Homelessness and Substance Use: The Numbers Don’t Tell the Whole Story

written by Lisa Stand
April 14, 2014

With today’s blog post we’re taking a special look at homelessness and substance use disorders in recognition of Alcohol Awareness Month.

It’s not uncommon for people experiencing homelessness to also struggle with alcohol and drug problems. In the 2013 homeless Point-In-Time Count, one in five people experiencing homelessness said they had a chronic substance use disorder. The proportion of chronically homeless people with substance use disorders is estimated to be much higher, and the condition frequently co-occurs with mental illness.

As troubling as these numbers are, they do not show the complete picture. Rarely noted, for instance, is the obvious fact that the vast majority of the 20 million people in this country with substance use problems are not homeless. That suggests that people with substance use disorders might be homeless for reasons other than substance use. Poverty, lack of access to treatment, justice involvement, strained family supports – these factors can also contribute to housing instability, compounding the effects of a substance use disorder. Therefore, in addition to treatment, some people will need help addressing these factors if they are to recover and become stably housed.

That’s why some communities choose to use a Housing First approach to ending homelessness, offering the most vulnerable people experiencing homelessness permanent housing with the voluntary services. Services might include behavioral health treatment, primary care, employment services, peer support, and intensive case management.  Research shows that this approach works – helping re-house people successfully and often lowering the public costs of homeless assistance.

People recover from substance use disorders in different ways. One person might be able to make progress living with or near others with substance use disorder. Someone else might have more success living in an environment free of past influences associated with the substance use disorder. So for people experiencing homelessness with substance use disorders, strategies must be flexible and offer a choice of supportive housing models.

Given the various ways people find strength in recovery, one question communities face is whether to require that only homeless people who abstain from substance use can receive housing and services. Recent studies on this topic tend to show that housing outcomes are just as good or better when abstinence is not required. Further, stable housing itself, once achieved, can eventually motivate people with substance use disorders to enter recovery programs and find success on their own terms. However, housing programs may be pressed for funding that allows for non-abstinence-based options.

April is Alcohol Awareness Month. September is Recovery Month. Between now and then, here are three questions for communities working to end homelessness to explore:

  • How can homeless assistance providers improve their screening and referral protocols for serving people with substance use disorders, including culturally competent practices?
  • Are housing options available to support diverse approaches to recovery?
  • What state and local policy changes are necessary to promote recovery and housing stability for vulnerable people with substance use disorders?

Resources for advocates:

Photo by Kymberly Janisch.