Barriers and enablers of addiction recovery amongst people experiencing homelessness in Dublin, Ireland: A proposed conceptual framework adapted from the REC-CAP

Abstract

Background

Worsening health disparities amongst individuals experiencing co-occurring homelessness and addiction underline a need to examine potential pathways towards recovery. This study consists of a secondary analysis to identify barriers and enablers of addiction recovery amongst people experiencing homelessness (PEH) in Dublin, Ireland, and to propose a conceptual framework adapted from the Recovery Capital Assessment & Recovery Planning Tool (REC-CAP).

Methods

The analysis drew on two data sources collected between September 2022 and April 2023 as part of a qualitative, community health needs assessment: in-depth interviews with 19 providers working with PEH in Dublin, and ethnographic fieldwork conducted with 40 homeless clients attending a primary care and addiction services clinic in the city.

Results

In addition to widely reported barriers to recovery such as limited access to housing, clients' recovery progress was blocked by unaddressed physical and psychological health conditions, and by harmful attitudes and beliefs about themselves, their substance use, and their treatment options. Societal stigma perpetuated those harmful beliefs and unfair access to recovery resources. Despite these barriers, once an individual found sufficient motivation to recover and reached a minimum threshold of physiological health and stability in their substance use, key elements of personal, social and community capital intersected and built upon each other to aid in recovery.

Conclusion

Key elements of recovery capital for PEH include a combination of self-confidence and self-efficacy, autonomy and freedom of choice, meaningful activities, social support, and access to satisfactory mental health, addiction, family, primary care, and housing supports. Though not essential for starting recovery, a safe and stable home is crucial for sustaining it.