The Relationship Between Substance Abuse, Addiction, and the Homeless Population
According to the National Alliance to End Homelessness, there were approximately 580,466 people experiencing homelessness in the United States in 2020.
Many people in the housed population stereotype the unhoused population as people who have severe mental illnesses, are addicted to drugs and alcohol, and are unable to function in society. Although substance abuse can cause homelessness, addiction issues often arise after people lose their housing. As a result, it’s vital to view substance abuse and addiction as illnesses rather than moral failing so that people who are affected by substance abuse and homelessness can have the opportunity to recover.
When provided with safe, supportive housing, comprehensive treatment, and peer support, people experiencing homelessness and addiction can get their lives back on track.
The homeless population is diverse, and people find themselves experiencing homelessness for a variety of different reasons. For some people, it is a traumatic event such as a house fire or natural disaster that stripped them of their housing with an inability to afford increasing rental prices or the down payment on a new home. For others, it is lifestyle circumstances, such as being kicked out of their parent’s homes for belonging to the LGBTQ+ community or leaving an abusive relationship.
Homelessness is not always caused by poor life decisions. It often happens to people through no fault of their own. After all, few people would choose to live on the streets or be unhoused rather than have a roof over their head.
Some people experience homelessness for short periods of time as they are transitioning from one life situation to another. These individuals often have family members, friends, or access to resources to support them. Others fall into a category known as “chronic homelessness” where they remain unhoused, without adequate support or resources, for many years or even a lifetime.
Homelessness is one of the most difficult things a person can experience. While unhoused, people not only struggle to secure shelter, food, and water, but they also struggle to stay warm in the winter and cool during the summer. They often face constant scrutiny and misunderstanding from the public, judgment from medical professionals, and violence or unrest between other individuals experiencing homelessness.
The truth is, homelessness can be traumatizing. Many unhoused individuals become the victim of violence, theft, sexual assault, rape, and more. Traumatic events combined with the trauma of being unhoused for periods of time can lead to the development of mental health or addiction issues.
The Connection Between Substance Abuse, Mental Health, and Homelessness
While substance abuse, addiction, and mental health problems can lead to homelessness, many unhoused individuals develop mental health issues once they lose access to housing. Then, they turn to drugs or alcohol to numb their feelings of despair and hopelessness or cope with symptoms of anxiety, depression, trauma, and loneliness.
More than one-third of the homeless population experiences a serious mental illness and more than half experience any mental illness. The most common mental illnesses among the homeless include:
- Bipolar disorder
- Schizoaffective disorder
- Major depressive disorder
- Severe anxiety
- Post-traumatic stress disorder (PTSD)–PTSD is specifically high in veterans experiencing homelessness
Without access to adequate treatment, many unhoused people self-medicate their symptoms using drugs or alcohol. Also, people who suffer from mental illness are far more likely to develop a substance use disorder than people who do not.
In addition to mental health, other risk factors contribute to substance abuse and homelessness, such as:
- Growing up unhoused
- Having parents who battled addictions to drugs or alcohol
- Physical, emotional, or sexual abuse
- Co-occurring disorders
- Early substance abuse
- Domestic violence
- Disabilities or terminal illness
Overall, research shows that more than one-third of unhoused individuals experience issues with drug or alcohol abuse, and up to two-thirds have a lifetime history of substance use disorder.
The most widely abused substances among the homeless population include:
Barriers to Treatment for Unhoused Individuals
While experiencing homelessness, the top priority becomes day-to-day survival–not finding drug and alcohol counseling. As a result, some people will delay getting treatment because they are more focused on finding food, water, and shelter, and simply getting through the day than they are on getting sober.
The problem is that continuing to stay trapped in a cycle of addiction will only make homeless issues worse and make it more difficult to secure housing. According to the National Coalition for the Homeless, many shelters and assistance programs do not accept people with substance use disorders. Instead, the unhoused are encouraged to go to residential treatment, but most people experiencing homelessness do not have health insurance. And, since state-funded rehabilitation facilities have long waitlists and strict admissions criteria, the homeless population has very little chance to be admitted to a free or state-funded facility. This leaves swaths of people experiencing homelessness, addiction, and mental health issues all on their own.
Homelessness and addiction are not the ends of the road–there are ways to get help. A new approach that is gaining popularity, known as the “Housing First” approach, claims to successfully reduce substance abuse among the unhoused by first supplying them with housing, then helping them address substance abuse and mental health issues. SAMHSA describes Housing First as the best practice for people experiencing homelessness.
Individuals who do not have access to a Housing First model can work with a social worker to apply for Medicaid, government-subsidized insurance, so they can attend a rehab facility for Medicaid patients.
Addiction Treatment for People Experiencing Homelessness
Sadly, less than a quarter of unhoused people receive the treatment they need and deserve. Most end up getting treatment at hospitals or emergency rooms when a health crisis occurs, and this treatment usually doesn’t pave the way for long-term sobriety.
While it is difficult to overcome substance abuse and homelessness, there is effective treatment available. The most promising treatment regimens for people experiencing homelessness and addiction include features such as:
- Access to permanent housing
- Compassionate, well-trained staff
- Personalized treatment plans
- Integrated mental health and addiction counseling
- A holistic approach to treating the “whole person” rather than just the symptoms
Treatment begins with detox where patients are temporarily housed in a medical facility for supervision. Doctors may prescribe detox medications as well as psychiatric medications to alleviate symptoms of withdrawal. Once patients are stabilized, they should transition to a residential program where they are provided with stable, supportive housing and long-term care.
Therapy must address all areas of a person’s life–not just their mental health and substance abuse. Services should be offered to help patients develop a resume, apply for jobs, and secure employment. Other services such as case management and recovery coaching can help individuals find local support groups and resources they may need based on their situation.
After residential treatment, patients should transition to a sober living home or a long-term housing facility. Without permanent housing, individuals in this demographic are likely to return to drug and alcohol abuse. The housing allows people to have their basic needs met so they can apply for jobs, save money, develop a support group, practice self-care, and, ultimately, stay sober. Secure housing should be combined with aftercare, such as:
- Continued counseling
- Medication management
- 12-Step groups
- Self-help groups
- Alumni program
- Outpatient Program
Find The Help You Deserve Today
Addiction can affect everyone no matter their background or life circumstances. It does not make you a failure or a bad person–it simply means you need treatment.
If you or a loved one are struggling with addiction and ready to take the first step toward recovery, please contact us today. A dedicated admissions counselor is available now to assess your needs, verify your insurance, and help you find the right treatment program for you.