Does Substance Abuse Cause Homelessness?

This is a question from our Q&A series connected by Infotech.

Homeless people have only one thing in common: the lack of safe, affordable housing. Beyond that, many of the things we've historically associated with homelessness, like substance abuse and mental health issues, play a role for some individuals, but generally don't cause homelessness. That said, misuse of drugs and alcohol can make it difficult for people to obtain and maintain housing, and put those individuals at greater risk for homelessness (Moxley, et al., 2020).

The data available on the topic shows that the vast majority of people struggling with substance abuse are housed. About 20,000 people in Alachua County have a substance abuse problem, yet fewer than 800 people are homeless on any given night. This tells us two things: (a) substance abuse is not a consistent predictor of homelessness, and (b) sobriety is not a requirement for people to maintain housing.

Why do we associate homelessness with substance abuse, especially when there's not much data to support the connection? Homeless people live their private lives in public. The struggles homeless people face are similar to those in the housed community - substance abuse, mental health, and domestic violence. The rest of us deal with similar problems, but we deal with them privately, behind closed doors.

It’s important to note that substance abuse, while it can play a role in someone becoming homeless, can also be a result of someone becoming homeless. People in traumatic situations often turn to less-than-healthy coping mechanisms when better alternatives aren’t available. A large Australian study found that 43% of more than 4,000 homeless people had a substance abuse problem. Only ⅓ of those individuals had a substance abuse problem before becoming homeless. The other ⅔ developed a substance abuse problem after becoming homeless (Johnson & Chamberlain, 2008).

Finally, research shows that substance abuse problems tend to worsen the longer someone is homeless (Fountain, et al., 2003). When we can get someone off the street, and into a home, quickly, we interrupt this progression. People - with or without substance abuse problems - need access to housing as quickly as possible. We set people up for failure when we require sobriety as a precondition to enter shelters and housing programs, and that has long-term impacts for our community, for human lives, and for public health expenses that arise when we address homelessness through systems that were never designed to solve the problem.

*Sources:

Fountain, J., Howes, S., Marsden, J., Taylor, C., & Strang, J. (2003). Drug and Alcohol Use and the Link with Homelessness: Results from a Survey of Homeless People in London. Addiction Research & Theory, 11:4, 245-256.

Johnson, G. & Chamberlain, C. (2008). Homelessness and Substance Abuse: Which Comes First? Australian Social Work, 61:4, 342-356.

Moxley, V. B., Hoj, T. H., & Novilla, M. L. B. (2020). Predicting homelessness among individuals diagnosed with substance use disorders using local treatment records. Addictive Behaviors, 102.

Substance Abuse and Mental Health Services Administration (2017). 2017 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/release/2017-national-survey-drug-use-and-health-nsduh-releases