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Updated on January 31, 2022

The Connection Between Homelessness & Substance Abuse

Understanding Homelessness

There is a strong connection between homelessness and addiction. Although these problems may not seem linked on the surface, they are often closely connected.

The lack of stability that comes with homelessness can lead to addiction. At the same time, those battling addictions are more likely to become homeless.

What is Homelessness?

According to the U.S. Department of Housing and Urban Development (HUD), homelessness is defined as “a person who lacks a fixed, regular, and adequate nighttime residence.”

The National Alliance to End Homelessness breaks this down further into two categories:

  1. Everyone staying in a place not meant for human habitation, including cars, parks, and public spaces.
  2. People living in emergency or transitional shelters and abandoned buildings.

Factors That May Cause Homelessness

Homelessness can occur due to a person's: 

  • Circumstances at home
  • Personal relationships
  • Level of drug and/or alcohol addiction, if present 

In general, though, there are three primary causes of homelessness:

1. Inability to secure or maintain employment

People with severe drug and/or alcohol addiction cases often can’t secure a job. Or, if they have a job, they may struggle consistently showing up to work on time.

This is usually because they’re tired and have trouble focusing. Such habits can result in job loss.

2. Addiction levels

Alcoholics and drug users have an increased need for money to support their habits. They sometimes steal from family and friends. 

In severe cases, they do anything just to fund their addiction, which leaves little money for housing.

3. Mental illnesses

Mental health issues, including anxiety disorders and bipolar disorders, can impact a person’s living situations. Severe mental health issues can exacerbate the risk of homelessness.

People with serious mental illness are sometimes unable to make sound decisions for themselves, including finding a safe place to live. 

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The Connection Between Addiction and Homelessness

Some of the most vulnerable and underserved populations are currently homeless. They live on the streets or in shelters and typically do not have access to:

  • Traditional recovery programs inside a treatment center or facility
  • Detox centers
  • Rehab programs
  • Substance abuse treatment

Mental health issues that homeless people face often lead to self-medication. Some people use alcohol or street drugs, which can lead to addiction.

When someone becomes homeless, they are automatically at risk for drug and alcohol use. Some people use these substances to dull the pain that comes with living on the street. For some people, drugs and alcohol act as a coping mechanism and a way to escape their reality.

Mental Health, Addiction, and Homelessness 

Not having a safe place to stay at night can cause insomnia. This may lead to substance use simply because it’s easier to find drugs than to find a bed for the night.

Many homeless people may also have post-traumatic stress disorder (PTSD). Traumatic events may have occurred in their lives, such as: 

  • War
  • Domestic violence
  • Rape
  • Assault
  • Theft
  • Molestation

Living on the streets may seem like a series of bad luck for some homeless people. For others, there may be a traumatic reason behind their situation.

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Addiction Treatment for the Homeless Population

It’s possible to be diagnosed with both a drug addiction and a mental health disorder. These are called co-occurring disorders or dual diagnoses. Both conditions must be treated, and professional, medical programs are equipped to handle these situations.

"People who are dually diagnosed with severe mental illness and substance use disorders constitute 10%-20% of homeless persons. They are a heterogeneous and extremely vulnerable subgroup with complex, poorly understood needs."

- Homelessness and dual diagnosis

Homeless people battling mental health and substance use issues may find support from: 

  • Substance Abuse and Mental Health Services Administration (SAMHSA) 
  • National Coalition for the Homeless 
  • Boston Health Care for the Homeless Initiative (BHCHP)

Some programs are solely focused on abstinence, while others are more concerned with damage reduction. Homeless populations can benefit from these programs, as they’re open to anyone.

The BHCHP, for example, recently launched the SPOT (Supportive Place for Observation and Treatment) program. Medical personnel from SPOT are on hand to examine and treat people with alcohol and drug abuse problems.

Wrapping Up

Homeless people have some of the most severe cases of mental health conditions. This is especially true because they do not have safe housing.

Understanding the relationship between addiction and homelessness can encourage us to address addiction treatment for the homeless population. It also provides insight into how to combat this substance use disorder (SUD).

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  1. "Substance Abuse and Homelessness." National Coalition for the Homeless, July 2009.
  2. Gomez, R et al. “Factors associated with substance use among homeless young adults.” Substance abuse vol. 31,1 : 24-34.
  3. "Yale Study Examines People in Housing with Substance Use Disorders." Substance Abuse and Mental Health Services Administration.
  4. Polcin, DL. “Co-occurring Substance Abuse and Mental Health Problems among Homeless Persons: Suggestions for Research and Practice.” Journal of social distress and the homeless vol. 25,1 : 1-10.
  5. Miler, JA  et al. “What treatment and services are effective for people who are homeless and use drugs? A systematic ‘review of reviews’.” PLoS ONE 16: e0254729.
  6. Garret, G. "Homelessness, Alcohol, and Other Drug Abuse: Research Traditions and Policy Responses." 23 March 1992.

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