While many may stereotype all homeless people as addicts, could there really be a correlation between substance abuse and homelessness? Avenues Recovery explores below.
Homelessness. Addiction. Two rampant and tragic realities that plague America. Is there any correlation?
The relationship between substance abuse and homelessness is complex, with the two issues tightly intertwined and very often reinforcing one another. When analyzing the connection between the two, there has long raged the chicken-and-the-egg debate – which came first? Do people become homeless as a result of their addiction, or does their homelessness serve as a catalyst for their substance abuse?
In reality, both scenarios are true. Substance abuse can be both a cause and result of homelessness.
On the one hand, substance abuse can often lead to homelessness. When a person is addicted to drugs or alcohol, their new passion overtakes their life completely - causing them to neglect themselves, their schooling, their finances, and their relationships. If left untreated, substance abuse can wreak havoc on a secure and stable life, ultimately leading to significant financial problems, loss of employment, breakdown of support systems and relationships, and eviction from housing. The person struggling with addiction now finds themselves on the streets, turning an already awful situation into a nightmare come true.
On the other hand, homelessness can also serve as a powerful trigger for substance abuse for the following reasons:
Regardless of what came first, once on the streets, a vicious cycle will play out – the homeless addict has nothing but his next high to look forward to and will pursue it at the expense of all else. He will use, get high, crash, and use again… each use lowering his chances of finding stable employment and pulling himself out of his awful situation. The cycle continues until he either becomes clean and recovers or tragically succumbs to his addiction.
To be clear, not every addict will be homeless, and not every homeless individual will struggle with substance abuse. But it's clear that addiction and homelessness are two strongly related issues that can feed into one another.
When analyzing the statistics of substance abuse and homelessness in the United States, we learn two things:
1. Homelessness and substance abuse are both rampant issues in America.
2. There is no definitive answer to our chicken-and-egg debate – addiction can cause homelessness, but homelessness can cause addiction as well.
Let’s take a look at some numbers.
The statistics below showcase how addiction can cause homelessness.
· The 2020 U.S. Department of Housing and Urban Development (HUD)’s Annual Homeless Assessment Report (AHAR) reported that on one night in 2020, 580,000 people in the USA were homeless.
· In a survey conducted by the United States Conference of Mayors, 68% of cities polled responded that the top reason for homelessness in their region was substance abuse.
· A separate survey polling homeless people found that two-thirds of interviewees listed substance abuse as a major cause of their homelessness. When polling homeless military veterans suffering from SUD, very similar numbers were found.
· A 2019 survey by the city of Los Angeles found that of the city’s homeless population, 42% reported substance use as a primary cause of their homelessness.
· A survey by Crisis, a homelessness charity based in the UK, found that 38% of the UK’s homeless population reported substance abuse as a contributing factor of their homelessness.
On the flip side, the numbers below illustrate how homelessness can trigger addiction, as well as how widespread addiction is among the homeless population in general.
· According to HUD’s Annual Homelessness Assessment Report, approximately 202,297 homeless people suffer from severe mental illness or substance use disorder.
· A 2019 report by the Substance Use and Mental Health Services Administration (SAMHSA), as well as a report by National Coalition for the Homeless, found that in the US 26 percent of the homeless use drugs and 38 percent use alcohol or are alcohol dependent. (In comparison, about 15% of the average adult population abuses drugs within a given year.)
· Alcohol abuse is more common among the older homeless population, while younger homeless people tend to abuse drugs.
· A study published in the 2020 Journal of Addiction Medicine reported that 50% of people who used emergency shelters in Toronto, Canada admitted to past-year substance use, and 26% met the criteria for a confirmed substance use disorder.
· A 2019 poll of homeless people in the UK found that 69% of respondents reported drug or alcohol use within the past month, and 44% of respondents reported daily use.
The numbers prove that there is a veritable epidemic of homelessness in America. The question begs itself: Aside from substance abuse, why are so many people in the United States homeless? Below are some factors that may contribute to homelessness.
1. High housing costs – Many people simply cannot afford a down payment, monthly rent, or the mortgage payments necessary to put a roof over their heads. Reflectively, the numbers of homeless are especially high in areas with steep housing costs – like San Francisco, Los Angeles, Boston, and Seattle.
2. Poverty – It’s understandable that people who don’t know where their next meal is coming from will likely be unable to afford rent or mortgage payments. The first to go is their home – and it all spirals downward from there.
3. Unemployment – Similar to poverty, when a person loses their job, they struggle to make ends meet, and are at risk of finding themselves without a roof over their heads.
4. Mental Illness – A person suffering from severe mental illness (like depression, psychosis, anxiety, or schizophrenia) may be simply incapable of living in one set, stable environment, and will find themselves chronically homeless despite others’ repeated attempts to help them.
5. Domestic Violence – Particularly for vulnerable populations like women and children, domestic violence can serve as a major contributor to homelessness. Such individuals may need to flee abusive situations without safe housing arranged beforehand, and consequently land up on the streets.
6. Trauma and adversity – Adverse life events (like childhood abuse and neglect) can lead to trauma and significant mental illnesses, which prevent a person from maintaining stable employment and housing.
In addition to substance abuse, ill mental health is one of the leading causes (and consequences) of homelessness. An individual suffering from a significant mental illness can be expected to have difficulty retaining gainful employment, managing their finances, or finding and maintaining stable housing. On the other side of the coin, homelessness is strongly associated with mental illness, since the stress, trauma, and instability it brings can serve as a major cause or aggravator of a mental health condition.
According to the Office of National Drug Control Policy, at least 30% of the homeless population suffer from a serious mental illness. This tragic reality may be attributed to a recent shift in American public policy: in an effort to quickly empty psychiatric hospital beds, there is a growing trend of discharging mentally ill patients before they are ready to be released. Aside from the morally questionable nature of this practice, it increases overall taxpayer costs by filling high-cost jails and detention centers. (The only party who benefits from this is the healthcare system.)
Mental illness will very often develop as a result of a neglectful or abusive childhood, especially when raised by parents who are mentally ill and/or substance dependent themselves.
A New York City study of alcohol-dependent, homeless people revealed that two thirds of the participating individuals came from dysfunctional homes with abusive, alcoholic parents. All of them began drinking as a child, and nearly all of them left home by age 18. More than half of the study participants suffered from a significant psychological disorder, such as psychosis, anxiety, and mood disorders.
Homelessness and substance abuse are each significant issues in their own right, and when combined, a number of dangers arise. Below are some of the risks facing homeless drug or alcohol addicts.
1. Overdose. Homeless people who abuse drugs are at a higher risk of overdose, since they lack access to critical overdose-reversal medication and emergency medical services. Additionally, homeless people often use alone, which means there is no one to call for help should they begin overdosing.
2. Infectious diseases. Lack of access to sterile needles, and highly unsanitary living conditions both contribute to an increased risk of homeless individuals contracting infectious diseases like HIV/AIDS and Hepatitis C.
3. Mental Illness. As previously explained, the challenges of addiction coupled with homelessness can trigger or exacerbate mental health conditions, especially in already-vulnerable individuals. Lack of access to support and mental health services makes finding help very challenging.
4. Legal Issues. Homeless people who abuse drugs or alcohol are at a high risk of arrest and incarceration, which only worsens physical, social, and mental health problems while withholding them from crucial treatment.
5. Social Isolation. One of the distinct features of homelessness is social isolation – and isolation is the #1 cause of substance abuse, poor mental health, and other issues.
6. Health Conditions. Homelessness significantly limits access to healthcare, which may cause delayed medical treatment when ill, lack of preventative care, and the development of new physical health conditions.
Homelessness and addiction are grave, pervasive issues that plague our nation; a tragic reality that impacts lives every day. But what is the path forward? How do we deal with this reality and create opportunities for this vulnerable population to build their lives anew?
This question has been asked by activists, policymakers, and relief workers alike. It’s easy to ask questions, but it’s a lot harder to give answers. As complex as homelessness and addiction are, so must be our response – a response that addresses the many social, mental, economic, and health-related issues that cause these problems. Some strategies suggested include:
· Increasing access to affordable housing (rental subsidies, supportive housing, rent control etc.).
· Increasing access to quality substance abuse treatment (counseling, MAT, peer support).
· Providing mental health counseling and services(therapy, medication, emotional support).
· Increasing access to healthcare (clinics, preventative care, chronic condition management etc.).
· Expanding employment opportunities for homeless and addicted populations.
· Providing social support services (education, training, peer support groups etc.).
· Addressing structural inequalities (such as poverty, racism, and discrimination).
The challenges that face us are great, but we are greater. With a strong commitment to reform and a spirit of perseverance, we can work on removing the stereotypes and barriers that so often challenge this vulnerable population. Small actions can amount to big changes!
If you know someone who is homeless and struggling with substance abuse or another mental health issue, the following organizations can help:
If you or a loved one are struggling with a substance use disorder, know that help is available, and there is always hope for a better future! Reach out to Avenues Recovery Center to speak to a friendly and knowledgeable addiction specialist for advice and guidance. Begin your journey home today!