Re-making selves and social worlds: Experiences of live-in substance use treatment among adolescents experiencing social structural marginalization in Vancouver

Across many settings in Canada and the US, overdose is now a leading cause of death among 10 to 18-year-olds. In the Canadian province of British Columbia (BC), there have been increased efforts to connect adolescents with substance use treatment, including live-in programs. While much previous work has focused on barriers to treatment among youth, less research has examined how adolescents, and in particular those experiencing high levels of residential instability, homelessness, and institutionalization via child protection, criminal legal and housing systems, understand and experience these programs. This qualitative study draws on semi-structured interviews with 37 adolescents and those who were very recently adolescents aged 14 to 20 who planned to access, were accessing or had recently accessed “Cypress Place” (a pseudonym), a live-in treatment program for adolescents in Vancouver, BC. Drawing on concepts of self and social world-making, our findings reveal that the changes adolescents envisioned making through live-in treatment extended far beyond abstinence from substance use, to encompass significant shifts in who they were and who they surrounded themselves with. While the weight of the social structural contexts that “followed” youth into treatment could powerfully undermine their abilities to make desired changes, this study nevertheless provides insights into how transformative projects of self and social world-making can be better supported across their treatment trajectories. Namely, providers and programs can work to bridge the kinds of self and social transformations achieved during live-in treatment with what comes next by providing opportunities for youth to stay connected and prioritizing the development of skills for living well – as individuals and as part of collectivities – that open up possibilities for recovery and healing over the longer term.