Addiction and public health researchers endeavor to understand the complex relationship between life events and substance using behaviors to better disentangle their interaction with access to health services and treatment outcomes.  Typically, this research relies on standardized questionnaires, which tend to overlook detailed lifetime experiences. Qualitative methods are one solution that allow for a more in-depth collection of individual experiences. However beneficial, these methods are more resource intensive than quantitative methods. Thus, obtaining a comprehensive picture of a person's patterns of drug use and treatment access poses methodological challenges to the public health researcher.  

Life event calendars and timelines are alternative methods used in health or social surveys that may provide the researcher with a feasible and efficient means for measuring detailed life events and their relationship with participant behavours, such as patterns of substance use, addiction treatment access and outcomes.  The life history calendar (LHC) is one example of a calendar and timeline instrument. This tool collects information on lifetime events and is used to identify the occurrence, timing, sequence and duration of events over the life course. 

The LHC has shown to improve the quality and completeness of the reported retrospective data.  A typical LHC uses a graphical display; the vertical axis shows the participant's life course or reference period of interest and the events are labeled on the horizontal axis. This graphical display facilitates memory recall of the timing and sequence of life events and is particularly useful for recalling less salient or more frequent events. The graphical display also allows interviewers to identify gaps in reported data. The accuracy of data is therefore greatly improved.

The LHC has been applied in the field of addictions, primarily to collect daily patterns of substance use, typically with a one-month follow-back time period. In addition, other studies have included questions in the LHC regarding substance use as one of the factors that could explain the health or social outcome of interest.  In our recent cross-sectional study among long-term opioid dependent (e.g., heroin) individuals, we used the LHC to strengthen quantitative data and to determine the relationship between life events (e.g., incarcerations, illnesses) with patterns of drug use and access to addiction treatment. Salient life events, such as the birth of a child, were used as reference points for recalling details surrounding drug use and treatment access. We were also able to determine transitions in the frequency and intensity of drug use and their relationship with life events and access to addiction treatment.

The primary challenge encountered was the use of a lifetime reference period for a large number of life events. To complete the LHC with accuracy and completeness, we emphasized the importance of the interviewer's role and training, as well as the use of complementary questionnaires. These questionnaires were used to refine the number of relevant life events.  Despite these challenges, detailed histories were collected and allowed us to uncover important time sensitive data on the relationship between events over the life course with patterns of substance use and access to addiction treatment. This data can explain relationships between these complex lifetime events otherwise not captured with questionnaires. Uncovering such complex relationships has the potential to improve addiction treatment outcomes in a number of capacities, and could be used for example, to inform timely interventions and to prevent relapses.

Kirsten Marchand, Heather Palis, Jill Fikowski, Eugenia Oviedo-Joekes are the authors of the recently published paper, Feasibility of Applying the Life History Calendar in a Population of Chronic Opioid Users to Identify Patterns of Drug Use and Addiction Treatment, available for download now in Substance Abuse: Research and Treatment

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