Homelessness and addiction

DEFINITION: Homelessness is the state of not having a stable, adequate place of residence. People experiencing homelessness, or unhoused persons, include those sleeping outdoors and in buildings not intended as housing, and persons temporarily dwelling in shelters or other institutions meant to lodge people without permanent housing. Substance use disorder can precipitate and develop from experiencing homelessness. Conversely, homelessness is often a consequence of substance use disorder or mental health conditions.

Prevalence and Patterns of Homelessness

Though homelessness is difficult to measure, between 2015 and 2025, various governmental and nonprofit agencies estimated that between 550,000 and 770,000 people were without a permanent place to sleep on any given night in the United States, peaking in January 2024. Most people who experience homelessness are located in urban areas, but the phenomenon also exists in suburban and rural areas.

The number of Americans facing homelessness rose dramatically in the last decades of the twentieth century, continuing into the first decades of the twenty-first century as the nation experienced a housing affordability crisis, increasing foreclosure rates, and widespread addiction issues increased through the 2010s and 2020s. Families with children accounted for more than 171,000 people experiencing homelessness in early 2020. That same year, about 34,000 unaccompanied youth under twenty-five experienced homelessness. By January 2024, 259,473 individuals in families with children were experiencing homelessness, the largest number on record, according to the 2024 Annual Homelessness Assessment Report to Congress produced by the US Department of Housing and Urban Development.

Women, girls, and gender-diverse individuals represent around 30 percent of the unhoused population. Transgender people, in particular, face high rates of housing insecurity due to discrimination and violence. Homophobia and transphobia can be contributing factors to the rate of homelessness among unhoused youth. According to the National Coalition for the Homeless, youth who identify as lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) are 120 percent more likely to experience homelessness compared to their peers. Individuals and families who experience poverty have the greatest probability of becoming unhoused, and demographic groups with high poverty rates are overrepresented among individuals experiencing homelessness.

The racial and ethnic makeup of the unhoused population in the US reveals a striking disparity. According to the 2024 Annual Homelessness Assessment Report to Congress, although African Americans represented only about 12 percent of the total US population, they accounted for 32 percent of persons experiencing homelessness. Native Americans and Alaska Natives, as well as Hispanic/Latino individuals, are also overrepresented, but to a lesser degree. White and Asian American individuals are underrepresented populations.

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 the increased costs of living, leaving many in debt and unable to pay their bills. Decreased availability of affordable housing and subsidies, along with increased numbers of foreclosure-related evictions, have led many families to homelessness. Among LGBTQ+ youth, many reported being thrown out of their homes or running away because they feared violence at home.

Healthcare, domestic violence, incarceration, mental illness, and substance use disorder are also related to homelessness. Lack of affordable healthcare is one problem that can leave individuals and families with 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 with 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 Abuse and Addiction

Substance use disorders, mental health conditions, and homelessness are closely linked. They frequently co-occur with mental illness at higher rates in the unhoused population, complicating diagnoses, housing stability, and treatment effectiveness in a challenging cycle. Vulnerable groups, including veterans, LGBTQ+ youth, and recently incarcerated individuals, experience disproportionately high rates of substance use and addiction within the homeless population. LGBTQ+ youth, for example, frequently report substance use as a response to family rejection or violence, while veterans may use substances to manage symptoms of post-traumatic stress disorder (PTSD).

Substance abuse can lead to homelessness by disrupting family relationships, employment, and financial stability. In the same way, homelessness itself often leads individuals to initiate or increase substance use as a coping mechanism for trauma, stress, and the harsh conditions associated with housing insecurity. Approximately 30 percent of individuals who experience chronic homelessness struggle with substance use disorders, with alcohol being the most commonly used substance. However, in the 2010s and 2020s, polysubstance and opioid-related substance use increased significantly among unhoused populations.

Many barriers to addiction treatment exist for unhoused individuals. Financial limitations, lack of insurance, limited availability of comprehensive services, and inadequate support systems often prevent sustained recovery. Inpatient treatment programs are typically brief, and at the end of treatment, individuals are discharged back into unstable environments that undermine recovery efforts. Some evidence supports implementing integrated models like Housing First, which prioritizes permanent housing without requiring sobriety or mandatory treatment participation. Stable housing has been consistently shown to enhance the effectiveness of substance use treatment, reduce relapse rates, and improve overall health outcomes. Additionally, harm reduction strategies—including needle exchange programs, medication-assisted treatment, overdose prevention education, and supervised consumption sites—have effectively reduced health risks and promoted stabilization among those experiencing homelessness and substance use disorders.

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