Substance Abuse, a Factor and a Consequence of Homelessness

written by Lisa Stand
June 10, 2013

One in five people who experienced homeless on a given night in 2012 also struggled with chronic substance use problems – 131,000 people altogether.

Clearly, responding to drug and alcohol addiction is an essential part of ending homelessness. One does not need to look far to find connections between behavioral health and risks of homelessness. Substance abuse disorders are commonly found among chronically homeless people and within homeless families. Anyone who has dealt with chemical dependence, or knows someone who has, understands well the connection with homelessness. Job and income loss, family estrangement, issues with landlords, drug-offense convictions – these often go hand in hand with untreated substance use problems – at the cost of housing stability.

Leaders in ending homelessness know that it takes more than housing to effectively serve people who have serious behavioral health conditions. For chronically homeless people, permanent supportive housing works because it combines housing with intensive supports and services. Even if homelessness is not chronic –yet – a strategy for stable housing is still important to support recovery. This is the essence of Housing First for homeless people with substance use challenges. It means access to stigma-free, meaningful voluntary services along with housing. In the health care world, this is known as treating the whole person, or meeting people where they are in the process of taking care of their own physical, mental and spiritual health.

If we are to end homelessness, we must pair the Housing First philosophy with holistic treatment, at least where serious behavioral health issues are involved. Health care reform can play an important role in the future. According to the Department of Health and Human Services (HHS), almost a third of people who lack health insurance now have behavioral health conditions. With implementation of the Affordable Care Act (ACA), millions more will potentially have access to basic benefits including coverage for needed substance abuse treatment. That could translate to funding for supportive services for homeless people with complicated conditions.

Vitally important policy questions remain. How many states will embrace the potential and utilize the ACA to help their most vulnerable citizens? Will the insurance coverage be enough to make a difference in the lives of people with substance use disorders, severe mental illness, trauma, and injury – and who are homeless or at-risk of becoming homeless? These questions will have to be answered as ACA implementation proceeds.


Photo courtesy of Jon Lopez's Flickr photostream.