Addiction and Homelessness – Risks, Causes, and Treatment Options

According to the US Department of Housing and Urban Development (HUD), there were more than 500,000 homeless people in the United States in 2019. It is estimated that about 100,000 of these people were children. Furthermore, HUD estimated that over 88,000 of these individuals suffered from substance use disorders (SUDs), and that another 116,000 struggled with severe mental health disorders. It is believed that the homeless population in the US has grown by another 20% during the years 2020 and 2021.^1,2,3

Evidence has shown that addiction and homelessness in America often go hand in hand, with chronically homeless individuals being the most likely to suffer from serious SUDs. Although evidence-based treatment is available, it is frequently more difficult for homeless individuals to get the help they need than it is for people who can afford permanent housing.²

Addiction and Homelessness Statistics

Research indicates that homelessness and addiction are closely intertwined. Individuals who battle severe SUD are often unable to remain employed, which can cause them to become homeless. Being homeless frequently drives an individual to abuse drugs and alcohol as a coping mechanism. HUD estimated that a total of 88,873 homeless individuals were suffering from SUD in 2019. Of those 88,873, HUD has also found that:^1,2

• 43,069 were living on the streets and other public areas.
• 31,263 were living in temporary/emergency shelters.
• 14,541 were living in transitional housing.

The Connection Between Homelessness and Addiction

Research indicates that homeless individuals are at a significantly higher risk of developing an SUD. They are also substantially more likely to experience adverse physical and mental health symptoms of SUD, up to and including overdose. They are also less probable to receive adequate healthcare than the rest of the population. The homeless tend to be at a greater risk of all of the above even when compared to individuals who live below the poverty line, but are housed.^2,5

The connection between addiction and homelessness is believed to occur in two ways:

• Individuals who suffer from severe SUDs frequently find it difficult to remain successful in their professional and personal lives. This may eventually cause them to become homeless.
• Homeless individuals may use alcohol and drugs as a way to cope with the daily stresses of their way of life, causing them to develop an SUD over time.

Which social issues are caused by substance use disorders?

If left untreated, SUDs can cause various social, physical, and psychological problems. SUDs are frequently accompanied by co-occurring mental health disorders that make it more difficult for individuals to stay employed, establish and maintain healthy relationships, and access evidence-based treatment. The consequences frequently include:^6,7

• Homelessness. Drug and alcohol abuse can cause individuals to become unemployed and, eventually, homeless. People who become homeless may also start abusing substances as a way to cope with the difficulties of being homeless. Since homeless individuals have limited access to healthcare, this makes it less likely that they are going to be able to obtain treatment for their disorders.⁵
• Criminal actions. Substance abuse is a common factor in criminal offenses. For instance, individuals who struggle with severe SUDs may resort to crime in order to obtain the funds they need to purchase drugs and alcohol. Evidence indicates that homelessness is a common cause of involvement in criminal actions.⁷
• Imprisonment. People who use illicit drugs are breaking several laws that may result in incarceration. It is believed that about 50% of Federal and State prisoners use illicit drugs. Most of them do not receive treatment. There are currently many attempts at cooperation between medical personnel and criminal justice workers, with the goal of providing prisoners with the treatment they require to address their SUDs.⁸

What Is the Link Between Alcoholism and Homelessness?

Alcohol use disorder (AUD) is a widespread problem among the homeless population, with studies indicating that as many as 38% of the homeless in the US were suffering from some form of AUD in 2003. Since alcohol is legal and easier to come by than illicit or prescription drugs, many homeless individuals turn to it as a coping mechanism. Evidence indicates that older homeless individuals are more likely to suffer from AUD, whereas the homeless youth are more likely to abuse drugs.^5,6

If left untreated, AUD can be just as detrimental to a homeless individual’s mental and physical health as drug abuse. Since the homeless are primarily concerned with finding shelter and food, they are less likely to seek treatment for their AUD and more likely to continue drinking as a way to deal with the daily stresses of homeless life. This perpetuates a cycle of addiction that can lead to severe health problems and even fatal overdoses.⁶

What Are the Risk Factors of Addiction and Homelessness?

When combined with a substance use disorder, homelessness can significantly limit a person’s ability to function in their personal and professional lives. It can also cause or exacerbate a number of other issues, including:

Mental health problems

Homelessness can cause individuals to develop various mental health issues, as well as exacerbate existing mental health disorders. Since mental health issues in homeless people frequently go untreated, many of these individuals start abusing drugs and/or alcohol as a way to cope with the negative feelings caused by their mental health disorders. The lack of social support, the refusal of alcohol and drug rehab centers to treat them, and engagement in criminal activities all serve to make it significantly harder for the homeless population to obtain the help they need.⁶

Lack of social support

Research shows that many homeless individuals receive no support from their family members and/or friends. This is particularly likely to be the case if they also abuse drugs and/or alcohol.⁹

Lack of education

Homeless individuals rarely have access to schools or other forms of education. This makes it substantially more difficult for them to obtain the training they need to be able to support themselves financially and/or cover the costs of treatment.⁹

Cognitive impairment

Many homeless individuals who suffer from SUDs and co-occurring mental health issues find it very difficult to adapt socially or acquire new skills. This often makes it even harder for them to address the issues that caused them to become homeless in the first place.⁹

How Homelessness Leads to Mental Health Issues and Substance Use Disorders

More than 20% of the homeless population struggles with mental health problems. The living conditions frequently cause them to be on the receiving end of, or engage in, physical and mental abuse. All of this adversely impacts their mental well-being, and can drive them to self-medicate with drugs and alcohol, which can take an even greater toll on their mental health.^1,2,6

As a result, many homeless individuals also suffer from these mental health issues:¹⁰

• Post-traumatic stress disorder (PTSD)
• Depressive disorder
• Bipolar disorder
• Antisocial personality disorder
• Schizophrenia
• Attention deficit hyperactivity disorder (ADHD)

What Are the Available Alcohol and Drug Rehab Programs for Homeless People?

Overcoming an SUD is never easy, but it becomes even more difficult when the treatment-seeking individual lacks a stable home, supportive friends and family, and the ability to cover the cost of treatment. Fortunately, various organizations have established programs that aid homeless individuals in getting the treatment they need to overcome their addictions and co-occurring mental health problems.11 Some of the available options include:

Counseling and Therapy

Care For The Homeless and similar organizations offer confidential, affordable, and patient-oriented therapy that is designed to meet the needs of the homeless population. Besides counseling, they also offer other types of medical care, including dental services, primary care, and so on.¹¹

Medication Management

Prescribed, non-addictive medication is frequently utilized in the treatment of substance use disorders. Although medication-assisted treatments tend to be too costly for homeless individuals, organizations like the National Healthcare for the Homeless Council can help treatment-seeking individuals obtain the medications they need.¹²

Housing Programs

Organizations such as Housing First strive to provide the homeless population with permanent and secure housing. Unlike other organizations, they do not require the homeless individual to be sober to apply. They also provide services that aid people in overcoming their SUDs or mental health disorders.¹³

Inpatient Treatment

Individuals who suffer from severe SUDs and who have a history of relapse usually require 24/7 monitoring and extended stays inside specialized addiction treatment centers or hospitals in order to increase the likelihood of long-term recovery. Usually, these treatments begin with 3-10 detox programs that are designed to rid the patient’s body of toxins. Inpatient stays can last anywhere between 28-30 days to 6 months or longer. The length and type of inpatient treatment is determined based on the homeless individual’s specific needs and situation.¹⁴

How to Find Alcohol and Drug Rehab Centers for the Homeless?

Since no two SUDs are quite the same, each individual’s treatment must be customized during their initial intake assessment at their chosen rehab center to meet their unique needs and circumstances. The lack of social support and permanent housing represents an additional obstacle that can make overcoming an SUD even more difficult for homeless individuals. This is why alcohol and drug rehab programs for the homeless often include attempts at housing rehabilitation as well.⁹

American Addiction Centers (AAC) is a nationwide network of reputable addiction rehab facilities that use evidence-based approaches to help patients achieve lasting sobriety and obtain effective treatment for any co-occurring mental health issues they may be diagnosed with.

If you or a loved one are struggling with addiction, it is recommended that you call the AAC hotline. This will give you an opportunity to speak to an experienced admissions navigator in absolute privacy. They will be able to answer your questions, help you verify your insurance coverage for addiction treatment, and provide guidance on how to find local rehab centers near you that meet your or your loved one’s needs, including free alcohol and drug rehab programs, state-funded rehab centers that offer treatment free-of-charge, and low-cost addiction treatment facilities. Depending on the severity of the treatment-seeking individual’s situation, they may also be able to arrange a same-day alcohol and drug rehab program admission.¹⁵

Other helplines that are available to homeless individuals include:

• Care For The Homeless maintains a 24/7/365 helpline that can be reached at 718 943 1341 and enables individuals to obtain various types of medical services.¹¹
• National Healthcare for the Homeless Council maintains a specialized hotline at 615 226 2292 that is specifically designed to aid the homeless.¹²
• Mental Health Services for the Veterans provides help for veterans (homeless or housed) who battle SUDs and mental health problems. Their free, 24/7 helpline can be reached at 1-877-424-3838.¹⁶
• Substance Abuse and Mental Health Services Administration provides information on evidence-based treatments for addiction and mental health issues. They offer a wealth of information on their website.⁹

How to Pay for Alcohol and Drug Rehab Programs for the Homeless?

The majority of homeless individuals live far below the poverty line, to the point where they cannot afford permanent housing. As a result, most of them are also unable to cover the cost of SUD treatment and often lack the motivation to overcome their addiction. This is why it is important to provide free or affordable SUD treatment options to homeless individuals and others who cannot afford to pay for treatment out of pocket.^2,9

These options include:

• Medicaid is a healthcare program for individuals who have a low income and are eligible to receive coverage.¹⁷
• Medicare helps individuals in need cover the cost of medical services, including mental health and substance use disorder treatment.¹⁸

SAMHSA offers grants to low-income people who require medical treatment, including addiction rehab.¹⁹