Substance Abuse Disorder and Homelessness Are Interconnected

Substance use disorder (SUD), and mental illness frequently go hand in hand. Both of these conditions can also occur in people who are experiencing homelessness. These three situations can exacerbate each other. Often, attempts to treat just one of these factors should include dealing with the other two factors simultaneously. Usually, it is difficult to treat just one of these issues if the other two are present.

Generally speaking, all three conditions need to be addressed simultaneously. Stigma and negative stereotyping can cause misinformation about all three conditions. Programs attempting to treat any of these three conditions must include a multipronged approach in order to be successful.

Several studies have shown that SUD is more common among people experiencing homelessness than among people in stable housing. SUD can be a contributing factor that leads to a person becoming unhoused. Although, people who lose their homes often turn to substances after becoming unhoused.

Causes of Homelessness

If an individual is suffering from SUD, this can cause them to develop strained relationships with their family and friends. These strained relationships can cause the person suffering from SUD to have their support networks fractured and disrupted. Should job loss occur when this happens and the person suffering from SUD has no support, the person may end up losing their housing. Some contributing factors to becoming unhoused include:

• Job loss
• Substance use disorder (SUD)
• Mental illness
• Lack of health insurance
• Physical health issues
• Lack of treatment availability
• Lack of financial security

Barriers to Wellness

Once someone becomes unhoused, there are many obstacles that prevent them from accessing quality care. In order to find a way back, people with mental illness and SUD desperately need long-term help and services. Unfortunately, there are many barriers that prevent people experiencing homelessness from accessing care. Some of the major barriers include:

• Long waiting lists at shelters and limited availability of beds
• Lack of transportation
• Lack of health insurance
• No money for treatment
• Lack of access to services and help
• Loss of identification documents i.e. driver’s license or state ID
• Lack of comprehensive, multipronged treatment programs
• Fear of the authorities
• Fear of judgment from others

Solutions Exist

The goal to help end the cycle of trauma and distress experienced by people with SUD who are also experiencing homelessness should be to find funding for programs that address all the issues at play. In order for people to be able to live securely, significant support and services are needed. In order to create a society where fewer people suffer homelessness, the following issues need to be addressed:

• Long-term solutions that address all factors concerned and that are individually created for each client with long-term goals
• Programs that exist need to be strengthened to be more comprehensive
• The availability of programs needs to be expanded
• Treatment and prevention are the most effective solutions, so they need to be made more available
• Mental health, SUD, and homelessness must all be addressed and treated at the same time
• Coordinate services for housing with behavioral health services
• Stable support networks need to be put in place
• Access to social service assistance and help to apply and receive assistance for things such as funds for food, transportation, and health insurance
• Harm reduction strategies and medication-assisted treatment (MAT) need to be made more widely available

Possible Solutions

Coordinating services and providing the tools people need to become independent promises the best outcome. When treatment starts with a long-term plan, people experiencing homelessness and SUD see better outcomes compared to when no long-term treatment plans are in place. Comprehensive care starts with creating funds to allow access to an integrated facility that can assist with not just treatment, but a long-term strategy offering support and ongoing adjustments to a treatment plan to add more services as needed.

Once detox treatment has started, and a safe place is found for that treatment to happen, the client is now able to focus on their health, rather than trying to survive. The next step is for the client to enter a facility that has the ability to provide treatment for all the co-occurring problems. In a treatment facility, the client is in a safe environment with support in place from staff and peers.

Once early recovery is complete, it is imperative that transitional housing is provided in a sober living community. This community should have the ability to offer many more services in addition to sober living. In addition to sober living, these communities should offer:

• Assistance in obtaining legal identification documents, if needed
• A long-term comprehensive alumni treatment plan which includes on and off-site recovery meetings (with transportation), group therapy, and educational workshops
• Access to social services for food assistance, health insurance, and job opportunities
• Assistance with developing new life skills to help establish more independence
• Assistance with vocational training or opportunity for programs allowing apprenticeship or on-the-job training
• Assistance in re-establishing an independent and stable home