Housing instability and economic insecurity across the continuum of active substance use, treatment, and recovery among women involved in the criminal legal system

Background: Prior research on the widespread housing instability, such as homelessness, and economic insecurity, such as difficulties gaining employment, faced by women with a history of opioid use disorder (OUD) highlights the need to explore the impact of these hardships on experiences of active addiction, medications for OUD (MOUD) treatment uptake, and recovery outcomes. Objectives: This study examines how the compounding and interactive effects of housing instability and economic insecurity impact the experiences of women involved in the criminal legal system (CLS) across the continuum of active addiction, treatment, and recovery. Design: This study utilizes semi-structured qualitative interviews. Methods: Qualitative interviews were conducted with 42 participants, including women with a history of OUD and CLS involvement ( N = 20), treatment providers ( N = 12), and criminal legal professionals ( N = 10), and analyzed with inductive thematic coding to explore substance use trajectories and issues with MOUD treatment. Results: Findings revealed housing instability and economic insecurity significantly influenced women’s experiences across the continuum of active substance use, treatment, and recovery. During active addiction, women faced hardship-related vulnerabilities due to low socioeconomic backgrounds, self-imposed isolation, and domestic violence, heightening the risk of worsening substance use. Related challenges experienced during treatment involved difficulties associated with meeting housing and medical assistance qualifications, which interfered with retention and stability. While housing instability remained a significant concern during recovery, economic insecurity became more prominent in recovery experiences compared to addiction and treatment phases. Conclusion: Policies should prioritize integrating interventions addressing housing instability and economic insecurity into patient-centered care across active addiction, treatment, and recovery to promote health, gender equity, and well-being for those affected by substance use. Actionable recommendations include vocational rehabilitation within carceral and treatment settings, coordinated efforts between the child welfare system and treatment system, and education about housing resources, among others.