Myth #1: Most Homeless People Are Either Mentally Ill or Have a Substance Use Disorder

Because homelessness, substance abuse and mental health issues often occur together, a cookie-cutter approach to the problem doesn’t work. It’s not enough to offer shelter and food to someone who is a paranoid alcoholic. Few programs aimed at the homeless include treatment for substance abuse, so those who work with these populations must get creative with their approach to treating individuals. Homeless individuals with co-occurring addiction and mental illnesses often find it difficult to get help.

How to Manage Stress Without Relying on Substances

Many communities offer state-funded treatment facilities for low-income and homeless people who require substance abuse and mental health treatment. Additionally, thanks to the passing of the Affordable Care Act, more rehab facilities are accepting Medicaid and Medicare. Substance abuse often emerges or escalates when individuals lack secure housing, and underlying addiction can make stable housing difficult to maintain.

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• Similarly, Lexi Taylor-Hill, co-ambassador for the Oklahoma City Youth Action Board, said another oft-heard (but incorrect) notion is that children become homeless by running away out of disobedience to their parents’ authority.
• Some people take buprenorphine for years as a maintenance medication because it’s so effective.
• The top two causes were finding a job that paid a sustainable wage, and finding housing that’s affordable.
• Research consistently highlights a close link between substance misuse and homelessness.

Homeless individuals may live in a shelter, transitional housing, or a car or bounce around from place to place, staying with people they know. Community support services play a vital role in ongoing recovery by fostering connection and accountability. Peer support groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) provide individuals with a sense of belonging and shared understanding. These groups offer a platform for sharing experiences, challenges, and strategies for maintaining sobriety, ensuring that individuals have ongoing support throughout their recovery journey. Economic evaluations consistently affirm that it is more cost-effective to provide housing and integrated care than to manage the fallout of untreated addiction among unsheltered populations.

Homelessness itself poses numerous environmental stressors that drive individuals to substance use as a coping mechanism. Exposure to exposure to harsh living conditions, hunger, trauma, and violence—especially among vulnerable groups like youth, women, and LGBTQ individuals—further catalyzes substance dependency. The lack of access to healthcare, mental health services, and shelter intensifies these risks.

Due to their financial situation, they also don’t have access to the level of care needed to address their drug, alcohol, and mental health issues. State Medicaid programs, including Washington’s, are required by federal law to cover medication for opioid use disorder, but any big funding cuts could force states to place caps or other limitations on high-cost drugs. For now, Fotinos said, the state wants to support what she sees as advances in addressing the fentanyl crisis. Initiatives like distributing Narcan (Naloxone), which can reverse opioid overdoses, and providing overdose education save lives and serve as entry points into treatment. These approaches recognize that harm reduction does not solely focus on abstinence but on minimizing health risks and engaging individuals in care. Many studies emphasize the significance of social influences, such as peer groups and street culture, in reinforcing substance use behaviors.

“We know how to treat substance use, but it is hard to do that while people are still homeless. Many respondents expressed that they wanted to receive treatment for their substance use disorder but were unable to access it. Just 7% said they were in treatment in the weeks surrounding the study, but 21% said they wanted to get treatment and were trying but were unable to get the care they needed. While the study is limited to California, the researchers said the results are likely to reflect similar patterns across the nation, particularly in regions with a high percentage of unsheltered homeless people. The CASPEH team administered 3,200 surveys and 365 in-depth interviews with people experiencing homelessness between October 2021 and November 2022 in eight regions of California representing urban, rural and suburban areas.

By analyzing the data behind these complex relationships, service providers, policymakers, and community members can design interventions that tackle housing and substance use simultaneously, rather than treating each in isolation. About 65% of people experiencing homelessness reported using illicit drugs regularly, or at least three times a week, at some point in their life. There are a lot of assumptions surrounding the topic of “why people become homeless”, especially here in Orange County. While discussing this topic, I often hear people cite mental illness or substance use disorders as the primary cause of homelessness. However, the data from studies looking into these topics and the stories that I hear from clients that I work with do not support this narrative.

• But Culhane said even a substantial increase in that rate wouldn’t equate to a direct tie between addiction and homelessness in the way the El Cajon mayor implied.
• We extracted ICD-10-CM codes in the veteran’s inpatient and outpatient records for one year following the index date.
• Comorbid MHDs and SUDs were examined in detail by diagnosis type, and healthcare use by addiction to CNS stimulants and depressants.
• A more contemporary epidemiological study is needed as an update to these older studies.
• Using a study period from July 1, 2021, to June 30, 2023, we extracted data on a cohort of 5,402,062 veterans (including 181,131 homeless veterans; 29,166 HUD-VASH veterans; and 5,191,765 independently housed veterans).

8 vouchers and case management services through the VA, and exists in all 50 states. Eligibility for the program are veterans who are experiencing homelessness, meet the criterion of low-income (i.e., 80% of the Area Median Income), and have a need for case management as determined by VA20. A deeper analysis of homeless veterans with different types of addictive disorders revealed some interesting findings. Homeless veterans with addiction to CNS stimulants generally tended to use less outpatient health care services, but were more frequent users of emergency department services than those with addiction to CNS depressants. The exception was among homeless veterans with severe MHDs and addictive disorders, which found no difference between those addicted to CNS simulants versus depressants on use of emergency department services.

Additionally, mental health issues frequently co-occur with substance use and homelessness, further complicating recovery efforts. Research consistently highlights a close link between substance misuse and homelessness. Studies reveal that more than a quarter of homeless individuals, and in some reports up to 70%, struggle with alcohol or drug dependence. Substance use among this population frequently acts as a coping mechanism against the stress, trauma, and harsh living conditions they face on the streets.

The potential breakthrough comes as fentanyl continues to kill hundreds of people in King County each year, many who are homeless, and as elected officials turn to arrests to crack down on people who use it in public. They say they have reached a point of compassion fatigue when it comes to drug users and the homeless. “We are making arrests. I know you’re not there 24 hours a day but we are and there are times when we are making arrests, times when we are in other parts of the city but we’re going to be relentless,” promised SFPD Assistant Chief David Lazar. Incident reports from SFPD show from April 2024 to April of this year, there have been 5,163 reported drug-related arrests and citations–an increase of 25 percent from the past three years.

In order to successfully treat addiction and homelessness, barriers to treatment programs must be removed. It’s hard enough for homeless people to meet their daily needs, let alone jump hurdles to receive treatment. For example, most homeless people lack access to transportation, even public transportation. Providing transportation to meetings and recovery centers or public transportation vouchers for are most homeless drug addicts the homeless is just one step that cities serious about helping to end homelessness and drug addiction can take to help homeless addicts get sober.

To address the obvious need for more drug treatment, King County has added treatment beds, including a much-needed detox facility on Beacon Hill, and is launching a treatment-on-demand program. The other thing we know about being homeless is that if you’re living on the street, self medicating may be the only way you can get through the day. After living a life of chaos, destruction and constant let downs, Mark was able to make a complete turnaround that sparked a new way of life.

Multimorbidity of mental health and substance use disorders among housed and homeless U.S. veterans

These caring counselors, therapists and others offer guidance and compassion throughout your stay at 12 Keys Rehab. Our approach includes mind, body, spiritual and family components that provide a holistic framework for recovery. However, alcoholics and drug addicts seldom consider this when they’re in the middle of a binge, or their addiction gets the best of them. It may be up to family members and friends to conduct an intervention or encourage someone they love to get help before it’s too late. The statistics on homelessness and substance abuse tell a compelling and troubling story. The following statistics are for single people only and do not include families or children who are homeless.

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These findings suggest there are some similar patterns among veterans in general, but also the heterogeneity of clinical needs among veterans in different states of housing and homelessness. Further research is needed to pinpoint if and how these different patterns of MHDs and SUDs contribute to or are the consequence of homelessness through longitudinal studies to examine any differential outcomes. Compared to independently housed veterans, HUD-VASH veterans were younger (i.e., less likely to be 70 or over); more likely to be non-Hispanic black, unmarried, and to have none/0% VA service-connected disability. HUD-VASH veterans were also more likely to have alcohol and drug use disorders; mood, anxiety, and stress disorders; and comorbid MHD and SUD diagnoses than independently housed veterans. It is also inaccurate to pin King County’s homeless crisis just on substance abuse. The county’s 2017 point-in-time count of homelessness included a survey of homeless people, and about 36 percent acknowledged a substance-abuse problem.

How to Stay Sober During Difficult Times

Detox, along with individual counseling and twelve-step programs, address the patient’s living situation. Because the homeless often suffer from comorbid conditions, they need access to an experienced, multidisciplinary team of healthcare professionals on-site that can coordinate customized treatment plans for these patients. In order for treatment to be successful, homeless addicts need access to stable, safe housing while in recovery. It’s also important that staff at a treatment center are flexible and experienced in caring for this part of the community. When homeless rates are calculated, they are often calculated based on how many people in a given night are sleeping either on the street, in shelters, or in transitional housing. Homelessness is usually defined as a person who lacks a fixed, regular, or adequate nighttime residence.

Unfortunately, they also experience homelessness at a much higher rate as well. Members of the LGBTQ community, especially young adults, have a 120% higher risk of experiencing homelessness. “One could argue that it is inadequate treatment supports or inaccessible housing that are bigger drivers, because having these conditions doesn’t result in homelessness in and of themselves,” Culhane wrote in an email. Culhane said that crisis may have increased the rate of substance abuse addiction by 20 percent – or even more.

“That would be a nonstarter,” said Charissa Fotinos, Washington State Health Care Authority’s Medicaid and behavioral health medical director. The oral form of the medication is much cheaper than its injectable counterpart. Monthly injections cost between $1,600 and $2,000, while oral options are about four to five times cheaper.