et al., 2015; Wade et al., 2014). For example, while some participants discussed experiences in foster care, a majority of participants in the current study described experiences of constant transition of care and housing outside of the child welfare system. Thus, measures continue to be limited in their ability to capture the full scope of traumatic experiences, specifically pertaining to housing.

Although our findings provide a clearer picture of what is happening, additional research is needed to understand how to mitigate the negative effects of both parental substance use and housing instability on young people. A multi-level approach may be warranted. Changes in housing policies that allow other relatives to receive benefits may offer additional support to caregivers who may be struggling to meet basic needs. At the community level, leaders of youth programs may also need to be skilled in identifying housing options for vulnerable families. Finally, future ACE measures should include indicators that capture frequency of transitions, presence of a primary caregiver and the conditions within their housing arrangement, as described by participants. These factors are consistent with other research that highlights how safe, supportive, and stable housing is foundational to healthy child and adolescent development (Mersky et al., 2017; Radcliff et al., 2019; Stahre et al., 2015). When housing transitions are inevitable, reliable primary caregivers play an essential role in helping manage childhood stress responses (Miller et al., 2011). Updating ACEs scales to include housing will help inform the development of policies and programs aimed at preventing experiences of trauma in vulnerable populations.

This study is not without limitations. The findings of the study may be subject to memory bias, as participants were young adults reflecting on their childhood experiences. Though the individual experiences of the participants are not intended to be generalizable to all youth affected by parental drug use or housing instability, the findings are context specific. Each participant was connected to a local partner organization and was willing to discuss their parental substance use and housing transitions, which is often difficult for this vulnerable population given the sensitivity of the topic. Therefore, the experiences of the study participants may not be representative of all youth affected by trauma. Finally, we were unable to assess the extent to which financial constraints contributed to housing transitions. Future studies might consider interviewing parent-child dyads to better understand additional parental factors that may be associated with housing transitions among families affected by parental drug use.

Despite these limitations, there are several strengths to this study. First, this is one of few qualitative studies that explores the combined effects of parental drug use and housing instability on youth from a youth perspective. Second, although youth often refrain from disclosing parental substance use history; this study amplifies the voices of youth who have had these experiences. Finally, the study provides insight to expanding our understanding and measurement of ACEs for vulnerable youth. When we are able to better identify and measure the housing needs of youth, we will be better equipped to provide appropriate support for families in need. As the United States is working to find viable solutions to end the opioid epidemic, this is an opportune time to explore more deeply the impact of parental substance abuse on children and seek ways to prevent future use among these youth. Addressing the needs and identifying resources of these young people must extend beyond quantifiable units into having an in-depth understanding of their experiences.

5. Conclusion

The residual impacts of the parental substance use have caused youth to experience the toxic stress and trauma associated with housing instability. It is important that young people have safe, stable, and reliable housing opportunities when they face compounded experiences of trauma. Future research should explore ways to include and capture housing indicators on ACEs scales. Such research could provide additional insight on the stress burden of vulnerable populations and provide evidence to support policies and programs to increase housing support for families with children.