Homelessness and addiction
Homelessness and addiction are deeply intertwined issues that affect many individuals and families, particularly in urban but also in suburban and rural areas. In the United States, over 580,000 people experienced homelessness on a single night in January 2020, with significant representation among marginalized communities, including racial and ethnic minorities, LGBTQ youth, and veterans. The pathways into homelessness often include factors such as poverty, job loss, domestic violence, and health care inadequacies. Substance use disorder plays a dual role in this context; it can both lead to homelessness and be exacerbated by the experience of being homeless.
The rates of substance abuse among the homeless population are notably higher than in the general population, often co-occurring with mental health challenges. Individuals facing homelessness may use substances as a coping mechanism, which can further complicate their ability to seek treatment. Limited access to affordable long-term care and treatment options perpetuates this cycle, emphasizing the need for integrated approaches that combine housing solutions with comprehensive support for addiction and mental health. Addressing these interrelated issues is vital for fostering recovery and stability for those affected.
Homelessness and Addiction
Definition: Homelessness is the state of not having a stable, adequate place of residence. Homeless persons include those sleeping outdoors and in buildings not intended as housing and persons temporarily dwelling in shelters or other institutions meant to lodge people without permanent housing. Substance use disorder can precipitate and develop from homelessness. Conversely, homelessness is often a consequence of substance use disorder.
Prevalence and Patterns of Homelessness
Though homelessness is difficult to measure, various governmental and nonprofit agencies estimate that in January 2020, more than 580,000 people were without a permanent place to sleep on a given night in the United States. The majority of people who experience homelessness are located in urban areas, but the phenomenon also exists in suburban and rural areas.
The number of people who face homelessness rose dramatically in the last decades of the twentieth century, and it continued to increase in the first decade of the twenty-first century as the foreclosure crisis in the United States displaced families and as addiction rates rose. The homelessness rate next experienced decline through the 2010s and into the 2020s. Families with children accounted for more than 171,000 people experiencing homelessness in 2020. That same year, there about 34,000 unaccompanied youth under the age of 25 experienced homelessness. Women and girls represent about 30 percent of the homeless population, while less than 1 percent identified as either transgender or gender nonconforming individuals. Individuals and families who experience poverty have the highest probability of becoming homeless and demographic groups with high poverty rates are overrepresented among the homeless.
The racial and ethnic makeup of the homeless population reveals a striking disparity, with African Americans being overrepresented. Though African Americans represented only about 13.9 percent of the total US population in 2020, they accounted for 40 percent of persons experiencing homelessness. Native Americans and Alaska Natives, as well as Hispanics/Latinos, also are overrepresented, but to a lesser degree, comprising about 3.3 percent and 22.5 percent of the homeless, respectively. Similarly, multiracial individuals constituted 6.1 percent of the homeless population. White Americans and Asian Americans are underrepresented and constitute 48.3 and 1.3 percent of the homeless, respectively. Other groups that are overrepresented among the homeless population are military veterans, people with mental illness, and persons with a substance use disorder. About 49,000 people experiencing homelessness on a single night in January 2020 had a pattern of chronic homelessness.
Homophobia and transphobia can be other contributing factors. According to the National Network for Youth, in 2020, youth who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) make up an estimated 7 to 9 percent of the overall youth population, but comprise about 40 percent of youth experiencing homelessness.
Causes of Homelessness
Although many factors contribute to homelessness, several factors are particularly prevalent. Poverty and job loss are leading factors. Persons who are unemployed or underemployed and those who work for less than a living wage often cannot afford housing. Low wages and insufficient social welfare benefits often cannot match increased costs of living, leaving many in debt and unable to pay their bills. The decreases in the availability of affordable housing and subsidies, along with the increased number of foreclosure-related evictions, have led many families to homelessness. Among LGBTQ youth, many reported being thrown out of their homes or running away because they feared violence at home.
Health care, domestic violence, incarceration, mental illness, and substance use disorder also are related to homelessness. Lack of affordable health care is one problem that can leave individuals and families with an insurmountable debt that precipitates homelessness. Many women and children are affected by domestic violence, and those who live in poverty may become homeless after leaving an abuser. Domestic violence shelters limit the amount of time a woman and her children can stay, and women without the resources to secure housing confront the prospect of extended homelessness when they leave.
Formerly incarcerated persons often lack the resources and job opportunities needed to acquire housing upon release from jail or prison and face the additional challenge of being ineligible for government-subsidized programs because of their criminal records. Persons who have a severe mental illness are at risk of homelessness, as they often have difficulty living independently and do not have adequate access to programs and supportive housing options. Substance use disorder also can contribute to or extend homelessness, affecting approximately 30 percent of chronically homeless persons. Alcohol is the most commonly used substance among this population.
Substance Abuse and Addiction
Substance use disorder can both precipitate and develop from homelessness because it often causes problems within family and work relationships, which can lead to homelessness, particularly for those with a limited income. For others, homelessness serves as an introduction to substances of abuse, which are often used to cope with the difficulties of being homeless. Rates of abuse and addiction are substantially higher among the homeless than among the general population, and substance abuse often co-occurs with mental illness. Homelessness can exacerbate addiction or misuse, as the increased pains of homelessness and the immediacy of survival take precedence over treatment.
Treatment options are severely limited for those who cannot finance in-patient programs, which often only involve short stays of a few days and then the eventual return to the streets or to shelters. A lack of long-term comprehensive care has prompted researchers and advocates to recommend nationwide implementation of integrative housing, treatment, and support programs that address not only issues surrounding substance abuse and addiction but also those additional problems that result from homelessness and mental illness.
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