“Once the heroin and crack addiction turned me into a homeless prostitute, I pretty much gave up on life. Laying there in a bed just staring into this mirror, I would sometimes see the beautiful little girl I used to be looking back at me,” recalls Lisa S. in her story at Heroes In Recovery. “One morning, I reached out to her and decided to save her.”
Such is the sordid relationship between substance abuse and homelessness, often bonded together by woundedness and despair. To find a brighter tomorrow, hope and courage are desperately needed. Michael’s House can help you or your loved one find the courage to begin recovery.
Research seems to point us to substance use disorders as a major factor contributing to or perpetuating homelessness. But can’t homelessness lead to substance abuse?
Is It a Simple Matter of One Causing the Other?
Prevalent stereotypes and stigmas in the world today often dismiss those who are homeless as simply drug addicts or alcoholics. Lisa S., quoted above, would probably be the first to admit that she took some wrong turns along the way in life. But, then again, life can deal out more than a fair share of trauma, stress, pain, and other negative factors that tremendously impact our lives.
Trying to answer the“the chicken or the egg” question, researchers have made a clear discovery. According to the National Coalition for the Homeless, addiction can be both a cause and a result of homelessness.2 To further complicate matters, mental illness is often an underlying cause of addiction and, therefore, homelessness as well. This fact makes negative stereotypes about addiction and homelessness all the more ill-founded.1
Understanding Homelessness
In most cases, homelessness is a temporary circumstance – not a permanent condition. It does not encapsulate who people are. So, from that perspective, the number of people who are homeless is very fluid – not static, as often naively thought. This population is determined through a snapshot in time.2
Actually, defining who is “homeless” can vary considerably, depending on the source and context used. But generally, the homeless are those who “lack a fixed, regular, and adequate night-time residence.”
Statistically, more than a half-million people are sleeping outside or in an emergency shelter or transitional housing program on any given night, reports the National Alliance to End Homelessness.3
The circumstances for “homelessness” can take various forms. People may experience it by being:
- Unsheltered – Living on the streets, camping outdoors, or living in cars or abandoned buildings.
- Sheltered – Staying in emergency shelters or transitional housing.
- Doubled up – Residing with friends or family temporarily.4
Homeless people suffer disproportionately from all health problems, and drug abuse and addiction are no exceptions.5
Substance Abuse Frequently Accompanies Homelessness
Research indicates that substance abuse is more common among the homeless than with the general population. It is estimated that:
- About 38% of the homeless abuse alcohol.
- Alcohol abuse is more common among the older set within the homeless population.
- About 26%of the homeless abuse drugs other than alcohol.
- Drug abuse is more common among younger homeless people.
A survey conducted by the United States Conference of Mayors asked 25 cities to share the top reasons for homelessness in their region. 68% reported that substance abuse was the number one reason among single adults. According to a separate research survey, two-thirds of the homeless who were interviewed reported that abuse of drugs and/or alcohol was a major cause of their homelessness. Very similar numbers are reported for homeless military veterans suffering from a substance use disorder.6
In other words, the correlation is clear: substance abuse is a major contributing factor for many people becoming and remaining homeless.
To cope with highly stressful life situations – such as family conflicts or dysfunction, traumatic loss or harm, devastating medical condition, abrupt career detour or disastrous financial loss, the newly homeless may turn to alcohol and/or drugs in an effort to self-medicate.
Once alcohol and/or other drug dependence forms, research points to users becoming even more entrenched in substance abuse. If this downward spiral is set against the backdrop of homelessness, it is only too obvious that these circumstances are rife with obstacles to attaining relief and recovery.1
Mental Health Issues and Homelessness
It is estimated that about two-thirds of the perpetual homeless have a primary substance use disorder or other chronic health condition, according to the Office of National Drug Control Policy. In addition, roughly 30% of people experiencing chronic homelessness have a serious mental illness.
Altogether, such physical and mental health issues may create difficulties in accessing and maintaining stable, affordable, and appropriate housing for an individual, or an entire family.4
Shifts in American public policy over the last few decades may account for the high number of mentally ill people(many of whom are substance abusers) living on the street. A trend is underway of releasing mentally ill patients as quickly as possible in order to free up hospital beds. While dumping patients out of psychiatric hospital beds saves the health care system money, it actually increases taxpayer cost overall by shifting care to more expensive jails and prisons. There’s also the question of what’s morally right.7
Alcoholism and Homelessness
A study of chronically homeless, alcohol-dependent people in New York City was conducted. All of these individuals began drinking as a child. They quickly became dependent on alcohol. It was found that over two-thirds of them were children of alcoholic parents. Many of them suffered abuse in their very own home. And nearly all of them left home by the age of 18. More than half of them had a psychological disorder. Common diagnoses are psychosis and anxiety and mood disorders.8
So, alcohol dependence in childhood often contributes to chronic homelessness. In such cases, alcohol may be a higher priority than paying for housing. Extending that thought, when an alcoholic doesn’t meet such basic needs, it is less likely that treatment and recovery will occur. This can lead to frustration and depression, which in turn fuels more alcohol abuse. It is truly a vicious cycle – one that can spin out of control for an entire lifetime…IF expert help isn’t sought.
Data collection on the homeless and their addictions, at any given time, is difficult to obtain. For one thing, the homeless are not usually included in census data. Also, the homeless in shelters may underreport their alcohol consumption if a condition of their stay is to remain abstinent.9
Treating the Homeless Population: What Works Best?
Less than 25% of homeless people with an alcohol and/or drug addiction are likely to get needed treatment. A comprehensive approach is vital for addressing the many factors involved in homelessness.
A review of 20 facilities offering substance abuse treatment to the homeless found these characteristics:
- Housing access –A stable living environment is a critical factor in recovery of the homeless.
- Well-trained staff –Compassionate, flexible and experienced care is vital to an effective program.
- Client-centered services –A tailored treatment plan can provide a better pathway to recovery than a one-size-fits-all program.
- Integrated services –Since the homeless often have co-occurring mental issues, having multidisciplinary professionals in-house can provide centralized, coordinated treatment for greater effectiveness.
- Comprehensive services –Addressing the many complex needs of a homeless person – including survival and social needs – treats homelessness holistically (treats the whole person, rather than just symptoms).10
While psychiatric hospitals and emergency rooms are where the homeless are often treated, other options exist. Non-hospital residential and outpatient programs often provide a broader menu of services. The most common type of residential treatment for the homeless is hospital detox. Outpatient treatment methods include individual counseling, outpatient detox, and 12-Step programs. But, alas, outpatient care does not provide housing – a critical factor to the homeless.
Additional housing options for the homeless that are sensitive to substance use and mental issues include:
- Sober or dry housing – Strict abstinence policy. Substance use can result in termination of housing.
- Damp housing – People both with and without substance use disorders live together. Abstinence is not monitored. However, illicit substances are prohibited. Alcohol use in public spaces is off limits. In addition, treatment services may be offered.
- Wet housing – Uses a harm-reduction approach that refers clients to substance abuse treatment services. However,it does not require participation. Alcohol use, but no illicit substances, permitted.11
Sources
1 “Substance Use: Pathways to Homelessness? Ora Way of Adapting to Street Life?” HeretoHelp. 2007. Accessed 11 Nov. 2017.
2 “How Many People Experience Homelessness?” National Coalition for the Homeless. 15 December 2011. Accessed 11 Nov. 2017.
3 “The State of Homelessness in America.” National Alliance to End Homelessness, 2016. Accessed 11 Nov. 2017. Accessed 11 Nov. 2017.
4 “Homelessness and Housing.” Substance Abuse and Mental Health Services Administration. 29 June 2017. Accessed 11 Nov. 2017.
5 “Overdose Deaths among Homeless Persons.” National Institute on Drug Abuse. January 2013. Accessed 11 Nov. 2017.
6 “Opening Doors: Federal Strategic Plan to Prevent and End Homelessness.” United States Interagency Council on Homelessness, As Amended in 2015. Accessed 11 Nov. 2017.
7 “250,000 Mentally Ill Are Homeless. 140,000 Seriously Mentally Ill Are Homeless.” Mental Illness Policy Org. Accessed 11 Nov. 2017.
8 “Voices of Homeless Alcoholics Who Frequent Bellevue Hospital: A Qualitative Study.” PubMed.gov, U.S. National Library of Medicine. February 2015. Accessed 11 Nov. 2017.
9 “Alcohol Use Disorders in Homeless Populations.” National Institute on Alcohol Abuse and Alcoholism. March 2005. Accessed 11 Nov. 2017.
1o “.” National Health Care for the Homeless Council. August 2003. Accessed 11 Nov. 2017.
11 “Behavioral Health Services for People Who Are Homeless.” National Center for Biotechnology Information. 2013. Accessed 11 Nov. 2017.
