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 stays 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

The Connection Between Addiction and Homelessness

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

The National Coalition for the Homeless found that 38% of homeless people are alcohol-dependent. Meanwhile, 26% are dependent on other substances.

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

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Mental Health, Addiction, and Homelessness 

The difficult conditions and stress of living on the street can cause people to self-medicate with harmful substances. This can often lead to co-occurring disorders (dual diagnosis), which involve struggling with a mental illness alongside AUD.

Not having access to safe, affordable housing 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), which can lead to substance abuse. Traumatic events may have occurred in their lives, such as: 

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

"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

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The Connection Between Homelessness & Substance Abuse

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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. If they have a job, they may struggle to show up to work on time consistently.

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

2. Drug and Alcohol Dependence

People who struggle with drug and alcohol abuse will often do anything to continue abusing substances. This is often because they've become dependent on the substance, which causes uncomfortable withdrawal symptoms when they stop using drugs or alcohol.

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

• Stealing from family and friends
• Making poor financial decisions
• Having legal troubles

3. Mental illnesses

Mental issues can impact a person's living situation. Severe mental health issues can further exacerbate the risk of homelessness.

These mental health issues include:

• Anxiety disorders
• Bipolar disorders
• Schizophrenia
• Major depressive disorders

People with serious mental illness sometimes cannot make sound decisions for themselves, including finding a safe place to live. 

Teenage Homelessness & Substance Abuse

Many homeless teenagers and young adults struggle with SUDs. Teenagers aged 12 to 17 are at a greater risk of homelessness than adults.

Factors that contribute to teenage homelessness and substance abuse include:

• Severe abuse
• Growing up in a homeless family
• Genetic substance abuse
• Coping mechanisms for stress
• Co-occurring disorders
• Early exposure to substances and substance abuse
• Running away from home

LGBTQ Homelessness & Substance Abuse

Members of the LGBTQ community suffer from high rates of drug and alcohol use. They also risk homelessness more due to cultural/societal exclusion and minority stress.

Homeless homosexual Americans are often subjected to more violence and sexual assault compared to heterosexual people. Homelessness is also more common in the transgender community.

They also struggle with the side effects of substance abuse and homelessness, which include:

• Depression
• Anxiety
• PTSD
• Suicidal ideation

Addiction Treatment for the Homeless Population

Those who struggle with co-occurring disorders can be difficult to treat. This is because the condition requires both substance abuse and mental health treatment.

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 focus solely 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.

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Summary

Homelessness and addiction are closely linked due to the stress of not having safe and secure housing. Homeless individuals often use harmful substances to self-medicate or to escape from reality.

Various factors contribute to homelessness and addiction, such as unemployment, dependence, and mental health disorders. Teenagers and minority groups, like the LGBTQ community, are also at risk of homelessness.

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

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