The number of homeless people in the United States exceeds three-quarters of a million people, and about one-quarter of those are children. Homeless people may be temporarily or intermittently homeless, with the chronically homeless being rarer.

Substance abuse among the homeless population is perhaps the most important public health problem in this vulnerable population. Estimates vary, but studies reveal that from 40 to 50 percent of homeless people are dependent upon alcohol or other drugs. There is little debate that substance abuse and full-blown drug addiction are significantly higher among the homeless than in the general population.

Substance Abuse Causes Homelessness and Vice Versa

Which comes first, homelessness or drug addiction? The answer is, “It depends.” For some people, drug abuse begins as a coping mechanism for life on the streets. For others, drug addiction leads to homelessness. However, the order in which the problems present themselves is secondary to the importance of addressing both problems.

Among older homeless people, alcohol is the drug of choice, but other substances, including opioids, are more widely used among younger homeless people. Homeless youth are also likely to use or abuse illicit substances. The American Journal of Public Health estimates that two-thirds of homeless youth living in shelters used alcohol to some extent. Other studies put the figure for youth at closer to 80 percent.

Economic and Mental Health Problems Are Major Factors in Homelessness

Unfortunately, many people think that alcoholism or drug abuse is the only reason people end up on the streets, but that is far from the truth. Poverty, unemployment, underemployment, mental illness, and physical disability all contribute to homelessness. When a homeless person suffers from mental illness or physical disability, the chances of drug addiction rise further. These problems can be exacerbated by prejudices, particularly against the LGBTQ homeless population.

Once a person becomes homeless, a cascade of effects follows. Their overall health declines, they have a harder time finding employment, and obtaining the basics like food and clothing become exponentially more difficult. In other words, homelessness makes existing problems worse, while causing its own set of problems.

Overdose Deaths Among Homeless People

Drug addiction

Homelessness and drug addiction are often found together, and each makes the other worse.

In the general population, heart disease is the number one cause of death, but in homeless people, drug overdoses were the leading cause of death during the years 2003-2008. The good news of falling death rates among the homeless from HIV has been more than offset by rising deaths due to drug overdose. Painkillers and non-heroin narcotics are major factors in these overdose deaths.

Homeless people suffer disproportionately from drug and alcohol abuse and from all health problems. Trying to separate out drug addiction treatment from addressing homelessness itself is short-sighted.

Recovery Programs Must Address Housing Issues for the Addicted Homeless

Maximizing treatment effectiveness and efficiency among homeless people requires that programs address housing needs, from rapid rehousing up-front to long-term housing solutions. Additional clinical and social services are necessary for successful drug addiction treatment among homeless people compared to services for the general population.

States are being encouraged to expand the availability and understanding of medications like Narcan for treating acute overdose, and of longer term treatment methodologies for opioid addiction such as buprenorphine. At the same time, organizations that serve the homeless are encouraged to train their workers and volunteers in overdose response planning.

Honesty Is Step One to Recovery

Reaching out for help can be profoundly difficult, and this may be particularly true for homeless people. The fact is, reaching out with honesty about your living situation is essential to accessing the services you need to address your substance abuse disorder and your housing situation. If you have questions or want to know more about drug addiction treatment, we encourage you to contact us at any time.