Substance abuse often follows homelessness, not precedes it — new study finds

On a California street corner, a shopping cart and bags are piled up on the side of the sidewalk

According to a recent poll from the National Alliance to End Homelessness, 57% of Americans believe that alcoholism and drug addiction directly lead to people losing their housing. 

Beyond it being a commonly held belief, it's a sentiment that is often repeated by voices of authority across the country. 

“Almost all homelessness is linked to drugs or alcohol,” Mayor Bill Wells of El Cajon, San Diego told Fox 5 during his first term. 

“The homeless crisis is really a drug and substance abuse crisis,” said former U.S. Representative Dave Reichert last summer

“I think that we see [drug use] as the true predominant driver of the crisis, even though some of the people in the political class in our progressive cities are unwilling to admit it and insist that it’s only housing,” reported Christopher Rufo, editor of Las Vegas’ City Journal

“When I think that anyone who has a good street-level view of this can see that that’s not true.”

On March 19, UC San Francisco researchers countered those assumptions by conducting a statewide study that found that the narrative surrounding homelessness is more complicated than people may assume.

In fact, 42% of unhoused Californians reported that they began to use regularly only after they experienced homelessness for the first time. 

The study was led by Margot Kushel, doctor and director of UCSF’s Benioff Homelessness and Housing Initiative, which funded the research.

“There is no question that substance use and mental-health challenges increase an individual’s risk of homelessness,” Kushel told the San Francisco Examiner after the report was released. 

A shopping cart piled high with bags and belongings on a city sidewalk
Image via Robin Kanouse / Flickr (CC BY-NC 2.0)

However, Kushel pointed out, the link between drug use, mental health struggles, and homelessness is not as linear as it appears.

“Homelessness increases the risk of behavioral-health challenges through a variety of mechanisms,” Kushel said, pointing to stressors like chronic pain and sickness, loss of belongings, and violent assault. 

The UCSF researchers also found that “28% of those with regular drug use or current heavy alcohol use reported wanting substance use treatment, but being unable to access it during this episode of homelessness.”

The researchers also said that their data should not be undervalued, calling it “the largest representative study of homelessness in the U.S. since the mid-1990s.” 

“This new UCSF BHHI report makes clear that homelessness and behavioral health are inextricably linked — and that the solutions lie in expanding supportive housing, fully integrating health and housing systems, and investing in proven evidence-based approaches,” Jeff Olivet, senior advisor at the Harvard T.H. Chan School of Public Health’s Initiative on Health and Homelessness, said in a statement

“Policymakers and communities across the country should take these findings seriously.”

Kushel and her colleagues hoped that their data would shed light on common misconceptions surrounding homelessness. This data comes on the heels of another recent study from the university, which found that the large majority of homeless people in California are not illicit drug users

A recent survey from Invisible People found that people were more likely to empathize with people experiencing homelessness upon learning more about their unhoused neighbors. 

“I think there are a lot of news stories that touch upon the humanity of people,” a Los Angeles resident told Invisible People.

“Hearing stories from homeless people that talk about their personal struggles shows me that there is very little difference between me and them.”

Header image via Robin Kanouse / Flickr (CC BY-NC 2.0)

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March 28, 2025 11:57 AM
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