Homeless veterans’ experiences with substance use, recovery, and treatment through photo elicitation

ABSTRACT

Background: Homeless veterans often have addictions and comorbidities that complicate utilization of longitudinal health care services, such as primary care. An understanding of experiences of veterans enrolled in a Homeless Patient Aligned Care Team (H-PACT) may improve addiction treatment engagement in these settings. The authors aimed to describe H-PACT veterans' experiences with substance use (SU), substance use recovery (SUR), and substance use treatment (SUT). Methods: Homeless veterans were recruited from a veteran primary care medical home clinic between September 2014 and March 2015. Twenty veterans were given digital cameras and prompts for taking photographs about their health and health care and participated in 2 photo elicitation interviews. For this secondary analysis, transcripts from the audio-recorded interviews were analyzed by 2 coders using qualitative content analysis. Results: The majority of participants (75%, n = 15) discussed SU, SUR, and/or SUT in regards to their health and health care utilization. SU themes centered on disclosure of addiction or dependency; substances used; repercussions of SU; SU as a coping mechanism; and association of SU with military service. SUR themes included disclosure of length of sobriety; perceived facilitators of SUR in health, beliefs, social, environmental, financial, and creative pursuit domains; and perceived barriers to SUR in beliefs, social, and environmental domains. SUT themes focused on perceived facilitators of SUT in access to Department of Veterans Affairs (VA) and non-VA services and social domains and perceived barriers to SUT in the social domain. Conclusions: Providers seeking to elicit addiction-related clinical history and facilitate SUR and SUT might look to the current findings for guidance. Provider training in motivational interviewing may be warranted, which allows for an exploration of health-related consequences of SU and supports patients' self-efficacy.

KEYWORDS:

• Health
• homeless persons
• primary health care
• qualitative research
• substance use disorders
• veterans
• veterans health

Acknowledgments

We would like to express our gratitude to the veterans who participated in this study for sharing their stories, photographs, and insights, and to the clinical and administrative staff of the Homeless Patient Aligned Care Team (H-PACT) at the VA Pittsburgh Healthcare System, where this study was conducted.

The authors declare that they have no conflicts of interest.

Funding

This work was supported by a stipend from the University of Pittsburgh School of Medicine (UPSOM) Dean's Summer Research Program (Student Investigator: Samuel F. Sestito). This work was also supported by a pilot research grant from VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System (Principal Investigators [PIs]: Michael A. Mitchell, Lauren M. Broyles). This work was also supported by Department of Veterans Affairs, Health Services Research & Development (HSR&D) Service, locally initiated research funding (PI: Michael A. Mitchell; 72–079). Finally, this work was supported by the Department of Veterans Affairs, Office of Academic Affiliations Advanced Fellowship Program in Addiction Treatment (Michael A. Mitchell), by a Career Development Award (CDA 10–014) from the Department of Veterans Affairs, Health Services Research & Development Service (Lauren M. Broyles), and with resources and facilities at the VA Pittsburgh Healthcare System, Pittsburgh, PA. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Author contributions

All authors contributed to the study concept and design. Mr. Mitchell and Dr. Rodriguez conducted the interviews. Mr. Sestito, Mr. Conley, and Dr. Rodriguez performed the analysis. All authors contributed substantially to the manuscript preparation and review.