People experiencing homelessness face many threats to their health, and drug addiction is an outstanding concern. Drug rehabilitation options for unhoused individuals do exist, offering opportunities for treatment at the state, local, and federal level. However, the harsh realities of being homeless can complicate the process.
One of the challenges when assessing drug rehabilitation options for people who are homeless is defining the parameters of homelessness. In general terms, unhoused people are those who do not have an established, consistent, and safe place to sleep at night. By this definition, and according to the National Alliance to End Homelessness, any given night in America has more than half a million people who have to sleep in an emergency shelter or a transitional housing program.
Homelessness is an umbrella term to describe various forms of housing displacement and insecurity. The National Healthcare for the Homeless Council explains that being homeless can also refer to being unsheltered, which means living on streets, sleeping on benches, camping outdoors, or living in vehicles and abandoned buildings. There is also sheltered homelessness, like staying in emergency shelters or transitional housing. Some unhoused people might be doubled up, which is when they stay with friends and family on a temporary basis and have no permanent address of their own.
Substance abuse is a frequent condition of homelessness. People who are unhoused suffer from a great variety of health problems, and drug addiction is widespread. In 2017, the National Coalition for the Homeless reported that approximately 38 percent of people experiencing homelessness abuse alcohol, and this is more commonly found among older people who are homeless. Additionally, approximately 26 percent of people experiencing homelessness abuse drugs (other than alcohol), and this is found more among young people.
The United States Conference of Mayors found that 68 percent of cities across the country reported that substance abuse was the primary driver of housing insecurity among single adults. Different survey data found similar numbers for homeless military veterans.
Ultimately, drug addiction is a significant contributing factor for many people who become homeless and remain homeless. Once the psychological dependence on drugs or alcohol forms, people tend to become more invested in their substance use, as a way of self-medicating against the stressful and negative life situations of their homelessness.
In 2016, the National Alliance to End Homelessness wrote that many unhoused people who said they did not get the care they needed at a specialty facility identified a lack of health insurance and personal finance as the reasons. This suggests significant barriers to treatment. The uncertainty about affording rehabilitation dwarfs the acknowledged necessity of getting help.
There are drug rehabilitation options for people experiencing homelessness. The federal government has a lot of resources available for people who fit in certain categories or who meet specific criteria. For example, the government funds treatment options through Medicare and the Department of Veterans Affairs. Furthermore, federal funds will match state spending on Medicaid and the Children’s Insurance Health Program. These funds allow low-income individuals to get access to treatment but only if they are enrolled in the appropriate program.
The government also funds the Health Center Program, which was established to provide community-based primary health care for low-income people. Since HCP sites accept federal grant funding, they can be considered federal treatment options for unhoused people who use Medicare or the VA. HCP sites can accept private insurance plans, but by law, they are required to provide health care for everyone regardless of a person’s insurance or ability to pay for services.
There are 1,400 HCP centers across the United States, serving as many as 27 million people who are struggling with homelessness and many concurrent health conditions, including diabetes, infections, sexually transmitted diseases, and addiction.
People who need immediate help might think about enrolling in Medicaid, which is normally administered by on a state level. Medicaid relies on federal funding to stay operational.
People will have to show proof of financial hardship to receive Medicaid coverage, and a lack of permanent housing will qualify most applicants.
The government encourages states to open up their Medicaid funds for addiction medication, outpatient care, supportive care like job placement, case management, and substance abuse prevention.
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On a state level, the drug rehabilitation options for unhoused people depend on the state in which they are located. All states get some form of funding for their mental health programs from the federal government, but it is up to the states to decide how to offer services that make use of those funds. One homeless person might receive very different care than another homeless person across a state border.
The Substance Abuse and Mental Health Services Administration national helpline is one way that concerned people can contact their state’s available service. It is free, open 24/7, and offers a straightforward way of finding the right drug rehab option for a particular person’s circumstances.
One advantage of state-based programs for people experiencing homelessness is that there might be a shorter wait time than if a person tried to get help from a federal source. State programs might not have the resources that a federal program would, but if an unhoused person meets the criteria for treatment, it is possible that they might get lifesaving treatment regardless of their living and financial situation.
On the local level, an example of a drug rehabilitation option for someone who does not have permanent housing is a 12-step or peer-support program, often based on the Alcoholics Anonymous model. As far back as 1990, some AA groups conducted outdoor meetings or meetings in public places so that they could reach unhoused people. Sometimes even a church basement, a rescue mission, or a shelter is not accessible for homeless individuals, so local programs with the flexibility and decentralized nature of Alcoholics Anonymous can go very far in presenting a tangible rehabilitation opportunity.
Other local rehabilitation efforts can include recovery housing programs, which help newly sober people find a stable and safe place to stay while they continue to receive outpatient therapy, learn job skills, and rebuild their lives until they are ready to move into a more responsible living arrangement. The goal of recovery housing is to minimize the risk of relapse, for which homelessness or unsafe housing is a potential trigger.
There is a threat to these programs being exploited by unscrupulous owners. In 2017, The New York Times wrote of a person who relapsed after getting sober due to abusive behavior from the manager of a recovery home. While recovery homes offer local access to unhoused people, they are often not regulated. Greedy owners will target their clients, who are usually incredibly vulnerable people with no safety net. As the Times put it, people caught in this trap are forced into choosing between recovery and homelessness.
State and federal programs might have limits on who can use their services, but the regulation that comes by way of official funding sources means that the risk of mistreatment at the hands of an unethical manager is negligible. As much as homegrown local services for the homeless offers accessibility, there are significant risks that patients should be aware of.
To that point, some research has suggested that people experiencing homelessness need treatment before housing. Researchers at Simon Fraser University noted that their study of 297 homeless residents of Vancouver, who received independent housing in addition to mental health care, “did not reduce daily substance use.”
Both the researchers and local politicians were quick to defend the work and intentions of recovery housing programs to give unhoused residents access to local options, but they equally acknowledged that recovery housing programs were not the “answer” to addictions, perhaps especially for such a vulnerable population.
Similarly, The Atlantic noted that even while Medicaid can “be extremely beneficial to homeless people,” the inherent limitations of not having permanent housing (no consistent contact information, limited means of transportation, and, as is often the case, “no trust for government programs”) mean that a regulated and funded program like Medicaid can still be a bridge too far for unhoused residents.
Both concerns highlight the difficulty of providing safe and accessible drug rehabilitation options for the homeless. Good programs exist, and they have given countless people a chance at controlling their substance abuse while helping them into better living situations. However, the complications of homelessness can be so vast and myriad that offering the necessary treatment opportunities to people experiencing homelessness is fraught with difficulty and risk.
State of Homelessness. National Alliance to End Homelessness. Retrieved April 2019 from https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness-report/
(December 2017) US Homeless People Numbers Rise For First Time In Seven Years. BBC. Retrieved April 2019 from https://www.bbc.com/news/world-us-canada-42248999
What is the Official Definition of Homelessness? National Health Care for the Homeless Council. Retrieved April 2019 from https://www.nhchc.org/faq/official-definition-homelessness/
(June 2017) Substance Abuse and Homelessness. National Coalition for the Homeless. Retrieved April 2019 from https://docs.google.com/viewer?url=https%3A%2F%2Fnationalhomeless.org%2Fapp%2Fuploads%2F2017%2F06%2FSubstance-Abuse-and-Homelessness.pdf
(December 2016) The U.S. Conference of Mayors’ Report on Hunger and Homelessness. United States Conference of Mayors. Retrieved April 2019 from https://endhomelessness.atavist.com/mayorsreport2016
(April 2016) Opioid Abuse and Homelessness. National Alliance to End Homelessness. Retrieved April 2019 from https://endhomelessness.org/resource/opioid-abuse-and-homelessness/
(August 2014) Medicaid And Permanent Supportive Housing For Chronically Homeless Individuals: Emerging Practices From The Field. 4. Health Centers, Health Care For The Homeless Programs And Federally Qualified Health Centers. U.S. Department of Health & Human Services. Retrieved April 2019 from https://aspe.hhs.gov/report/medicaid-and-permanent-supportive-housing-chronically-homeless-individuals-emerging-practices-field/4-health-centers-health-care-homeless-programs-and-federally-qualified-health-centers
(September 2007) Condensed Version of a Primer on How to Use Medicaid to Assist Persons Who Are Homeless to Access Medical, Behavioral Health, and Support Services. HHS.gov U.S. Department of Health & Human Services. Retrieved April 2019 from https://www.hhs.gov/programs/social-services/homelessness/research/how-to-use-medicaid-to-assist-homeless-persons/index.html
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