In January 2020, more than 580,000 people were experiencing homelessness in the United States.[1] In cities and towns throughout America, people slept in tents, boxes, and cars.
During the day, they looked for food, health care, and opportunities. Some of them were also looking for mind-altering drugs and alcohol.
The Connection Between Homelessness & Struggles with Habit-forming Drugs and Alcohol
Why homelessness and drug and alcohol use are associated, or seen more commonly together, is likely bi-directional. For one thing, regular substance use can lead to personal and familial chaos, leading to financial strain, social isolation, unemployment and loss of shelter. On the other hand, the hardships of being homeless might lead people to use drugs and alcohol more often to cope. There are also factors, such as severe mental illness, which can increase risk of both. Ultimately, the connection between homelessness and substance use disorder is complex, interwoven, and deeply personal.
Research shows that high housing costs drive most cases of homelessness. Cities with brisk competition have the highest rates of homelessness.[1]
Homelessness is not easy to address. However, the more we know about how substance use can play a role in homelessness, and vice versa, the more likely we will find solutions..
How Common Are Substance Use Disordersin Homeless Communities?
It can be difficult to obtain accurate data for research on homelessness. Surveys are difficult to conduct, as people move often and are sometimes unwilling to cooperate with authorities. Stigmatization by others may render someone more resistant to answering research questions truthfully.
Research shows that many people experiencing homelessness struggle with substance use[2], and both homelessness increases the risk of substance use and the likelihood of developing an addiction and vice versa.
About 30% of all people experiencing homelessness have mental illnesses.[3] Depression, anxiety, post-traumatic disorder, and similar ailments dramatically increase a person's risk for substance misuse.
In one study performed in 2017, 14% of people experiencing homelessness admitted to struggling with substance misuse, and another 10% reported problems with alcohol.[4]
Since studies are hard to conduct and results subject to bias, these estimates may be too high or too low. But it's safe to say that in all likelihood most people experiencing homelessness are not dealing with a substance use disorder (SUD). But those who do have a SUD may find it hard to leave homelessness behind.
Which Comes First: Homelessness or Addiction?
Do people with SUDs become homeless? Or do people who are homeless develop SUDs?
Each person is different, and their journeys individually unique too. But we know several factors influence the relationship.
Low Access to Mental Health Care
In the 1960s, people with mental illnesses got care in large, state-run, residential facilities. They lived there day in and day out, and sometimes, those buildings grew crowded and chaotic.
In Oregon, for example, authorities opened a new mental health facility in the 1960s to prevent overcrowding. Soon, that new building was also full.
In the 1980s, funding priorities changed most of these places were closed, leaving many of the residents had no other place to go.[5] People who had trouble functioning in their daily lives due to mental illness were left to fend for themselves, and many became homeless. Mental illness, especially severe mental illness, is a well-known contributor to substance use and substance use disorder. This resource deficit for people with severe mental illness is still an ongoing problem today.
In a scenario like this, mental illness precedes both the homelessness and the drug and alcohol use.
Peer Pressure
Joining with other people can help lessen the burdens of homelessness. A peer could watch your campsite while you're away, share food as needed, and offer protection.
But finding affiliation isn't always easy. Some people report beginning substance misuse as a way to get accepted by others while they are also in the throughs of homelessness.[6]
In this scenario, homelessness comes first. People begin using to fit in, and soon, they can't control how much or how often they use drugs.
Stressful Situations
It's not easy to live on the streets. People who have no regular shelter jump from one situation to another.
Even entering a shelter is a short-term solution.[7] Most people enter when the sun goes down, and they must leave again in the morning.
A relentless, uncertain life like this isn't easy. Some people turn to substances to help them escape, even if it's just for a few moments.
In this scenario, homelessness comes first, and SUDs swiftly follow.
Loss of Opportunities
People with a substance use disorder lose judgment and have financial hardship, difficulties maintaining employment, and become increasingly isolated from supportive family or friends.
In this situation, a substance use disorder comes first, leading to homelessness.
Causes of Homelessness in People with SUDs
Why do some people lose their homes while others don't? Answering this question is critical in solving homelessness, and we're years away from real solutions. But some factors are clear.
Homelessness and poverty are closely related.[8] Low-income people can't pay for necessities like these:
- Food
- Childcare
- Health care
- Education
Someone like this is just one paycheck away from homelessness. An unexpected medical bill, car repair fee, or police citation could tip the scales and leave them with nothing.
A lack of affordable housing also causes homelessness. In surveys, people cite these issues as sparking their homelessness:[9]
- Eviction
- Overcrowding
- Doubling-up rents
- Job loss
- Hazardous housing conditions
Homelessness & Substance Misuse in Women
Most homeless people are male. Out of 10,000 women, only 13 are homeless. In men, 22 are.[1] But women who are homeless face issues their male counterparts don't.
When compared to women with stable housing, women experiencing homelessness are four times more likely to have an alcohol use disorder and 12 times more likely to have a SUD.[10]
Homeless women often have a history of trauma. Up to 50% of all women experiencing homelessness were found to have fled their homes to get away from domestic violence situations.[11]
Life on the streets can bring further insecurity and victimization, leading to more traumatic experiences.
As a woman's traumas compound, her substance misuse issues can deepen. She might use substances to escape, which can quickly spiral into an addiction.
Homeless & Substance Misuse in Youth
Up to 70% of youth experiencing homeless abuse drugs or alcohol.[12] Usually they are primarily using marijuana, but cocaine, amphetamine, and alcohol abuse are common too.
The majority of homeless youth have endured some kind of trauma, such as these:[13]
- Combat-related trauma
- Community violence
- Disasters
- Domestic violence
- Neglect
- Physical abuse
- Psychological abuse
- Sexual abuse
These early experiences can change neural pathways in a growing brain and make substance use disorders more likely. And youth accustomed to coping through drugs and alcohol may not be aware of how habitual use of alcohol and drugs will only compound their problems.
Homelessness & Substance Misuse in the LGBTQ Community
People who identify as gay, lesbian, transgender, bisexual, or gender-curious face unique risks as they enter homelessness. And their pathways to homelessness may be unique too.
Many LGBTQ youths become homeless due to conflicts with their parents about their sexual orientation or gender identities.Of all homeless youth, 20% identify as LGBTQ.[11] Of those, 62% will attempt suicide.[11]
LGBT homeless youth are more likely than non-LGBT homeless youth to lean on cocaine, crack, or methamphetamines.[14]
Treatment Options for SUD
Efforts to to reduce the size of homeless are ongoing. Modest gains in reducing homelessness took hold in the mid-2000s. But when COVID moved into the United States, everything changed.
Widespread job losses, high medical bills, and poor prospects combined with skyrocketing housing prices during COVID. Any gains made in reducing homelessness prior to 2020 were likely wiped out due to the pandemic.[1]
The best way to help homeless people with SUDs is to support both the homelessness and addiction problem at the same time.
The best way to reduce homelessness is to help people find and keep safe and secure housing. This is a challenge, and an ongoing problem, but whether or not substances are in the picture, helping people find shelter should be top priority.
Experts claim that there are three key aspects to addressing SUDs best ways to address SUDs among the homeless:[15]
- Harm reduction measures: Rather than focusing only on getting people sober, offering people who are not ready to quit help with reducing the risks associated with drug use is now a standard approach. Examples of harm-reduction approaches include needle exchange clinics and naloxone to prevent overdose.
- Case management: Each person has a dedicated professional who can help them find housing options, discuss substance use disorder treatment, and get help for medical problems and mental health problems.
- Housing interventions: Professionals offer a safe, stable place for the person to live, even temporarily.
As with anyone with a substance use disorder, homeless individuals should be offered counseling, referrals to 12-step programs if they are considering stopping, Medication for Addiction Treatment (MAT) for their opioid use disorders, psychiatric care in the case of comorbid mental health problems and residential treatment when needed.
Homelessness & SUD FAQs
Does SUD cause homelessness?
Sometimes. The chaos of a life with SUD can cause people to lose financial security and supports, culminating in homelessness.
Does homelessness cause SUD?
Sometimes the stresses of being homeless lead people to turn to substances to cope. Ongoing stress, trauma, and continued use lead to development of a substance use disorder, or an addiction.
What is the main cause of homelessness?
Poverty. People with a low income that experience a short-term financial stress can suddenly find themselves without a place to live. Once someone is homeless, it is hard to get out of that cycle.
What is the best way to help someone recover from a substance use disorder?
Substance use disorder treatment works best when it is individualized. But as with anyone a combination of medication, counseling, 12-step work, and if needed financial, housing and employment support will increase someone’s chance of breaking free.
If you know someone struggling with substance use disorder, getting them into treatment is the best path forward.
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