Substance Abuse and Homelessness: Statistics and Rehab Treatment

Seeking treatment can be beneficial for those who are homeless and struggling with substance use disorders. However, many people who are homeless don’t know where to turn for help when they’re struggling with substance abuse issues. Or, they may not feel that they have the resources to get help. If you or someone you care about is struggling with homelessness and addiction, you may benefit from learning more about substance abuse, homelessness, and the treatment options available to those who are struggling with both complications.

Homelessness & Addiction

According to the National Coalition for the Homeless, substance abuse is more prevalent in people who are homeless than in those who are not.¹ In many instances, substance abuse is the result of the stress of homelessness, rather than the other way around. Many people begin using drugs or alcohol as a way of coping with the pressures of homelessness.¹

It can be more challenging for people who are homeless to stop using substances, because they may not have easy access to treatment, often have smaller social support networks, may have decreased motivation to quit drugs or alcohol, and may have other, higher priorities, such as finding housing or food.¹

Statistics on Homelessness & Addiction

Current and accurate rates on the coexistence of homelessness and addiction can be difficult to determine due to the nature of these two conditions.^{2 p.1 prevalence} Generally speaking, available statistics indicate that rates of addiction are higher in people who are homeless.²

• The 2020 U.S. Department of Housing and Urban Development’s Annual Homeless Assessment Report to Congress (AHAR) reports that on a single night in 2020, 580,000 people experienced homelessness in the U.S.³
• According to the 2013 AHAR, 257,000 people who were homeless had a severe mental illness or a chronic substance abuse issue.²
• The 2015 AHAR reports that more than half of adults living in permanent supportive housing (an intervention that provides affordable housing to chronically homeless people) had a mental health disorder or a co-occurring mental health and substance use disorder.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) points out that people who are homeless have a high risk of overdose from illicit substances.³  One study found that homeless people had a higher risk of opioid overdose, with an adjusted risk rate of 1.8% for homeless vs. 0.3% for low-income people who had housing.⁵
• Most research shows that around 1/3 of people who are homeless have problems with alcohol and/or drugs, and around 2/3 of these people have lifetime histories of drug or alcohol use disorders.⁶
• According to SAMHSA, 38% of homeless people abused alcohol while 26% abused other drugs.²
• A 2014 report from the United States Conference of Mayors indicates that substance abuse was one of the top three causes of homelessness in single people as well as families.²

Causes & Risk Factors for Substance Abuse in Homeless Populations

Many causes and risk factors can influence the development of substance abuse in people who are homeless, such as:^2,3

• Self-medication. People may use substances to receive relief from their stresses and problems.
• A lack of social support. People may have little to no contact with families and friends.
• One report indicates that trauma was a factor for 68% of men and 76% of women who were homeless and in treatment for substance abuse.
• Co-occurring physical health conditions. HIV/AIDS, hepatitis B and C, cardiovascular conditions, dental problems, asthma, diabetes, and other medical problems have been reported to be more prevalent in people who are homeless and have substance use disorders.
• Social acceptance and easy access to substances. One report indicates a greater level of acceptance of substance use in the homeless community. Substances may also be more easily available in homeless communities.
• Untreated mental illness. Substance abuse commonly co-occurs with mental illness (known as co-occurring mental health disorders), as people with mental illnesses may self-medicate to obtain symptom relief. Homeless people with mental illness and substance abuse issues also often encounter additional stressors, such as the increased risk of violence and victimization, which can fuel the cycle of addiction and act as barriers to recovery.

Treatment Options for Those Who are Homeless

The cost of rehab and a lack of accessible treatment programs for homeless people can prevent them from seeking treatment. Even when people who are homeless are motivated to seek help, they may struggle to find treatment programs that will accept them, according to the National Coalition for the Homeless.²

However, there are ways to address these common barriers to treatment and make help more accessible to people struggling with substance abuse and homelessness. Since housing is a primary concern, government-funded rehab options like Housing First address a person’s housing issues first, and then offer a personal choice as to whether the person wants to address their mental health and substance abuse issues afterwards.⁶ Another model of assistance for those struggling with homelessness and a substance use disorder is known as a linear approach, which aims to address the importance of obtaining abstinence as a way of eventually obtaining permanent housing.⁶ Studies have shown different benefits for both options.⁶

People who are homeless can also participate in state-funded rehab options. These state-funded rehabs receive grants from SAMHSA, which administers two types of block grants: the Community Mental Health Block Grants (MHBGs) and the Substance Abuse Block Grants (SABGs). These grants are designed to provide funding so people without health insurance or other resources can obtain specialty mental health or substance use services.⁷

Rehabs that accept Medicaid or Medicare can also be potential options. With the passage of the Affordable Care Act (ACA), some states have increased efforts to enroll people who are homeless and in need of substance abuse treatment in Medicaid, a government-sponsored health program for low-income people. ⁷ Medicare is a federal program that is designed for anyone over 65, regardless of income. You can read more about how to apply for these programs here.

Potential treatment options for homeless people can include:²

• Detox, which helps a person safely withdraw from substances and become medically stable.
• Outpatient treatment, which means living offsite, such as in a shelter or supportive housing, and traveling to rehab for treatment
• Inpatient treatment, which means living onsite for the duration of treatment.

How to Help a Homeless Person Struggling with Addiction

If you know someone who is homeless and struggling with addiction, you can assist them in several ways, such as:

• Contacting your local HUD Continuum of Care (CoC), the coalition designated to connect homeless people with different services in their geographical area.
• Searching the National Association of Free & Charitable Clinics (NAFC) website for clinics that offer free healthcare (including behavioral/mental health care services).
• Connecting them with community resources (see this list of community services organizations provided by the National Coalition for the Homeless or the National Coalition for Homeless Veterans if they are a veteran).
• Visiting SAMHSA’s gov website to search government-funded or free or no-cost treatment centers. You can also call their helpline at 1-800-662-HELP (4357).
• Calling 211, the Federal Communications Commission (FCC) designated 3-digit number for information and referrals to social services and other types of assistance.
• Contacting your county’s Department of Human or Social Services, churches, non-profit social services organizations, or a local food pantry.