Drug And Alcohol Rehab Programs For Homeless Individuals

The homeless population faces a variety of issues that make traditional drug and alcohol rehab programs less effective for long-lasting recovery. Programs must go beyond standard health and behavioral care services and treat the whole person, including providing care which will improve their personal environment.

For example, effective rehab programs should not only use integrated care to address addiction and mental illness, but also provide additional services such as life-skills development, housing, and employment assistance to reduce homelessness and other issues.

The Relationship Between Homelessness And Substance Abuse

While every person is different, substance use disorder often leads to or causes homelessness. Substance use disorders, the medical term for addiction, tend to cause problems in relationships, with family and friends, and within professional careers. These problems, along with someone already struggling to make payments or pay the bills, can worsen addiction and lead to homelessness.

According to the Office of National Drug Control Policy, around two-thirds of people experiencing chronic homelessness have a primary substance use disorder or other chronic health condition.

However, substance use disorder can also be the result of homelessness, not the cause. Homeless people often turn to drugs or alcohol to help manage or cope with their situation. They may believe drugs or alcohol can relieve them of their problems and provide escape or comfort.

Some homeless persons also believe drug and alcohol use is necessary for acceptance among the homeless community, prioritizing things like food and shelter over counseling, therapy, and managing addiction.

The Prevalence Of Homelessness And Addiction

More than 770,000 people were experiencing homelessness on a single night in January 2024, the highest number ever recorded, according to HUD. That number is an 18% increase from 2023.

According to HUD’s 2024 point-in-time count, 18% of adults experiencing homelessness (approximately 113,000 people) were identified as having a chronic substance use disorder, compared to about 3% of adults in the general population. Other research puts that estimate closer to 50 percent.

Tracking substance use disorder among homeless populations is difficult. Federal surveys like NSDUH exclude people without fixed addresses who are not in shelters, meaning the true prevalence is likely higher than any single estimate suggests.

Among homeless people who struggle with substance abuse, an estimated 10 to 20 percent also struggle with mental illness. Homeless people have a high need for treatment but experience multiple barriers and difficulties when it comes to accessing help and care.

Co-Occurring Disorders And Homelessness

Many homeless people suffer from both substance use disorder and mental illness, which is called co-occurring disorders or dual diagnosis. People suffering from co-occurring disorders, especially among the homeless population, often use drugs and alcohol to self-medicate unpleasant symptoms caused by mental health conditions.

A homeless person suffering from a co-occurring disorder is presented with multiple obstacles to recovery and treatment, which may include:

• being in and out of jail or the criminal justice system
• frequent cycling of the streets and emergency rooms
• lack of access to health and behavioral services
• lack of social support
• problems with payment or lack of insurance
• risk for violence or victimization
• lack of access to medications for opioid use disorder (MOUD)

Unfortunately, homeless people are often unable to find facilities or rehab programs that will help them overcome addiction. While many programs exist for homeless people with mental illness, several may not accept people with substance use disorders. Effective rehab programs for homeless individuals should address both substance abuse and mental illness, as well as provide additional services to help improve their situation.

For homeless individuals who are not ready to enter a formal treatment program, harm reduction services can provide a critical bridge. Syringe service programs, naloxone distribution, fentanyl test strips, and low-barrier shelters that do not require sobriety create contact points where people can access care and build trust with providers over time.

Research consistently shows that harm reduction services increase the likelihood of eventually engaging with treatment.

Drug And Alcohol Rehab Programs For Homeless Individuals

To effectively serve the homeless population, rehab programs must do at least three things: provide services that address the needs for employment, income, and housing; offer access to low-demand, flexible, and affordable interventions; and provide continuous and long-term care, treatment, and support.

The best rehab programs for homeless persons understand that substance use disorder and addiction cannot be effectively treated without addressing the needs of the whole person, or in the context of their environment.

For example, effective programs should include assistance with:

• clothing
• counseling
• employment services and job training
• financial assistance or entitlements
• food
• housing or shelter
• identification papers
• legal assistance
• medical and dental care
• psychiatric care

Programs should offer comprehensive services that address a homeless person’s safety and material, social, and health needs. To help address all the challenges homelessness presents, effective rehab programs must coordinate multiple services to link people with community-based resources.

The Housing First model has strong research support as a foundation for addiction recovery. This model provides permanent housing to homeless individuals without requiring sobriety or treatment compliance as a precondition.

Studies show that stable housing significantly improves treatment engagement and long-term recovery outcomes. Many effective programs now integrate Housing First principles with substance use disorder treatment, rather than requiring recovery before housing access

Themes Of Effective Rehab Programs For Homeless Individuals

Effective drug and alcohol rehab programs for homeless individuals should provide client-centered services that are comprehensive and multidisciplinary, meaning they’re capable of treating various conditions and coordinating additional services.

The following are some common themes of successful rehab programs geared toward the homeless:

Comprehensive Services: Programs must offer multiple services that address all aspects of an individual’s condition and circumstances. This includes building relationships with other service organizations that can help with the person’s various needs, like having appropriate materials and resources to stay healthy and safe.

Integrated Services: An array of clinical professionals should collaborate or make a coordinated effort to provide treatment for both mental health and substance use disorders at the same time. This should ideally take place in one environment or treatment center that emphasizes the need for housing and promotes healthy living.

Client-Centered Care: Treatment plans should be individualized and based on the unique needs of the homeless individual. Plans also take into account their wishes, capacities, and readiness to participate in treatment. There is no need to implement predetermined goals for treatment outcomes, as plans should instead focus on the individual’s pace and circumstances.

Uniquely Qualified Staff: Staff should approach people with kindness, compassion, empathy, patience, and flexibility. Dealing with homeless people can be difficult, and difficult situations may arise. Staff should be trained to handle these situations and react in ways that show understanding and care for the diversity of the population.

Access to housing: For treatment to be effective, homeless people must have a stable living situation. Appropriate housing can help individuals achieve a sense of stability and safety. Once basic needs are met, they can focus on increasing control over their lives, environment, and problems with addiction. Stable housing, however, is not a substitute for addiction treatment.

Inpatient Rehab Programs For The Homeless

Inpatient rehab programs, or residential treatment, for homeless people can be effective when programs are modified to address the needs of the population. Therapeutic communities (TCs) are offered within several long-term rehab programs, and not only focus on addressing substance abuse issues, but also focus on the whole person to help inspire overall lifestyle changes.

Research of TCs has shown they are effective for lessening drug and alcohol use, promoting healthy behaviors, increasing psychological functioning, reducing criminality, and helping with employment.

Modified TCs for homeless people may incorporate additional resources to involve educational, legal, vocational, and housing services. Plus, staff are more likely to be less confrontational, more supportive, and to integrate mental health treatment along with substance abuse counseling.

Inpatient rehab programs can also provide a network of support that many homeless individuals lack. Homeless persons have a difficult time remaining sober on the streets, where substance abuse is prevalent. Building relationships in a supportive environment can help homeless individuals connect with resources and services that encourage long-lasting recovery and improve quality of life.

Finding Help For Homeless Individuals

SAMHSA’s National Helpline (1-800-662-4357) provides free, confidential referrals to local treatment programs, including those specifically designed for homeless individuals.

The National Alliance to End Homelessness (endhomelessness.org) maintains resources for both individuals and advocates. The HUD Exchange (hudexchange.info) provides information on federally funded programs that combine housing and substance use disorder treatment.

Browse AddictionResource.net to find treatment programs near you that serve individuals experiencing homelessness.

Written by the Addiction Resource Editorial Staff