The recovery experiences of homeless service users with substance use disorder: A systematic review and qualitative meta-synthesis

•This review presents qualitative evidence for recovery from homelessness and SUD.•Services could be enabling or disabling for recovery depending on approach.•Close relationships could be challenging or change-inspiring.•Meaningful participation and positive personal traits fostered recovery.•Housing was foundational for recovery by affording safety and ontological security.•Harm reduction, person-centred services with unconditional housing are recommended. The relationship between homelessness and substance use disorder (SUD) is layered and complex. Adults pursuing recovery while dealing with homelessness and SUD face many challenges. Little research has inspected qualitative first-person accounts of recovery in the context of homelessness and SUD, and few studies have employed conceptualisations of recovery beyond abstinence. In this systematic review study, we examine the qualitative literature on the recovery experiences of adult homeless service users with SUD. 2,042 records were identified via database and secondary searching strategy. After title and abstract and full text screening, 15 eligible studies remained. Critical Appraisal Skills Programme quality appraisal criteria was used to assess potential bias in the studies. Meta-ethnography was employed to synthesise extracted data. Four themes were generated from the extracted data: Two sides of the Service Coin; Navigating Relationships; Recovery Practices and Personal Attributes; and Housing as Foundational for Recovery. Unconditional housing, a broad array of supports, opportunities to contribute to society, and family reunification supports all facilitate the development of recovery for adults with SUD experiencing homelessness. Implications for policy are discussed.