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Homelessness and Substance Use: What The Facts State

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Compiling statistical information about homeless people is very difficult, but it is estimated that a high percentage of people who are homeless suffer from substance abuse and mental illness.

Prevalence of Substance Use Disorders 

Based on the information provided by the U.S. Census Bureau, it is estimated that in 2017, about 253 million Americans were over the age of 18. Based on the information provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), about 18.7 million Americans over 18 admitted to struggling with some form of substance use disorder in 2017.

Based on these figures, we can estimate that about 7.4 percent of people over the age of 18 struggled with some form of substance use disorder (a diagnosable substance abuse problem or addiction) in 2017.

How Prevalent Is Substance Abuse Among the Homeless?

There are major issues in attempting to gather demographic information about individuals who are homeless, basically because they are homeless.
The latest estimates from the National Alliance to End Homelessness and SAMHSA suggest that approximately 35 percent of individuals who are homeless struggle with some form of substance abuse.  Approximately 26 percent of all people who are homeless struggle with some form of mental illness.
The current estimate is that slightly over 552,000 people are homeless in the U.S.

The Department of Housing and Urban Development (HUD) has provided estimates that suggest over half of the people living in supportive housing programs have a diagnosable psychiatric disorder, a diagnosable substance use disorder, or both.

The figures suggest that a large proportion of homeless people who have a mental illness and substance use disorders. Certainly, the rate of mental illness and substance abuse among this segment of the population is significantly higher than it is in the general population.

Reasons for Homelessness 

The National Coalition for the Homeless (NCH) offers a list of the major contributions to becoming homeless.

  • Foreclosures on homes have increased significantly over the past 10 years (by nearly a third over the previous period), leading to loss of housing among renters and homeowners who are evicted.
  • Medical costs associated with accidents or health problems are some of the most common reasons for going bankrupt. Bankruptcy due to medical bills can be a significant contributor to homelessness.
  • Funding cuts for public assistance programs have increased the potential for low-income or disabled individuals to become homeless.
  • The federal government’s support for low-income housing has decreased, resulting in a lack of low-income housing for people who need it.
  • Economic factors, such as a proliferation of lower-income jobs that are not sufficient to pay for housing, may contribute to homelessness.

The Connection Between Homelessness and Substance Abuse

Although becoming homeless may be a risk factor that can contribute to the development of substance use, the research does not suggest that homelessness causes substance abuse in the majority of cases. Instead, there are other reasons that there is a higher proportion of mental illness and substance abuse issues among the entire group of individuals who are homeless.

Homelessness and Mental Illness

According to the American Psychiatric Association (APA), there is a strong relationship between being diagnosed with any psychiatric/psychological disorder and also having a co-occurring diagnosis of a substance use disorder.
The relationship is bidirectional, such that if someone is diagnosed with nearly any psychiatric disorder, they are at an increased risk to also be diagnosed with a substance use disorder. If they are diagnosed with any form of a substance use disorder, they are also at an increased risk to be diagnosed with some other form of mental illness.

Given the high rate of mental illness that occurs in homeless people, one would expect that there would also be a significantly increased rate of substance use disorders in this group.
Moreover, individuals with more serious forms of mental illness are even more likely to have a co-occurring substance use disorder. They would also be expected to have difficulty providing a home for themselves without significant assistance.

More serious forms of mental illness can lead to problems functioning within society, and this can contribute to homelessness, family conflicts, and social isolation among this group.

Thus, it is more likely that issues with mental illness and substance abuse result in someone becoming homeless than it is that being homeless leads to an increased risk for substance abuse or mental illness.

High Levels of Stress Among Homeless Individuals 

The significant stress associated with unemployment, lack of social support, family disputes, and peer pressure contributes to substance use disorder in anyone. Homeless individuals are exposed to stressful conditions that can further increase the risk that they will turn to drugs or alcohol.

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What Substances Are Commonly Abused by the Homeless?

Alcohol is the most common substance of abuse used by individuals who are homeless.
Other drugs that are commonly sold on the street, like heroin, cocaine, and methamphetamine, can also be significant drugs of abuse. Tobacco use disorders may be common among homeless individuals.


The strategy to address the complications associated with the high rate of substance use disorders in homeless individuals is not an easy one.
Better access to quality mental health care treatment for this group and access to affordable housing could go a long way in addressing the situation.  Providing job skills training for these individuals has been proposed to decrease substance abuse.
Other proposals, such as community injection site programs, have been proposed to control the spread of disease related to needle sharing among this segment of the population.


(July 2018) Quick Facts. US Census Bureau. Retrieved May 2019 from

(October 2018) National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration. Retrieved May 2019 from

(April 2015) The State of Homelessness in America 2013-2016. National Alliance to End Homelessness. Retrieved May 2019 from

(December 2018) The 2018 Annual Homeless Assessment Report (AHAR) to Congress. The Department of Housing and Urban Development. (Retrieved May 2019 from

(July 2009) Why are People Homeless? National Coalition for the Homeless. Retrieved May 2019 from

(2013) The Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition. American Psychiatric Association. from

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