Substance abuse remains among the major problems the health care industry is facing, also in developed countries. The difficulties emerging in the course of treatment are, however, not the key reason, as there exists a range of social issues to factor into the complexity of the situation. They are, for instance, dramatic stigmatization, which is based on negative stereotypes and such phenomena as poverty, mental illness, or homelessness. People who suffer from whichever of those belong to the most disadvantaged categories, and addictions aggravate their vulnerability. The homeless are at a special risk, particularly because of poor access to regular medical aid, but the greatest challenge of treating them is the ever-stronger interdependence between homelessness and drug abuse.
The Connection between Homelessness and Addiction
One may guess that abusing alcohol or other substances is a frequent cause of becoming homeless, and it actually is. It would not, however, be reasonable to simply describe the connection between the two calamities as a cause-and-effect relationship. First, the National Coalition for the Homeless emphasizes that addiction can not only lead to homelessness but result from it as well. Second, both may root at the same condition, most frequently, a mental illness along with a lack of proper care, which is observable in almost a third of unsheltered individuals (Michael’s House, 2017). Substance abuse in an unhoused population is, therefore, not a single problem but a complex one comprising several issues that are closely intertwined.
The need to overcome the difficulties of living on the street makes people drink excessively and/or use other psychoactive chemicals. Michael’s House (2017), the addiction treatment center, reports that approximately 38% of the homeless abuse alcohol, and about 26%, mainly youngsters, give their preference to illicit drugs. In the vast majority of cases, the substances are seen as a medication able to distract a person from the highly stressful situation they have found themselves in.
The behavior of that kind is, actually, not solely typical of the unhoused, but of people in general, for which reason a recovery from an addiction does not only involve sobriety. Stevens and Smith (2013) define it as “changes in physical, psychological, social, familial, and spiritual areas of functioning” (p. 261).
Since the homeless population are less likely than average to experience such changes in a relatively short period of time, the probability of relapses is substantially higher in them. Not addressing the underlying issues is among the reasons why so-called abstinence-based treatment shows a lower efficiency than it could do otherwise (Carver et al., 2020). Peer support and a temporary change in the environment are not sufficient for a complete recovery, as the origin of the addiction is rather social than purely biological.
It is also worth mentioning that the individuals who became unsheltered as a consequence of alcohol and/or drug abuse normally continue consuming for the same reasons. Despair, social isolation, risks to health, and extreme poverty determines further excessive intake of chemicals, due to which an individual grows entrenched in the addiction. In such patients, relapses are apparently more probable and intensive, which additionally complicates the treatment and reduces the chance for a complete recovery. Furthermore, they apparently have less motivation to quit since their lives had been destroyed long before they found themselves on the street.
Motivation is, meanwhile, critical for recovery, as the strength of the patient’s will is actually the key to relapse prevention (Stevens & Smith, 2013). Negative emotions, which such people experience on a permanent basis, are also on the list of major determinants.
Accompanying Problems
It has already been mentioned that about 30% of the homeless population suffers from certain mental conditions. This is a serious problem since such people are frequently deprived of appropriate medical care. Although there exists a considerable variety of programs for the unhoused, the amount of those designed for treating mental disorders is dramatically limited (“Addiction and homelessness”). Even notwithstanding the recent upward trend, practitioners normally release patients as soon as possible so that they do not occupy beds (Michael’s House, 2017). As a result, the condition is quite probable to grow worse, hence the addiction as well.
However, even if there are no psychological or psychical disorders, unsheltered individuals do not necessarily receive the aid they need. In numerous cases, they “cycle between jails, streets, and emergency rooms with a discontinuity in medical care” (“Addiction and homelessness”). Partly, this may result from poor motivation for overcoming the disease. Michael’s House (2017) highlights that it may be challenging to convince a person to get help if they do not believe it to make sense. This creates additional problems in treatment, as it cannot be effective without the patient’s participation.
Environment
As said above, abstinence does not equal recovery since the problem is complex and has a social origin. Although a patient is able to stay sober in the “protected and supportive” atmosphere of medical practice, returning to the usual environment may challenge their perseverance (Stevens & Smith, 2013). Negative emotions, poor socialization, and even locations or activities associated with the addiction may work as triggers and cause a relapse. Meanwhile, it is hardly possible to monitor a homeless patient continuously after release, which precludes prolonged medical supervision.
Therefore, it is critical to teach patients self-control so that they do not return to substance use. Here, the umbrella term of self-control comprises coping as well as decision-making skills, stress management, and handling the cravings (Stevens & Smith, 2013). This is actually the main component and the greatest challenge of the treatment that makes the process substantially longer and more sophisticated compared to a patient who receives support constantly. In fact, a complete recovery from substance abuse means a reorganization of the entire life, which is especially difficult for a homeless.
Conclusion
Treating alcohol and drug addictions in an unhoused population is outstandingly difficult, as a lack of shelter and excessive use of substances are interdependent. The latter may whether cause or result from the former; furthermore, both may be the consequences of a mental illness. Therefore, treatment does not purely presuppose sobriety but requires managing the underlying problems. This is, however, scarcely possible unless the patient is motivated enough, while the homeless usually live in an atmosphere of never-ending despair. Another problem lies in insufficient accessibility of the needed medical assistance, which has two main reasons.
First, not all programs for the unsheltered address those who suffer from mental conditions. Second, the existing medical practices tend to release patients soon after the symptoms disappear in order to make more beds available. Such an approach renders a recovery impossible, as it involves changes to the social context before everything else.
References
Addiction and homelessness: Causes and challenges. (n.d.) Addiction Resource. Web.
Carver, H., Ring, N., Miler, J., & Parkes, T. (2020). What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography. Harm Reduction Journal, 17(10). Web.
Michael’s House. (2017). The connection between homelessness and addiction. Web.
Stevens, P., & Smith, L. R. (2013). Substance abuse counseling: Theory and practice (5th Ed). Pearson.