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Substance Abuse And Addiction In The Homeless Community: How To Find Help

David Hunter, MA.Ed, LPC

Medically reviewed by

David Hunter, MA.Ed, LPC

February 11, 2019

Drug abuse and addiction, including alcohol abuse, is a risk factor for homelessness, to the extent it is one of the most frequently cited reasons for an individual becoming homeless. Fortunately, many individuals are able to find support and healing, so that they can begin living a more stable, sober life.

Understanding Homelessness

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2016, on one evening alone, 549,900 people were homeless. Of this number, over 176,357 were unsheltered, and 202,297 people had a severe mental illness or a chronic substance use disorder.

An individual confronting homelessness may be in one of three groups, as directly sourced from SAMHSA:

  • Unsheltered—living on the streets, camping outdoors, or living in cars or abandoned buildings
  • Sheltered—staying in emergency shelters or transitional housing
  • Doubled Up—staying with friends or family temporarily

Roughly 16 percent of the homeless population confronts chronic homelessness. As explained by SAMHSA:

“A person is considered to be experiencing chronic homelessness when he or she has a disability and has been continuously homeless for 1 year or more or has experienced at least four episodes of homelessness in the last 3 years where the combined length of time homeless in those occasions is at least 12 months.”

This population faces an especially high risk for substance abuse due to the greater levels of instability they face. Roughly two-thirds of this group have a primary substance use disorder or other chronic health condition, as detailed by SAMHSA.

Chronic health problems are often risk factors for substance abuse and addiction, as is crime, which also often precedes and accompanies homelessness.

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The Role Addiction Plays In Homelessness

Homelessness occurs from many reasons: poverty, lack of affordable or stable housing, domestic violence, and mental illness, to name only a few. Accompanying these are drug and alcohol abuse—one of the biggest risk factors that precedes homelessness.

On the other hand, while certain individuals may not have experienced homelessness as a result of a substance use disorder, many have become addicted to drugs or alcohol as a result of homelessness. In either case, continued substance abuse after the onset of homelessness quite often deepens the state of homelessness.

Whatever the connection, if an individual is facing both homelessness and a substance use disorder, it’s critical that they understand their treatment options, so that they can access them to their fullest extent for an opportunity to obtain a drug-free life.

In addition to alcohol, frequently abused substances include both illicit drugs and diverted prescription medications, including, but not limited to:

  • benzodiazepines (Ativan, Valium, Xanax)
  • cocaine, including crack
  • heroin
  • marijuana
  • methamphetamine
  • prescription opioids (fentanyl, methadone, OxyContin, Vicodin)
  • prescription stimulants (Adderall, Ritalin)

Research has found that rates of alcoholism run higher in older individuals, whereas abuse of other drugs is more pervasive within the youth and young adults. In many cases, drug or alcohol abuse begins as an attempt to self-medicate an untreated mental health disorder, before culminating as a full-blown addiction.

As a person becomes consumed by drug seeking and using, they quite frequently alienate loved ones, negate responsibilities within their job (often resulting in job loss), spend large amounts of money on the drug, and ignore important responsibilities (such as the payment of mortgages and bills). All of these factors can be risk factors for homelessness.

The Dangers Of Substance Abuse And Homelessness

Substance abuse exposes a homeless individual to a myriad of risks, including addiction, overdose, crime, violence, abuse, unsafe sex, greater financial instability, and mental and physical health problems.

Without stable housing and a support network, and as an individual is striving hard just to survive, it can be exceedingly hard to overcome these challenges, and in turn, to overcome a state of homelessness.

Today, drug overdose deaths are responsible for the greatest number of injury-related fatalities within our nation, an impact which is felt particularly hard within the homeless population. Emerging research shows that this group may face even higher rates of drug-related overdoses, as made evident by a study focused on the Boston homeless community.

This study found death rates 16 to 24 times higher than the state’s average, accounting for one in three deaths of homeless individuals under the age of 45. Over 80 percent of these deaths were attributed to opioids, a statistic which closely echoes the severity of our nation’s opioid epidemic.

Treating Addiction In The Homeless Community

Substance abuse treatment for homeless individuals needs to be more nuanced than treatment for those with stable housing, with special attention granted to the unique issues which shape a homeless person’s life.

Namely, during treatment, an individual needs to be supported in ways which allow them to regain the highest measure of self-sufficiency, most notably through housing, employment, medical care, and access to peer support networks. Treatment also builds coping, relapse prevention, interpersonal, and stress reduction skills to further stabilize a person’s health and life.

A primary component of substance abuse treatment is psychotherapy and counseling sessions, elements which are especially useful for those individuals confronting a co-occurring mental health disorder.

In addition to these behavioral health services, the National Institute on Drug Abuse asserts that in general, the most optimal treatment outcomes offer:

  • medication
  • medical services
  • family therapy
  • parenting instruction
  • vocational rehabilitation
  • social services
  • legal services

For an individual confronting the instability and uncertainty of homelessness, these services are made even more vital within rehabilitation from drugs or alcohol. Due to the complexity of these situations, inpatient drug rehabilitation programs quite often offer the most thorough and individualized measure of care, especially for those who require medically-supervised detoxification.

As many individuals become estranged from family while homeless, family therapy and support can be a bridge which begins building healing and communication, and in turn, fostering the growth of a support network. For these individuals and for those without family, peer support groups can also be transformative during this time.

Creating opportunities for stable housing, both during and after treatment, should be a priority within substance abuse rehabilitation, as should aftercare support. The National Coalition for the Homeless speaks on this:

“In addition to housing, supported housing programs offer services such as mental health treatment, physical health care, education and employment opportunities, peer support, and daily living and money management skills training. Successful supported housing programs include outreach and engagement workers, a variety of flexible treatment options to choose from, and services to help people reintegrate into their communities.”

Research shows that access to stable housing can markedly reduce instances of relapse. The most effective treatment programs will take this into account, and design a treatment plan which recognizes and fulfills these needs as much as possible.

After, and even during certain outpatient programs, sober living arrangements may be offered as part of treatment. For a homeless individual, this provides not only an opportunity for a continuous immersion within recovery principles and a sober lifestyle but access to stable housing.

A variety of state and federally-funded programs may offer free to low-cost treatment options, scholarships or grants and other programs for those individuals in need of assistance.for those individuals in need of assistance.

Once in treatment, sensitivity needs to be granted to those homeless individuals with unique concerns, such as youth, veterans, and LGBTQIA+ individuals of any age.

Substance Abuse And Addiction In Homeless Youth And Young Adults

The National Conference of State Legislatures reports “that on any given night there is approximately 1.3 million homeless youth living unsupervised on the streets.” Many of these individuals are runaways, and far too great a number, substance abusers.

Homeless young people are far more apt to start using drugs or alcohol at younger ages, more frequently than their non-homeless peers. In young adults (defined as those aged 12 to 24), one study found substance abuse rates to be two to three times higher than those associated with non-homeless individuals of the same age.

At an age when positive influences are especially needed, substance abuse more readily takes hold due to the lack of social and family support which accompanies this lifestyle. The aforementioned study reported that homeless youth face rates of alcohol and drug abuse ranging from 39 percent to 70 percent, noting certain research which found that 71 percent of homeless youth had an alcohol and/or illicit drug use disorder.

Within this age group, marijuana was found to be the drug of choice, however, illicit drugs are of great concern within this age bracket as well. Stimulant drugs seem particularly favored, with homeless youth using cocaine four to five times more, and amphetamine, three to four times more, than non-homeless youth.

Treating Addiction In Homeless Youth And Young Adults

Like all age brackets, certain risk factors precipitate and/or accompany homelessness in youth and young adults, with abuse (physical, sexual, and emotional) and mental health problems ranking high. Forty-five percent of this age group confronts mental health issues within one year.

For these reasons, effective treatment for these ages should offer dual diagnosis care which adequately addresses trauma and mental illnesses, should an individual requires these services. Huffington Post cautions that “LGBT young people aged 13 to 25 are 120 percent more likely to become homeless than their straight peers.” For these youths, we strongly recommend you consider an LGBT-friendly program.

At this age, schooling, family dynamics, employment opportunities, and the establishment of a healthy support network, are also of concern, to the extent they should be integrated into treatment as well. A variety of programs offer a treatment which is specially designed to meet the needs of individuals these ages.

Substance Abuse And Addiction In Homeless Veterans

Within the veteran population, the threat of homelessness looms large, and with it, the dangers of substance abuse. One-fourth to one-fifth of homeless Americans are estimated to be veterans. Of all homeless veterans, roughly 70 percent struggle with substance abuse.

As a whole, homeless veterans experience longer periods of homelessness than non-veterans, with an average of six and four years spent, respectively, according to a national survey of homeless veterans. The survey offers a sobering perspective on this: “Combat ought to be the most difficult experience of a veteran’s life, but many veterans go on to become homeless for eight or nine times the length of their deployments.”

With greater amounts of time spent living this way, comes greater health risks, including increased instances of substance abuse.

The survey details that 62 percent of homeless vets surveyed had lived two years or more homeless. Of these individuals:

  • 76 percent had a substance abuse habit
  • 61 percent had a serious physical health condition
  • 55 percent had a mental health condition
  • 46 percent had a dual diagnosis
  • 32 percent had all three conditions

All of these conditions contribute to an increased risk of death among homeless populations. Physical and mental health conditions can be both risk factors for the development and aggravation of a substance use disorder.

Treating Addiction In Homeless Veterans

Treatment for homeless veterans may be sought on an individual’s own accord or through the assistance of the U.S. Department of Veterans Affairs (VA). With the high incidences of co-occurring mental health disorders and serious physical health conditions, treatment should be individualized to meet any existing mental and physical health needs.

With the prevalence of post-traumatic stress disorder (PTSD) in the homeless veteran population, many of the most effective treatment programs offer services which focus on this dual diagnosis. The VA notes that certain methods show greater promise in the treatment of co-occurring PTSD and substance use disorders, specifically:

Treatment should also work to rectify any damage done to a person’s employment eligibility, family life, and/or academic ability so that they’re able to begin building a stronger life from the ground up.

Homelessness And Co-Occurring Mental Health Disorders

A great number of homeless persons struggle with a mental health disorder. The SAMHSA reports that of those encountering a state of chronic homelessness, roughly 30 percent have a serious mental illness, compared to only 4.1 percent of the general population.

Many homeless individuals with mental health concerns also battle a substance use disorder.
When this occurs it’s termed a co-occurring disorder or dual diagnosis. Either or both of these conditions may have preceded homelessness, become more severe because of it, or resulted from it.

Commonly occurring dual diagnoses include:

  • anxiety
  • attention deficit hyperactivity disorder (ADHD)
  • bipolar disorder
  • depression
  • personality disorders
  • post-traumatic stress disorder (PTSD)
  • schizophrenia
  • trauma (emotional, mental, and/or physical)

The American Psychiatric Association found that over half of those homeless individuals with a mental illness have a co-occurring SUD, including those linked to alcohol, cocaine, or marijuana.

While any form of mental illness may precede a substance use disorder, serious mental illnesses place an individual at an even greater risk for homelessness. The National Coalition for the Homeless cautions that those individuals with bipolar disorder or schizophrenia are especially susceptible to homelessness.

Dual Diagnosis Treatment For Homeless Individuals

The National Coalition for the Homeless writes that “Homeless people with both substance disorders and mental illness experience additional obstacles to recovery, such as the increased risk for violence and victimization and frequent cycling between the streets, jails, and emergency rooms.” To counter these risks, dual diagnosis treatment helps to establish protective and supportive factors within a person’s life.

Counseling and behavioral therapies, either in an individual or group setting, form the axis of dual diagnosis treatment. Examples of researched-based treatments for co-occurring disorders include:

  • motivational interviewing (MI)
  • cognitive behavioral therapy (CBT)
  • dialectical behavioral therapy (DBT)
  • family therapy and support program

In addition to psychotherapy sessions, mindfulness and stress management practices may also be taught, a combination which aids in healing and strengthens an individual’s ability to cope.

Severe mental illnesses make it difficult for an individual to perform basic, everyday tasks which are foundational to self-sufficiency, such as self-care, stress management, and household management.

These conditions may also make it difficult for a person to bond with other individuals. As a result of a person often becomes alienated from loved ones and caregivers who could otherwise aid them in maintaining a more stable life and living arrangements.

Dual diagnosis care for mental illnesses should help a person cultivate enhanced methods of self-care, basic life skills, and interpersonal skills so that they can better take care of themselves and develop and maintain meaningful, stable relationships. In fact, these goals should be addressed within any comprehensive program for the treatment of addiction where homelessness is of concern.

Contact today to learn more about addiction treatment for the homeless community.

National Coalition for the Homeless - Homeless Veterans

National Institute on Drug Abuse - Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)

Substance Abuse and Mental Health Services Administration - The TEDS Report

Substance Abuse and Mental Health Services Administration - Mental and Substance Use Disorders

U.S. Department of Veterans Affairs - PTSD and Substance Abuse in Veterans

US National Library of Medicine - Characteristics of Homeless Adults Who Died of Drug Overdose

US National Library of Medicine - Factors associated with substance use among homeless young adults

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