What is the relationship between homelessness and addiction?

Prevalence and Patterns of Homelessness

Though homelessness is difficult to measure, various governmental and nonprofit agencies estimate that in 2013, more than 600,000 people were without a permanent place to sleep on any given night in the United States, and between 3 and 4.5 million people per year experience homelessness. The majority (more than 70 percent) 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 has risen dramatically in the last decades of the twentieth century, and it continues to increase as the foreclosure crisis in the United States displaced families and as addiction rates rise. Families with children comprise one of the fastest growing groups among the homeless (more than 20 percent of the total population). Children account for approximately 1.5 million of the yearly homeless population. Women and girls, who comprise about one-third of the single homeless population, make up 65 percent of homeless families. 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 grossly overrepresented. Though African Americans represent only about 12 percent of the total US population, they account for more than 40 percent of homeless persons. Hispanics and Native Americans also are overrepresented, but to a lesser degree, comprising 20 and 4 percent of the homeless, respectively. White and Asian Americans are underrepresented and constitute 38 and 2 percent of the homeless, respectively. Other groups that are overrepresented among the homeless population are military veterans, people with mental illness, and persons with substance use disorder. About 20 percent of the homeless qualify as chronically homeless.

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 and subsidized housing, along with the increased number of foreclosure-related evictions, have led many families to homelessness.

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 40 percent of 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 inpatient 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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