Homelessness and Substance Abuse Addiction Treatment Programs

Homelessness and Addiction – Risks, Causes and Treatment Options

Although different organizations count the number of the homeless differently,2 the US Department of Housing and Urban Development (HUD) estimated that there were over a half a billion homeless people in the USA in 2019.1 Needless to say, that number is disturbingly high, especially keeping in mind that over 100,000 of them were children.1 Life on the streets, in shelters or transitional housings poses a lot of challenges, a lot of them being threats to mental health. According to HUD, more than 116,000 of the homeless were severely mentally ill and another 88,000 were chronically using substances in 2019.1 

The number of the homeless is only increasing – the chronically homeless population has risen by 20% between 2020 and 2021.3 And it is those who are chronically homeless that most often suffer from substance abuse.2 Addiction and homelessness are frequently intertwined, and despite there being many resources for help with addiction, it is harder for the homeless to access it and to get the help they need.

Homelessness and Addiction Statistics

The number of the homeless is constantly on the rise. In 2019 there were 567,715 homeless people,1 whereas that number increased to 580,466 on a single night in 2020,4 only to escalate by another 20% when it comes to chronically homeless in 2021.3

Addiction and homelessness in America are connected in that one causes the other – sometimes it is a vicious circle where addiction leads to homelessness, but also the state of being homeless engenders addiction as a coping mechanism.2 In 2019, a total of 88,873 homeless people were addicted to substances, and the statistics about addiction and homelessness show that:1

• 43,069 were unsheltered (meaning that they live in public places not allotted for accommodation, e.g. streets4).
• 14,541 were in transitional housing (i.e. places in programs which offer them for up to 24 months4).
• 31,263 were in emergency shelters (i.e. temporary shelters4).

What is the connection between substance abuse and homelessness?

The nature of the relationship between substance abuse and homelessness is controversial, because there is stigma around labeling all homeless people as addicts.2 However, it is a fact that the homeless are at a higher risk of becoming addicted and it is also harder for them to access help when they need it.5 Both drug abuse and homelessness are severe issues in America, but they are often not discussed in relation to one another; however, this should change, as the risk of an overdose is higher for the homeless than for the general population, due to the lack of healthcare.5 Moreover, the homeless are more likely to have all the other adverse health outcomes.5 Even in comparison to the population which is very poor, but housed, the homeless are at a higher risk of all of the above.5 

There could be 2 ways to explain the connection between substance abuse and homelessness:5

• The homeless may be using substances as a coping mechanism for the stress and hardship of their way of life.
• Their abuse of substances may lead to homelessness due to the inability to work, form healthy relationships or access treatment.

Therefore, it is important not to make premature assumptions, due to the complex relationship between the two.

What are three social problems that are caused by substance abuse?

Substance abuse can lead to many other problems which are physical, psychological and social. That is why substance abuse treatment varies from one person to another, since no one has the same experience and/or consequences when it comes to addiction. Some of the consequences may be:

• Homelessness. As mentioned, drug addiction may leave people unemployed and – homeless. Then, people who are homeless might resort to using drugs to cope with their situation. Moreover, the lack of healthcare can make it hard for them to get treatment, only to make the situation worse and harder to escape.5 
• Incarceration. Drug abuse can result in imprisonment. About one-half of State and Federal prisoners abuse drugs and many of them do not have treatment. However, there are many attempts of cooperation between the criminal justice personnel and medical workers in order to treat the prisoners.8 
• Criminal behaviors. Drug abuse and criminal offense are as intertwined as homelessness and crime – one can lead to and enhance the other. Homelessness is a frequent cause of involvement in criminal activities.7

What is the Connection Between Alcoholism and Homelessness?

A subcategory of addiction is alcohol abuse, and alcoholism and homelessness are a combination just as detrimental as drug abuse and homelessness.. Research has shown that alcoholism is more prevalent among the older population of the homeless, while drug abuse is more characteristic of the homeless youth.6

In 2003, 38% of the homeless were suffering from alcohol use disorder (AUD).6 Though this number may be different today, it is certainly still high. The reason is that the homeless usually do not have the motivation to stop drinking.6 Since they often use it as a coping mechanism, it is hard for them to quit drinking on their own.5 In their cases, survival takes precedence over treatment, and finding food or shelter will always be more important than seeking rehab centers.6 This, unfortunately, only makes the vicious circle of addiction worse.

What are the Risk Factors of Homelessness and Addiction?

Homelessness is difficult enough on its own, but when combined with addiction, it can become impossible to function in a society. Some of the risks may include:

• Mental health issues. Can Homelessness Cause Mental Health Issues? The short answer is – yes. In 2019, over 100,000 of the homeless were severely mentally ill.1 Since the issues usually go untreated, many people resort to drugs as medications, so they end up in even worse states. Many obstacles to their recovery include criminal activities, refusal of rehab centers to take them in, or the lack of support due to which they do not even look for treatment options.6
• Lack of social support. Many homeless people are left on their own – they do not have support, especially if they also suffer from substance abuse.9
• Lack of education. Apart from shelter, they are also stripped of access to schools, which are often expensive.9
• Cognitive impairment. They are unlikely to be able to learn new skills or adapt socially, which can make it even harder to escape homelessness.9
• Increased risk of contracting HIV.9

Homelessness, Mental Disorders, And Substance Abuse Addiction

Almost a fifth of the homeless population experiences mental health issues.1,2 Their mental state is affected by their living conditions, but it is also hard for them to deal with those problems due to their inability to find rehab facilities. They also have a high risk for violence or victimization which is why they are often either in prison or hospital, making it impossible to look after their mental health.6

Since their state of homelessness is often combined with substance abuse, mental health takes a heavier toll. Some of the co-occurring issues may include:10

• PTSD.
• Depression.
• Bipolar disorder.
• ADHD.
• Schizophrenia.
• Antisocial personality disorder.

What are the Addiction Treatments Programs available for Homeless People?

Addiction treatment is never easy, but it is even harder when one does not have a safe home, a circle of family and friends, and ultimately, finances. Many of the homeless lack the motivation to seek treatment, either because they have existential issues (e.g. finding food) or because they use the substances as a coping mechanism, therefore not wanting to cease.6

However, it is important for them to have treatment available. These are a few of the options:

• Therapy and Counseling. Organizations such as Care For The Homeless offer affordable, confidential and patient-centered therapy. Apart from counseling, they have other medical care available, like primary care, dental services etc. They focus on the homeless population in their work and take people in regardless of their financial status.11
• Medication Management. Treatment of addiction is often accompanied by prescribed, non-addictive medication. This may be expensive, especially for the homeless, but there are places such as The National Healthcare for the Homeless Council which help with accessing medication necessary for recovery.12

• Housing Programs. Secure and permanent housing is the main concern of the homeless and organizations like Housing First offer just that. They differ from other approaches in that they do not require sobriety or any similar precondition. They even offer services which help people with their addiction or mental health issues, allowing them to take the next step in life on their own.13
• Inpatient Treatment. In some cases, a stay in a rehab center or a hospital may be necessary. This is a legitimate and effective way of treatment which is also available for the homeless. The duration and nature of the stay will depend on the needs of a patient.14

How to Find Drug Rehab Centers for the Homeless?

Addiction treatment is a difficult task when it comes to the homeless, and requires extra effort on behalf of the rehab centers. It is often combined with mental health issues, but the biggest obstacle is naturally the lack of permanent housing and social support. That is why treatment includes attempts at housing rehabilitation, too.9 

American Addiction Centers is a place to start your search for a drug rehab center for the homeless, it is available nation-wide and offers different programs near you or someone you know is struggling.15 You can also call any of the hotlines to seek help:

• Care For The Homeless has a 24/7 available hotline for any medical service: 718 943 1341.11
• National Healthcare for the Homeless Council aims specifically at helping the homeless, you can contact them at: 615 226 2292.12
• Mental Health Services for the Veterans offers help to the veterans who have mental health or addiction issues, including those who are homeless. Namely, there were almost 20,000 sheltered homeless veterans, meaning that the total number is even higher.3  The National Call Center for Homeless Veterans is free and available 24/7 at 1-877-424-3838.16

How to Pay for Addiction Treatment for Homeless People?

Most of the homeless population is unable to pay for their treatment, considering the fact that they cannot even afford housing. This is an additional reason as to why they do not seek treatment – without a home, social support, or money, the motivation to quit substance abuse can be very slim. This is why it is necessary to have affordable or free treatment available for those in need.2,9

• Medicaid. This is a health program for low-income people. Although it differs among states, it offers health coverage for the eligible.17
• Medicare. Another organization where you can find financial coverage for your medical issues, including substance abuse.18
• Grants. The SAMHSA block grants are available to low-income individuals who seek any kind of treatment.19

Any help is better than none at all, so seek treatment and in case you have insurance, verify it with admissions navigators.

Frequently Asked Questions