Drug use among the homeless population is a challenging dilemma. Drug overdose is among the leading causes of death of homeless and transient individuals and is the leading cause of homelessness for single adults.
Drug addiction can cause homelessness and addiction can be a confounding issue for the population, making it harder to obtain stable income and housing. Drug use can also be a result of homelessness in many cases, adding to the individual’s difficulties. One study in the UK found that 80% of respondents reported that they had started using at least one new drug since becoming homeless. Drugs are used to distract from current situations, violent environments, abuse, trauma, and to cope with or self-medicate for mental illness.
Drug abuse can lead to loss of job and income, which, in turn, leads to eviction and homelessness. Once homeless, the addicted individual may lose hope and continue to abuse drugs as a way of coping with their situation. This uses up what money or income they do have and continued addiction doesn’t assist homeless individuals in attaining a job to acquire income and housing.
Once homeless, there are many factors that decrease the individual’s ability to become housed. The homeless person may not have an address or phone number to put down on a job application or resume. If they do get an interview, they may not have a place to shower or access to clean appropriate clothes in which to interview. They may not have a vehicle or means to pay for public transportation to and from work, should they be offered the position. Additionally, if they have children, they may not have any way of acquiring childcare. Addiction confounds all of these factors.
Drug overdose was found to be the leading cause of death among homeless adults in Boston and opioids accounted for 81% of overdose deaths. Overdoses can happen for several reasons including suicide attempts, mixing drugs, taking too much of a drug, and changes in tolerance after not using for a while or cutting down.
Infectious diseases from drug use, frequently from paraphernalia sharing or unprotected sex, are common among the homeless population. HIV, Hepatitis C, and tuberculosis are the most commonly reported. In the UK, the prevalence of Hepatitis C among the homeless is nearly 50 times that of the general population and the prevalence of tuberculosis is more than 34 times greater.
Homeless individuals frequently don’t have health insurance and therefore do no seek appropriate health care when needed. When a transient individual urgently needs medical attention then he or she might go to the ER, but will not be able to pay the bill, putting him or her in more debt and decreasing the chance of getting into housing.
So what do we do about it?
- Wrap-Around Services: Travis Baggett advocates for wrap around behavioral health services, increased funding for mental health and substance abuse problems, and increased use of pain management intervention strategies other than prescription pain killers like opioids. He stresses the importance of approaching the issue by “first recognizing that addiction is a chronic illness that requires compassionate care and not judgment. Everything else follows from there.”
- Housing First: The Housing First, or rapid-rehousing, model is based on the idea that homeless are “more easily engaged in robust clinical services and experience greater success once the chaos of living on the streets has been eliminated from their lives.” Housing First focuses on getting the homeless individual off the street and into housing before mental health and addictions treatment. Stable housing before and after treatment increases the rate of successful rehabilitation and decreases the rate of relapse. The philosophy is that once that individual is in secure housing, it will be easier to successfully complete treatment and that their chance of recidivism and relapse will decrease. Additionally, the focus is on the fact that housing is a basic human need and right and should not be a reward for clinical success.
- Case Management: Case management services assist the individual in obtaining referrals and utilizing resources and services in the community to assist with the aspects that the individual needs to address in order to remain housed. Case managers assist their clients by assessing their needs, providing referrals, advocating for services, and monitoring progress. They help the client to receive wrap around services to address not only addiction, but mental illness, employment needs, legal issues, physical health care, education opportunities, child care, social skills, support networks, and money management. These services can provide the support that this population needs to conquer their addiction issues that go hand-in-hand with many other issues prevalent in the lifestyle.
- Harm Reduction: The harm reduction model has been found to be more effective than abstinence models. Emphasis is on decreasing use gradually and reducing potentially harmful effects of use. It is a practical model that focuses on public health and safety, as well as the safety of the individual. Programs that exemplify this are designated driver, needle exchange, and methadone programs.
The information for addressing the needs of the homeless are not overly represented in current research, however, recent studies have found that addiction is a prevalent problem that both causes homelessness and precipitates from homelessness. This is a national epidemic and studies have shown that intervention strategies such as Housing First and harm reduction have been more effective than abstinence models. Because of this, it is important for those working with the population to advocate for these models to assist the population of homeless individuals in rehabilitating and reintegrating into society.