This document is a thesis submitted by Yolisa Nandipha Gibson for a Master's degree in psychology. It surveys previous research on the relationship between substance abuse and homelessness. While substance abuse is common among homeless populations, the research has not determined if it is typically a cause or result of homelessness. Most studies find evidence supporting both causal pathways. Gibson's thesis research involved surveying 28 homeless individuals at two shelters. They reported long histories of drug use but did not view it as the primary cause of their homelessness. Rather, they most often cited sudden economic hardship as the proximate cause, along with other synergistic factors like job loss, low education, mental illness, and lack of family support.

1. Running head: Substance Abuse and Homelessness 1
Substance Abuse and Homelessness:
An In Depth Survey of Perceived Causal Pathways
By
Yolisa Nandipha Gibson
A thesis submitted in partial fulfillment of the requirements
for the degree of
Master of Science in Psychology
Kaplan University
2014

2. Substance Abuse and Homelessness 2
KAPLAN UNIVERSITY
Abstract
Substance Abuse and Homelessness:
An In Depth Survey of Perceived Causal Pathways
By Yolisa Nandipha Gibson
Individuals become homeless for various reasons, such as economic struggles, mental health
issues, and substance abuse. Substance use is common among homeless persons in America, but
previous studies have been unable to determine the extent to which homelessness is a product of
substance abuse vs. a response to it. Evidence supports both causal pathways. As such, this study
asked homeless persons themselves what factors they believed caused their homelessness and
substance use, and in what time sequence. Forty surveys were distributed at 2 homeless shelters
in Midwest United States; 28 responded, yielding a 70% response rate. The homeless subjects
endorsed long histories of drug use, but did not perceive drug use as the primary or immediate
cause of their homelessness. Rather, subjects most often named sudden economic hardship as the
proximate cause of their homelessness, and identified multiple synergistic factors, including job
loss, low educational attainment, substance abuse, mental illness, and lacking family support as
leading in combination to their homelessness. The extent to which this is an accurate
understanding of causal pathways to homelessness or an act of denial so common among those
with substance use disorders, one cannot say. Longitudinal data would be needed to tease out the
true time sequence and contribution of the multiple factors that appear to lead to homelessness
for most people. Since most US citizens with substance abuse are not homeless, substance abuse
likely cannot be considered the primary cause of homelessness; as such, the perceptions of the
homeless subjects may be largely accurate.
Keywords: homelessness, substance abuse, addiction, causal pathways.

3. Substance Abuse and Homelessness 3
Table of Contents
Introduction ...........................................................................................................................................5
Literature Review............................................................................................................................5
Hypotheses/Research Questions...................................................................................................12
Method.................................................................................................................................................12
Participants....................................................................................................................................12
Measures........................................................................................................................................13
Procedures.....................................................................................................................................14
Data Handling ...............................................................................................................................14
Statistical Analysis........................................................................................................................14
Results .................................................................................................................................................15
Discussion............................................................................................................................................16
Hypotheses ....................................................................................................................................16
Considerations...............................................................................................................................16
Limitations ....................................................................................................................................23
References ...........................................................................................................................................25
Appendix A: Questionnaire ................................................................................................................30
Appendix B: Consent Form .......................................................................................................... 36-37
Appendix C: Research Announcement ..............................................................................................29
Appendix D: Tables ...................................................................................................................... 38-43

4. Substance Abuse and Homelessness 4
Acknowledgments
The author wishes to express sincere appreciation to her Thesis Adviser, Dr. Edward Cumella,
her Thesis Committee Dr. Dusti Sisk-Fandrich and Dr. Alyssa Gilston, to Mission of Hope
Shelter and Willis Dady Shelter in Cedar Rapids, Iowa, as well her family and close friends; all
these individuals have offered encouragement, patience, and assistance during this process.

5. Substance Abuse and Homelessness 5
Homelessness is an ever growing concern in the United States (US; Witte et al., 2012).
Individuals and families become homeless for various reasons, such as economic struggles,
mental health issues, and substance abuse. According to a 2012 report from the National Alliance
to End Homelessness, around 636,000 were homeless in 2011 (Witte, Roman, Berg, Mulkey,
Stand, & Batko, 2012). These numbers are not 100% accurate due to homelessness not being
accurately reported or observable, but this is as accurate a national number as could be obtained
from existing data sources.
Of this large population, veterans are a significant concern. Not only is it common to hear
of homeless veterans with Post-Traumatic Stress Disorder (PTSD), but it seems that there are far
more homeless veterans than any other group of Americans (National Coalition for the
Homeless, 2009). The rate of veterans is 7% of the general population, but 63% of the homeless
population (National Coalition for the Homeless, 2009). From a national perspective, almost half
of homeless veterans have a mental health disorder and about 70% suffer from substance abuse
problems (National Coalition for the Homeless, 2009).
The chronically homeless population often experience more substance abuse and mental
health issues than those who are not chronically homeless. In order to be considered chronically
homeless, an individual would have to have been continuously homeless for a year or more, or
homeless at least four times in the last three years, with each of those separate occasions lasting
at least 15 days (National Coalition for the Homeless, n.d.). In addition to this, the individual
should have a disabling condition, such as serious mental illness, a diagnosable substance abuse
disorder, developmental disability, physical disability, or co-morbidity.
The National Coalition for the Homeless (as cited by Didenko & Pankratz, 2007)
reported that alcohol and drug abuse is a much more common phenomenon among the homeless

6. Substance Abuse and Homelessness 6
populations, with the older generations more likely to abuse alcohol and the younger generations
more likely to abuse legal and illegal drugs (National Coalition for Homelessness, 2009).
Although it is not true for 100% of the homeless population, substance abuse is often found to be
a main cause of homelessness. Didenko and Pankratz (2007) reported that two thirds of the
homeless population acknowledged that drugs and alcohol were a core reason for their becoming
homeless. A diagnosis of lifetime substance dependence, with either alcohol or illegal drugs, is
seen as one of the most common and great risk factors associated with homelessness (Booth,
Sullivan, Koegel, & Burnam, 2002). Despite these troubling facts, drug and alcohol abuse is not
always the cause of homelessness, but can sometimes be the result of homelessness.
Many individuals turn to drugs or alcohol for self-medication and to cope with their
current situations. In turn, this only makes their situation worse, as drugs and alcohol are hard to
avoid on the streets, and many programs for substance abuse treatment are not well suited for
those with multiple issues (Fisher & Roget, 2009). The battle against homelessness and
substance abuse seems daunting; there are many factors that contribute to homelessness, but
substance abuse is a big issue since it can be the cause and/or the result of homelessness.
Just as preventing someone with alcohol abuse from drinking is not the only approach
needed to promote long-term sobriety, treating the substance abuse alone is usually never the
only resolution to homelessness. There are many vulnerabilities associated with the loss of stable
housing and living on the streets. Childhood trauma, lack of social support, and mental health
issues are just a few of the personal and social vulnerabilities (National Healthcare for the
Homeless Council, 2003).
In a study done of 1185 homeless individuals, face-to-face interviews were conducted to
look at substance abuse as it relates to other vulnerabilities linked to homelessness (Booth,

7. Substance Abuse and Homelessness 7
Sullivan, Koegel, & Burnam, 2002). The main focus of the investigation was to see if those
suffering from unstable housing or living on the streets would report higher vulnerabilities that
would need to be treated before housing stabilization could be successfully achieved. The results
showed that over 65 percent of the sample received a lifetime diagnosis of substance
dependence; out of this large percentage, it was found that substance dependent homeless
persons reported having more than one episode of homelessness, longer episodes, more criminal,
social, and mental health problems before their first bout of homelessness, and an earlier age of
first homelessness.
The vulnerabilities mentioned in the previous study are also mentioned in other studies
and articles about homelessness (United States Interagency Council on Homelessness, 2013).
This should not come as a surprise, since many issues regarding homelessness can occur from
the trickledown effect, meaning there usually is not just one factor that leads to loss of housing.
For example, an individual whose choice to move away from home due to a break in family ties
might have just created the deciding factor of whether or not he ends of up on the streets without
a support system.
Lowe and Gibson (2011) also pointed out the links between homelessness and substance
abuse, saying that the rate of alcohol and drug abuse tends to be higher when taken from samples
in shelters, streets, and clinics. One explanation of these data is that many shelters have
resources, training, and counseling to help someone work through their substance abuse issues,
regardless of whether or not the homelessness came before or after the substance abuse, and thus
homeless persons with substance abuse may gravitate toward shelters. The study conducted by
Lowe and Gibson was done with a sample of 90 homeless individuals, from which 93% of
participants admitted to using multiple substances at any given time, and abused alcohol more

8. Substance Abuse and Homelessness 8
often than not. The conclusion of the study was that substance abuse did increase the risk of
becoming homeless, but also played a part in the problems occurring after becoming homeless.
There was strong evidence regarding risk factors of homelessness and substance abuse, as many
individuals in the sample had a family history of addiction. But many also had family histories of
mental health problems, suggesting a variety of issues such as instability, low self-esteem,
neglect, or abuse (Lowe & Gibson, 2011).
So far, the literature has not conclusively demonstrated whether or not substance abuse is
more a cause or a result of homelessness (Kushel, Perry, Bangsberg, Clark, & Moss, 2002). Yet
the literature has shown that there is more to stably housing the homeless population than simply
finding them a permanent residence. To better help homeless individuals and families, a greater
understanding of all the circumstances must be obtained. This is especially important, since
homelessness can lead to premature death. The lack of health care benefits, resources, and
finances leads many to seek substance abuse services in emergency rooms, which are not
equipped to provide meaningful, long term treatment for this problem (Kushel et al., 2002).
In a sample of more than 2,000 homeless persons, over 40% reported the use of
intravenous drugs, and almost 50% reported having a drug or alcohol problem during the last 12
months (Kushel et al., 2002). Yet over half the participants reported having no health insurance
at all, while some had Medicare/Medicaid, but even fewer had insurance due to their veteran
status (Kushel et al., 2002). Without health insurance, or with merely state sponsored Medicaid,
most homeless persons have few or no benefits to cover the costs of substance abuse treatment.
These numbers are supported by a study published by the US Public Health Reports (2010), in
which surveys were taken from emergency departments across the US to look at correlations
between homelessness and hospital use. Although drug and alcohol use was not the primary

9. Substance Abuse and Homelessness 9
reason for emergency visits among homeless persons, it was significantly higher among them
compared to the non-homeless population, 18% versus 1% (Ku, Scott, Kertesz, & Pitts, 2010).
What the study did not cover was whether or not the 55% of persons seeking emergency care for
physical injuries had injuries that were drug or alcohol related. Injuries can occur due to assaults
related to drug use, incapacitation due to drug or alcohol use, and other factors related to
substances.
Considering the lack of coping options available to the uninsured, socially isolated
homeless person with minimal financial resources, once becoming homeless, substance abuse
and dependence can sky rocket. The homeless population can be seen as its own separate
community, where the newly homeless often feel the need to fit in. Substance us can be an entry
ticket into a dysfunctional substance abusing local homeless community. Even when it is not
about finding a place in the community, substance abuse may be about coping with the current
stressors of the situation. Since much of the homeless population suffers from the co-morbidity
of substance abuse and mental health problems, it is further understandable how the untreated
mental health problem may push someone towards an increased use of substances, leading even
to substance dependence.
The United States Conference of Mayors (as cited by the National Coalition for the
Homeless, 2009) conducted a survey throughout 25 cities to determine the top three causes of
homelessness. Almost 70% of the cities surveyed reported that substance abuse was the top
cause of homelessness. The substance use precipitates homelessness in various ways, such as
disrupting relationships between family and friends and losing housing due to income going
towards the preferred substance. The article also reinforced the fact that substance abuse is often

10. Substance Abuse and Homelessness 10
used as self-medication to temporarily escape from life’s problems (National Coalition for the
Homeless, 2009).
Since it has been shown that multiple factors can contribute to the situation of
homelessness, it is safe to say that childhood experiences also play a large role. This is especially
true when it comes to any dual diagnosis of mental health and substance abuse. Especially
among homeless adults, experiences with at least one childhood risk factor, i.e., sexual abuse,
parental substance abuse, and physical abuse, contributed to homelessness in more than 75% of a
dually diagnosed homeless sample of 156 persons (Blankertz, Cnaan, & Freedman, 1993) .
Physical abuse and parental drug or alcohol abuse were the top two risk factors reported by the
participants.
Research by Johnson and Chamberlain (2008) in Australia reinforced the research that
has already been presented, suggesting a common, worldwide relationship between homelessness
and substance abuse. This is perhaps the most extensive and methodologically sound study of
homelessness available, and thus its results should be seen as authoritative. The study used a
large sample of homeless individuals (N=4,291) from two agencies that normally served 6,000 to
7,000 households per year. Both agencies supplied family case files as part of the study. In
addition to the sample from the case files, there were also 65 in-depth face-to-face interviews
that took place to minimize the limitations of determining the homeless and substance abuse
process from only quantitative data (Johnson & Chamberlain, 2008). The sample included only
those who had either been homeless or were currently homeless at the time of the study. There
were two issues that were looked at in the study: substance abuse prior to becoming homeless
and substance abuse as a result of becoming homeless.

11. Substance Abuse and Homelessness 11
Only 15% of the sample reported having a substance abuse issue before their first
occurrence of homelessness (Johnson & Chamberlain, 2008) . Factors that played into this were
identified by three stages: the labor market, the break or loss of a support system, and achieving
new social networks (Johnson & Chamberlain, 2008). The last stage of new social networks ties
into the fact that newly homeless individuals will seek new ways to support their habits and, in
turn, find new groups of acquaintances and friends.
For substance abuse following homelessness, approximately 66% of the total 43%
reporting substance abuse stated that the problem developed after they became homeless
(Johnson & Chamberlain, 2008). This is a major finding, since this authoritative study is the only
study to suggest that the majority of homeless persons develop substance abuse problems after
becoming homeless rather than before. The findings of this study, although from Australia,
make it clear that the causal sequence between homelessness and substance abuse remains
unclear.
The final stage also impacts substance abuse. Johnson and Chamberlain (2008) reported
that drug use is often a form of initiation into the homeless community. In addition to finding
ways to cope, many homeless individuals feel a strong need to fit in; this could be because
protection is easier in groups, the city or town is new, or the new friendships help fill a void of
social support. This is especially true for individuals under the age of 18, where the need to fit in
and belong can often be at its strongest, because they are forming their identities.
The dispiriting reality of the study was that those who had a history of substance abuse,
whether or not it came before or after homelessness, were more likely to be homeless more than
once, or more than a year, as opposed to those with no substance abuse history (Johnson &
Chamberlain, 2008). Over 80% of those with substance abuse had been homeless for a year or

12. Substance Abuse and Homelessness 12
longer, as opposed to 50% of those without substance abuse. This makes sense, due to the fact
that it may be difficult for an addict to keep a residence or job when obtaining their substance of
choice is their top priority. Once a job and residence is attained, if the substance abuse is not
dealt with, it is likely that such persons will return to homelessness again because their resources
are being used to obtain the substance.
All of the studies reviewed addressed similar issues and asked the same fundamental
question: does homelessness happen because of substance abuse, or does substance abuse occur
because of homelessness? There is evidence to support both causal pathways, but the proportion
who takes each pathway remains unclear. Furthermore, with the recognition that various factors
contribute to substance abuse among the homeless, such as childhood trauma and mental health
problems, it remains unclear how these other factors impact the causal pathways. This leads to
the research question for this study. In the perception of homeless persons, what factors caused
their homelessness and substance use, and in what time sequence?
Method
Participants and Recruitment
Participants were found within several shelters of the Cedar Rapids, Iowa area. In order
to ensure the most diverse group of participants, the shelters were made up of all age groups,
ethnic and racial backgrounds, and both men and women. The only requirements to participate in
the survey were that participants had to be at least 18 years of age and had spent at least one
night in a homeless shelter. Within each shelter, flyers were posted on the front desks where
each individual passes by when coming and going; see Appendix A for flyer. Surveys (see
Appendix B) were available for those interested by asking each facility’s front desk staff.
Attached on the top of each survey was to each survey, on top, was the Informed Consent Form

13. Substance Abuse and Homelessness 13
(Appendix C). In the main area, away from common traffic, was a sealed box into which
participants could place their completed surveys. The boxes were put out every morning and
placed behind staff desk at the end of every night, unless there was a staff member at the desk at
all times. The surveys were available for a two week period to ensure an ample number of
participants within each shelter.
The participants found the Informed Consent document (Appendix C) explaining the
purpose of the study and inclusion/exclusion criteria, attached on top of the survey. Participants
were asked not to identify themselves in any way whatsoever. This was done to maintain the
anonymous nature of the study, protecting their identity and their data from virtually any
possibility of disclosure.
Measures
The questionnaire used in this study (Appendix B) was developed by the researcher. The
questions written for the survey were included based on the literature and the researcher’s
professional experiences working with the homeless. For the creation of this questionnaire the
researcher also consulted with a specialist in survey design and doctoral level addictions
professionals. Questions include sociodemographics and cover a range of topics related to
substance abuse and homelessness. See Appendix B for all questions.
There were minimal anticipated risks to those who decided to participate in the survey.
Although unlikely, the possibility existed that completion of the survey would lead to a small
amount of anxiety or emotional discomfort if specific questions prompted complex or disturbing
thoughts for the respondents. Respondents were notified in the Informed Consent that any such
discomfort could usually be addressed through conversation with members of their support
system, including supportive persons at the shelter. The Informed Consent also mentioned that

14. Substance Abuse and Homelessness 14
subjects could contact the Emotional Distress Hotline, 24/7, at 1-800-LIFENET, to receive free
telephone assistance with any concerns that may have arisen.
Data Handling
For this study, data from the survey was keyed into an SPSS database for analysis. All the
results were presented in aggregate form to protect subjects' identities. Data was accessible to
the researcher only in the form of physical completed surveys that were kept in a locked file
cabinet. The SPSS database used for data analysis was accessible only by using a strong
password known to the researcher and thesis adviser. Neither dataset contained any coded
identifiers and, as such, were completely anonymous.
The electronic data was placed in a separate Windows folder on each computer,
segregated from any other files that were not related to the data set. The two computers are
locked by strong Windows passwords, known only to the computer owners. The data will be
retained on these computer systems for the duration of the research, approximately six months.
Following completion of the research, the data set and related files will be retained by the
researcher for a minimum of seven years in case questions arise about the analyses. The data set
and related files will be transferred to any future computer owned by the researcher until the
seven years have expired. Throughout the study and subsequent seven years, the researcher will
implement a weekly backup plan wherein the data set and related files are backed up. After the
seven years, this file will be destroyed using current Department of Defense data destruction
standards. An affordable technique, such as encryption, will likely be chosen, pending
technology at the time.
Statistical Analysis

15. Substance Abuse and Homelessness 15
This thesis asks the following research question: In the perception of homeless persons,
what factors caused their homelessness and substance use, and in what time sequence? To
explore this question, survey response frequencies will be calculated and presented in tabular
format for logical analysis.
Results
Forty paper surveys were distributed at two different homeless shelters in the researcher’s
community. Out of those 40, 28 responded; this yielded a response rate of 70%. The socio-
demographics of the subjects can be found in Table 1.
The mean age of the subjects was 44, with 90% of subjects being male and 80% White.
Twenty percent were minorities, mostly African-American. Three-fourths of subjects had a high
school diploma or less; only three were college graduates. Nearly 6 out of 10 participants had
been homeless once in the past 3 years, with the remaining 40% being homeless 2, 3, or more
times during the past 3 years. Three-fourths of participants were homeless for a month or less,
with only 3 subjects being homeless 3-6 months; no one endorsed more than 6 months of
homelessness. About 6 in 10 reported that they were currently employed.
Psychosocial characteristics of subjects can be found in Table 2. Of 9 family background
characteristics, the 3 most commonly endorsed were family of origin drug use, 65%; family of
origin alcohol use, 46%; and mental illness in the family, 46%. Loss of job affected 70% of the
subjects. Six reported foreclosure or eviction. Taken together, 80% reported the financial
concern of either job loss or eviction/foreclosure. Five reported recent release from jail/prison.
Table 3 presents the subjects’ experiences with drug and alcohol use. Seventy-one
percent reported using drugs before becoming homeless, but only 14% reported using alcohol
before becoming homeless. Most, 26 out of the 28 subjects, denied current drug and alcohol use;

16. Substance Abuse and Homelessness 16
such denial is most likely due to fear of consequences or loss of community services, since use of
the shelter was contingent on abstention from drugs and alcohol. Almost 60% of subjects said
drug and alcohol abuse has caused them significant life problems; specific problems endorsed
appear in Table 3. The most common problem reported was legal issues, which affected 4 out of
10 subjects. Twenty-five percent also endorsed that drug and alcohol use exacerbated job
problems and job loss.
About 30% of subjects indicated that their drug use was either related to or increased by
their homelessness; see Table 3. The most common link made by subjects was that they used
drugs to forget about their current problems. Three subjects endorsed a direct connection
between their alcohol use and homelessness; they believed their alcohol use increased
homelessness.
Discussion
This exploratory study asked the following research question: In the perception of
homeless persons, what factors caused their homelessness and substance use, and in what time
sequence? Overall, 11 subjects, 39%, believed there was a connection between their
homelessness and their use of substances. The subjects were not asked if they had a diagnosis of
substance misuse/abuse, however, eight made the connection between homelessness and drug
use, and three between homelessness and alcohol use. For 10 of these 11 subjects, the connection
between substance use and homelessness was indirect, including use of substances because most
people they know are doing so, to forget about their homelessness, because there is nothing else
to do, because it is one of few things that makes them feel good, and because of a mental health
issue for which they cannot obtain adequate professional care. Clearly, from these endorsements,
a sizable minority of subjects, 36%, believed that homelessness exacerbated their problems with

17. Substance Abuse and Homelessness 17
substance use, mostly with drug use, but not all respondents reported having issues with
substances before or after homelessness since not all homeless persons abuse substances.
Few saw a direct causal connection between their substance use and their homelessness.
In fact, only 1 subject endorsed a direct causal connection, specifically between drug use and
increased homelessness. Nevertheless, 57% of subjects indicated that substance use caused one
or more of the problems known to lead to homelessness, including missed work/late for work,
financial problems, job loss, marriage problems, separation from family/friends, and legal
problems. As such, it would appear that for nearly 6 in 10 subjects substances were, in their
perception, indirectly related to their becoming homeless. Either the subjects were recognizing
substance use as one among several factors that led to their homelessness or they were in denial
about a direct causal link between substance abuse and homelessness; most likely for one of
these reasons, they were less likely to endorse substance use as the primary and direct causal
factor of homelessness even though they were endorsing the impact of substances on the factors
that did ultimately lead to their homelessness. In sum, then, the data appear to suggest that in the
perception of 57% of subjects, substance use indirectly led to homelessness in conjunction with
other life stressors.
In reviewing the data obtained from the survey participants, education seemed to be far
below the average of the general US population. Out of the 28 participants, 1 completed high
school or had received a GED, and 10 had less than a high school diploma; combined, this means
that 75% had only a high school diploma or less. Compared to a couple different sources from,
this is higher than the general population. In fact, in 2009, statistics indicate that 90% of
Americans were high school graduates or more. Twenty-five percent of the general population
had a bachelor’s degree or higher and 7.4% had an advanced degree or higher (Ryan & Siebens,

18. Substance Abuse and Homelessness 18
2012). As such, the homeless subjects in the present study appeared to have much less education
compared to Americans at large. Although none of the participants said so, it is highly likely that
this lack of education was a primary causal factor in their homelessness. Because the subjects did
not mention this factor, it is possible that homeless persons are less aware of the impact of
education on job success in the US compared to other persons, or that the homeless persons were
in denial about this factor.
It is difficult to obtain education data on homeless people across the US. However, in
Minnesota’s 2012 statewide homeless study, educational attainment of all adults was obtained
and compared between homeless adults and non-homeless adults (Wilder Research, 2013). Out
of the entire Minnesota adult population, only 8% reported not completing high school,
compared to 23% of homeless adults in Minnesota. Twenty-seven percent of all adults had a high
school diploma or GED, compared to a much higher rate of 43% within the homeless population.
Finally, 65% of all Minnesota adults had at least some college, compared to the 34% of homeless
adults (Wilder Research, 2013). Minnesota’s data on the educational achievement of homeless
adults in that state suggest a very similar educational profile to the homeless respondents in the
present survey. This supports the contention that lacking education, particularly not completing
or completing only high school, may be a major factor in leading to homelessness among US
adults.
According to data collected for the present study, 25% of survey participants reported
being homeless for more than a month and none reported being homeless for more than 6
months. Seventy-five percent reported being homeless for up to 4 weeks. According to Wilder
Research (2013), only 6% of Minnesotans had been homeless for a month or less. Over 40% had
been homeless more than a month but less than a year and 50% experienced homelessness that

19. Substance Abuse and Homelessness 19
lasted a year or longer (Wilder Research, 2013) . As such, homelessness in Minnesota may differ
in duration, and appears to last longer than among the Iowa individuals who participated in the
current survey.
Several psychosocial characteristics stood out from the 28 homeless Iowans who
completed the present study. The most prominent characteristic was family of origin drug use,
which affected 65% of respondents. Alcohol use and mental illness were second in endorsement,
equal at 46%. Six, or 21%, reported loss of housing due to foreclosure or eviction. About 18%
reported a recent release from a county jail or state penitentiary. These numbers resemble closely
the data reported by the United States Conference of Mayors status report, which consisted of
surveys from 25 responding cities (United States Conference of Mayors, 2008). In relation to the
causes of homelessness among single adults, the multi-city report indicated 68% related
substance abuse (The United States Conference of Mayors, 2008). It is important to note that the
National Institute of Mental Health (2012) reports that 25% of American adults have a substance
abuse problem. With 65% of the homeless adults in the present study reporting substance abuse
issues, it would seem quite possible that substance abuse may be a primary causal factor in
homelessness.
The multi-city report indicated 48% of homelessness causally related to mental illness
(The United States Conference of Mayors, 2008). In the present study the results were quite
similar, at 46%. It is apparent that the percentages of mental illness cited here are large compared
to the general US population. According to the National Institute of Mental Health (2012), only
4.1% of all US adults had mental health problems in 2012; these numbers do not include the
homeless, those who were institutionalized, or members of the military who remained in the
military for the entire year. As such, with 10 times more mental illness reported by homeless

20. Substance Abuse and Homelessness 20
persons in the present study compared to the general US population, it would seem likely that
mental illness may also be a primary causal factor of homelessness.
According to SAMHSA, rates of substance dependence/abuse are associated with
decreased education attainment (Substance Abuse and Mental Health Services Administration,
2013). Among those ages 18 and up, individuals who graduated from college had lower rates of
substance use, 7.2%, as opposed to those without a high school diploma, 10.3%, those with some
college, 9.7%, and high school graduates with no college, 8.8%. These numbers are important
because they tie back into the educational attainment of those who suffer from homelessness,
which in the present sample was much lower than in the general population. The national data
suggest a relationship between high school dropout and substance abuse. Data from the present
subjects also indicated a relationship between high school dropout and homelessness, and also
between substance abuse and homeless. Furthermore, other research has established a
relationship between substance abuse and mental illness (Butcher, Mineka, & Hooley, 2009), and
the present subjects likewise reported a relationship between mental illness and their
homelessness. Thus, there may be several intersecting causal pathways leading to homelessness,
perhaps directly from low educational attainment, substance abuse, and mental illness, but also
through a combination of pathways, such that one factor exacerbates the other. Since
homelessness is a catastrophic life event for most persons in the US, it would seem possible that
most people do not end up homeless because of one factor, but perhaps because of a
concatenation of synergistic factors. One could also add the reported high rates of substance
abuse and mental illness in the families of origin among the present subjects; these high rates
suggest that their families may be in distress and unable to help them. As such, lack of family
support may be a final, critical factor in the causal chain(s) that lead to homelessness in the US.

21. Substance Abuse and Homelessness 21
Another psychosocial characteristic was job loss, which affected nearly 70% of the
survey participants in this study. This percentage is very high, compared to the general
population throughout the United States and Iowa alone. The Bureau of Labor Statistics released
a report that said Iowa’s unemployment rate was 4.5% in 2012 (Bureau of Labor Statistics,
2014). The United States as a whole had an unemployment percentage of 6.7% as of 2013. Even
the highest unemployment rate over the last 10 years, 10% (Bureau of Labor Statistics, 2014),
does not approach the high unemployment rate of the present homeless population. Thus, job
loss would seem to be another critical factor in homelessness. Logically, job loss is also causally
linked with low educational attainment, substance abuse, and mental illness, leaving 4 primary
factors in homelessness, plus lacking family support.
In prior research and in the present study, homeless persons have been much more likely
to endorse histories of drug use (not alcohol use alone). In the present study, subjects specifically
reported that their homelessness helped maintain their drug use for several reasons--because
most people they knew were using substances, to forget about their homelessness, because there
was nothing else to do, because it was one of few things that made them feel good, and because
of a mental health issue for which they could not obtain adequate professional care. But only 1
out of the 28 subjects believed that substance use, past or present, led directly to their
homelessness. Rather, most subjects, 80%, reported recent financial concerns of either job loss or
eviction/foreclosure, much more likely seeing these financial concerns as the proximate cause of
their homelessness.
Among the 4 main factors in homelessness emerging from prior research and the present
study—i.e., job loss, low educational attainment, substance abuse, and mental illness—most
homeless persons in the present study pointed to financial concerns as the proximate cause of

22. Substance Abuse and Homelessness 22
their homelessness. Only 1 out of 28 believed that substance abuse was the direct cause of the
homelessness. Clearly, then, the present homeless subjects saw financial concerns, and not
substance abuse, as the trigger of their homelessness or the straw that broke the camel’s back.
Most acknowledged family of origin and personal past histories of substance use, but did not
openly recognize this substance use as a primary cause of homelessness. This suggests the
following question: Is the collection of synergistic factors that lead to homelessness offering a
smokescreen that allows homeless persons to deny the importance of their substance abuse in
causing their homelessness? Among the present homeless subjects, 25% reported that substance
abuse had led to financial problems such as eviction or job loss. As such, persons in the present
sample appeared capable of openly admitting significant life consequences from their substance
abuse. One would need to ask, then: Why would the subjects choose to be in greater denial about
substance abuse as the cause of their homelessness vs. their job loss or home eviction and
foreclosure? At this point, the present data cannot shed light on this question, and future research
is clearly needed. In the absence of information pertaining to this question, one may conclude
that for most persons in the present homeless sample, a summary of how they see their situation
might read as such: “I have had a substance abuse problem for a long time. Because it has been
there all along, it did not cause my homelessness. My recent financial setback is what caused me
to become homeless. Now being homeless, I use even more substances than I did before.”
Conclusion
In conclusion, the present study makes clear that although homeless persons may have
long histories of drug use, they do not normally perceive this drug use as the primary or
immediate cause of their homelessness. The extent to which this is an accurate understanding of
the causal pathway to homelessness or an act of denial so common among those with substance

23. Substance Abuse and Homelessness 23
use disorders, one cannot say. Clearly, with the multiple synergistic factors identified in prior
research and the present study as leading to homelessness, longitudinal data are needed to tease
out the true time sequence and contribution of factors that cause homelessness for most people.
Nevertheless, since most persons with substance abuse are not homeless in the US, it may be that
substance abuse alone cannot be considered a primary cause of homelessness. More likely, it is
the concatenation of factors identified-- job loss, low educational attainment, substance abuse,
and mental illness, combined with lacking family support—that leads to homelessness. The
subjects endorsed all these factors as contributing to their homelessness, but most often named
sudden economic hardship as the proximate cause of their homelessness.
Limitations
There were several limitations in this research. First, the research was conducted in a
relatively small geographic area which may not represent the national population of homeless
persons. Second, the number of participants in the research was relatively small. Third, the
questionnaire was designed by the researcher, so the validity and reliability of the questionnaire
were not established beyond face validity. In light of these limitations, for future research
outreach to a large number of homeless shelters within a wider geographic area would be
warranted to obtain a larger and more nationally representative sample of homeless persons.
Since this research was unable to capture subjects’ formal diagnoses pertaining to substance
abuse, it would be helpful in future research to gather such information from reliable sources,
such as medical records, as a validity check on the self-reports of substance use by the homeless
subjects, since denial is a known problem among persons who abuse substances. Finally,
although this thesis research did not permit sufficient time to pilot test the survey before its
actual use, in future research pilot testing would be valuable to assess, at least in a preliminary

24. Substance Abuse and Homelessness 24
way, the validity and reliability of the survey instrument. Alternatively, if funds are available, an
already validated instrument might be purchases and used in lieu of an independently developed
survey.

25. Substance Abuse and Homelessness 25
References
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http://www.ashland.or.us/Files/Homelessness_Supporting_Documents.pdf
Blankertz, L., Cnaan, R., & Freedman, E. (1993). Childhood risk factors in dually diagnosed
homeless adults. Social Work, 38(5), 587-596.
Booth, B., Sullivan, G., Koegel, P., & Burnam, A. (2002). Vulnerability factors for homelessness
associated with substance dependence in a community sample of homeless adults.
American Journal of Drug & Alcohol Abuse, 28(3), 429-452.
Bureau of Labor Statistics. (2014). Labor force statistics from the current Population Survey.
Washington, DC: U.S Department of Labor.
Bureau of Labor Statistics. (2014). Regional and state employment and unemployment.
Washington, DC: U.S Department of Labor.
Butcher, J. N., Mineka, S., & Hooley, J. M. (2009). Abnormal psychology (14th
Ed.). Upper
Saddle River, NJ: Allyn & Bacon.
Fisher, G., & Roget, N. (2009). Encyclopedia of substance abuse prevention, treatment, and
recovery. Thousand Oaks, CA: SAGE Publications, Inc.
Johnson, G., & Chamberlain, C. (2008). Homelessness and subatance abuse: Which comes first?
Australian Social Work, 61(4), 342-356.
Ku, B., Scott, K., Kertesz, S., & Pitts, S. (2010). Factors associated with use of urban emergency
departments by the U.S. homeless population. Public Health Reports, 125(3), 398-405.
Kushel, M., Perry, S., Bangsberg, D., Clark, R., & Moss, A. (2002). Emergency department use
among the homeless and marginally housed: Results from a community-based study.
American Journal of Public Health, 92(5), 778-784.

26. Substance Abuse and Homelessness 26
Lowe, J., & Gibson, S. (2011). Reflections of a homeless population's lived experience with
substance abuse. Journal of Community Health Nursing, 28, 92-104.
National Coalition for Homelessness. (2009). Substance abuse and homelessness. Washington,
DC: Author.
National Coalition for the Homeless. (n.d.). Questions and Answers About the "Chronic
Homelessness Initiative". Retrieved from
http://www.nationalhomeless.org/publications/chronic/chronicqanda.html
National Coalition for the Homeless. (2009, July). Substance Abuse and Homelessness.
Retrieved from http://www.nationalhomeless.org/factsheets/addiction.html
National Healthcare for the Homeless Council. (2003). Homelessness & family trauma: The case
for early intervention. Healing Hands, 7(2), 1-6.
National Institute of Mental Health. (2012). Serious mental illness (SMI) among adults.
Retrieved from http://www.nimh.nih.gov/statistics/SMI_AASR.shtml
Ryan, C., & Siebens, J. (2012, February). Educational Attainment in the United States: 2009.
Retrieved from http://www.census.gov/prod/2012pubs/p20-566.pdf
Substance Abuse and Mental Health Services Administration . (2013). Results from the 2012
National Survey on Drug Use and Health: Summary of National Findings. Rockville,
MD: HHS Publication.
The Unites States Conference of Mayors. (2008). Hunger and homelessness survey. Washington,
DC: Author.
United States Interagency Council on Homelessness. (2013). Vulnerability Index. Retrieved from
http://usich.gov/usich_resources/solutions/explore/vulnerability_index

27. Substance Abuse and Homelessness 27
Wilder Research. (2013, September). Retrieved from http://www.wilder.org/Wilder-
Research/Publications/Studies/Homelessness%20in%20Minnesota%202012%20Study/H
omelessness%20in%20Minnesota%20-
%20Findings%20from%20the%202012%20Statewide%20Homeless%20Study.pdf
Witte, P., Roman, N., Berg, S., Mulkey, S., Stand, L., & Batko, S. (2012). The state of
homelessness in America. Washington, DC: National Alliance to End Homelessness.

28. Substance Abuse and Homelessness 28
Appendix A
Volunteers Needed for Research Study:
Substances Used by Homelessness Americans
To Participate: The only requirement for participating in this survey is that
you are 18 years of age or older and have spent at least one night in a homeless
shelter in the last 30 days.
The Purpose: The purpose of the survey is to add to the information about
homelessness and substance use, to better serve and help those in the
community.
What to do: Please ask a staff member of this shelter for a copy of the survey.
It should take no longer thean 10 minutes to complete. When you have
completed the survey, there is a sealed box near the front desk and you can
place the survey in the box. The box will remain sealed and available all day for
a two week period. The only person with access to the surveys will be the
person conducting the research through the Psychology Department at Kaplan
University.

29. Substance Abuse and Homelessness 29
Appendix B
Survey
Your Age: ____________________
Gender: Male / Female
Ethnicity: Hispanic/Latino__ White__ Asian__ African-American__
Other:_______________________________
Family History / Growing Up
1. Is there a history of physical violence toward you within your family? Yes__ No__
2. Were you ever sexually abused inside or outside of your family? Yes__ No___
3. Is there a history of drug abuse in your family of origin? Yes__ No__
4. Is there a history of alcohol abuse in your family of origin? Yes__ No__
5. Did anyone in your immediate family have a history of being in prison or jail? (i.e., parents,
uncles, grandparents, siblings) Yes__ No__
6. When you were younger, did your family ever experience homelessness? Yes __ No__
7. Is there a history of mental health concerns in your family of origin (e.g., depression, anxiety,
schizophrenia, PTSD, etc.) Yes__ No__
8. Were you adopted? Yes__ No__
9. Were you ever in foster care? Yes__ No__
10. Approximately how many times did you move, from the time you were born until you were
18? If you are not sure, please just estimate the number of times: __________________
Peers
1. When you were younger, did you have a lot of friends who used or experimented with drugs
or alcohol? Yes___ No___
2. As an adult, but before you became homeless, did you have a lot of friends who used or
experimented with drugs or alcohol? Yes___ No___
3. After you became homeless, have you spent more time than you used to around people who
use drugs or alcohol? Yes___ No___
Community
1. As an adult, but before you became homeless, were drugs readily available in your household
or neighborhood? Yes__ No__
2. As an adult, but before you became homeless, was alcohol readily available in your
household or neighborhood? Yes__ No__

30. Substance Abuse and Homelessness 30
School
What was the last grade you completed in school?
Little to No Schooling ___
Elementary School Completed___
Middle or Junior High School Completed___
Some High School____
High School Diploma___
GED___
Some College___
College Graduate___
Graduate School___
Personal History
1. How many times have you been homeless during the last 3 years?
1 time ___
2-3 times ___
4 or more times ___
Ongoing for the whole time ___
2. How long have you been homeless during your latest episode of homelessness?
Less than a week __
1-2 weeks __
3-4 weeks __
1-3 months __
3-6 months__
6 months to a 1 year__
More than 1 year __
3. Have you experienced any traumatic or stressful life events in the last year? If yes, check all
that apply:
__ Death of relative/loved one
__ Loss of job/Sudden loss of income
__ Physical abuse or attack
__ Sexual abuse/rape
__ Divorce/Family separation
__ Home foreclosure/Eviction
__ Natural disaster
__ Recent release from jail/prison
__ Loss of health insurance
__ Diagnosis of major illness
4. Did you ever use any illegal substances before you became homeless? Yes__ No__

31. Substance Abuse and Homelessness 31
5. Do you use any illegal substances now?
__ None
__ Marijuana
__ Cocaine/Crack
__ Meth
__ Heroine
__ Other, please say what: __________________________________________________
If you use illegal substances now, how often have you used them in the last 30 days?
__ Once
__ Twice
__ Several times per week
__ Daily
__ Several times daily

32. Substance Abuse and Homelessness 31
6. Do you believe there is a connection between your homelessness and your drug use?
No__ Yes__: IF YES, please check below ONE Primary Connection between your drug use
and homelessness, and also check any that are Secondary Connections (that is, real but not
as strong as the Primary Connection:
 Drug use led me to become homeless: Primary__ Secondary__ Not Connected__
 I use drugs because most people I know are using drugs: Primary__ Secondary__ Not
Connected__
 I use drugs to forget about my situation: Primary__ Secondary__ Not Connected__
 I use drugs because there is nothing else to do: Primary__ Secondary__ Not
Connected__
 I use drugs because they are one of the few things that make me feel good: Primary__
Secondary__ Not Connected__
 I use drugs because I have a mental health concern, such as depression or anxiety, that I
can’t get adequate medical care or counseling for: Primary__ Secondary__ Not
Connected__
 Other Connection: Primary__ Secondary__ Not Connected__ Please say what the
“Other Connection” is:
________________________________________________________________________
________________________________________________________________________
7. At what age did you first use drugs?________
8. Did you drink a lot of alcohol before you became homeless? Yes__ No__

33. Substance Abuse and Homelessness 32
9. Do you drink a lot of alcohol now? Yes__ No__
10. If you answered yes, how often have you had alcohol in the last 30 days?
__ Once
__ Twice
__ Once Per Week
__ Several times per week
__ One drink every night
__ Several drinks every night
__ I drink most of the day, everyday
11. At what age did you start drinking a lot of alcohol? _______________
12. Do you believe there is a connection between your homelessness and your use of alcohol?
No__ Yes__: IF YES, please check below ONE Primary Connection between your alcohol
use and homelessness, and also check any that are Secondary Connections (that is, real but
not as strong as the Primary Connection:
 Alcohol use led me to become homeless: Primary__ Secondary__ Not Connected__
 I use alcohol because most people I know are drinking: Primary__ Secondary__ Not
Connected__
 I use alcohol to forget about my situation: Primary__ Secondary__ Not Connected__
 I use alcohol because there is nothing else to do: Primary__ Secondary__ Not
Connected__
 I use alcohol because it is one of the few things that makes me feel good: Primary__
Secondary__ Not Connected__
 I use alcohol because I have a mental health concern, such as depression or anxiety, that I
can’t get adequate medical care or counseling for: Primary__ Secondary__ Not
Connected__
 Other Connection: Primary__ Secondary__ Not Connected__ Please say what the
“Other Connection” is:
________________________________________________________________________
________________________________________________________________________

34. Substance Abuse and Homelessness 33
13. Has your drug or alcohol use ever caused you any problems? Yes__ No__
If you answered yes, check all that apply:
a. Missed work/late for work ___
b. Financial problems __
c. Marriage problems (arguments, divorce, etc.) __
d. Separation from family/friends __
e. Legal problems (e.g., DUI, jail/prison, stealing)__
f. Job loss __
g. Physical problems (e.g., weight, sleep, liver/kidney damage, heart attack, etc.) ___
h. Mental/Behavior problems (depression, violence, mood swings, etc.) ___
14. Are you currently working? Yes__ No__
15. Do you believe that you currently have any mental health concerns? Yes__ No__
If yes, what mental health issues are you dealing with now?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
16. Did your mental health concerns begin before you were homeless? Yes__ No__
17. Did your mental health concerns begin as a result of being homeless? Yes__ No__
If you answered yes, please explain how the homelessness caused your mental health concerns:
______________________________________________________________________________
______________________________________________________________________________
18. Please write a short description of your experience being homeless. For example, how do you
feel about it? How has the community treated you? How has the homeless community treated
you?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

35. Substance Abuse and Homelessness 34
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

36. Substance Abuse and Homelessness 35
Appendix C
Kaplan University
Consent for Participation in Research
“Substances Used by Homelessness Americans”
Why am I being asked?
You are being asked to be a participant in a research study about substance abuse and
homelessness. The study is conducted by Yolisa Gibson, a Master’s of Science in Psychology
student at Kaplan University. You have been asked to participate in the research because you
have spent at least one night in a homeless shelter and may be eligible to participate. We ask that
you read this form and ask any questions you may have before agreeing to be in the research.
Your participation in this research is voluntary. Your decision whether or not to participate will
not affect your current or future relations with Kaplan University or any homeless shelters. If you
decide to participate, you are free to withdraw at any time without affecting those relationships.
What is the purpose of this research?
The purpose of this research is:
To look at the relationship between homelessness and substance use to add to existing research
on this topic, thus better understanding how to help and serve individuals in the homeless
community.
What procedures are involved?
If you agree to be in this research, we would ask you to do the following things:
1. Ask a staff member for a survey, complete the survey honestly, and place it into the
completed survey box.
2. Do NOT identify yourself in any way on the survey--no names, no addresses, etc. This
will assure that your survey will be anonymous, so that no one can ever discover what
your answers were.
3. Approximately 100 individuals may be involved in this research at Kaplan University.
What are the potential risks and discomforts?
There are no physical risks associated with this survey. The survey does ask questions about
personal history, which may be slightly uncomfortable for some to answer. Any such discomfort
can usually be addressed through conversation with members of your support system, including
supportive persons at the shelter. You can also contact the Emotional Distress Hotline, 24/7, at 1-
800-LIFENET, to receive free and anonymous telephone assistance with any concerns that arise.

37. Substance Abuse and Homelessness 36
Are there benefits to taking part in the research?
There are no immediate, personal benefits to taking part in the survey. However, this survey may
give more insight into the relationship between homelessness and substance use, so that
communities can better understand how to help individuals.
What about privacy and confidentiality?
Because the survey is anonymous, no one will know if you chose to fill it out or not. Therefore,
no information about you can ever be disclosed to anyone. The information provided by you
during the research can be disclosed to others, but it will not identify you as an individual in any
way. When the results of the research are published or discussed in conferences, no information
will be included that could reveal your identity, because no such information is being collected.
Will I be reimbursed for any of my expenses or paid for my participation in this research?
There is no reimbursement available for participating in the survey.
Can I withdraw from the study?
You can choose whether to be in this study or not. If you volunteer to be in this study, you may
withdraw at any time without consequences of any kind. You may also refuse to answer any
questions you don’t want to answer and still remain in the study.
Whom should I contact if I have questions?
The researcher conducting this study is Yolisa Gibson. You may ask any questions you have
now. If you have questions later, you may contact the researchers at: Phone: (319) 241-7468.
You may also contact the researcher’s thesis adviser, Dr. Edward Cumella PhD, at
ecumella@kaplan.edu.
What are my rights as a research subject?
If you feel you have not been treated according to the descriptions in this form, or you have any
questions about your rights as a research subject, you may contact the Institutional Review Board
(IRB) at Kaplan University through one of the following representatives:
Susan Pettine, IRB Chair
Phone: (772) 607-1944
Email: spettine@kaplan.edu
Remember: Your participation in this research is voluntary. Your decision whether or not to
participate will not affect your current or future relations with the University or any homeless
shelters. If you decide to participate, you are free to withdraw at any time without affecting that
relationship.
You can keep this informed consent form for your information and your records.

38. Substance Abuse and Homelessness 37
Appendix D
Tables
Table 1
Sociodemographic Characteristics of the Subjects (N = 28)
Measure All Subjects
Age 44.5 (14.1)
Gender
Male
Female
25
3
Ethnicity
African-American
White
Other
5
22
1
Education
Less than high school
High school completion/GED
Some college
College graduate
10
11
4
3
Homeless episodes during last 3 years
Once
2-3 times
4 or more times
16
7
5

39. Substance Abuse and Homelessness 38
Duration of last homeless episode
Less than a week
Up to a month
1-3 months
3-6 months
11
10
4
3
Currently Employed 16

40. Substance Abuse and Homelessness 39
Table 2
Psychosocial Characteristics of the Subjects (N = 28)
Measure % Yes
Physically abused
Sexually abused
Drug use in family of origin
Alcohol use in family of origin
Family history of imprisonment
Family homelessness
Family history of mental illness
Adopted
In foster care as a child
# times family relocated until subject was 18
33%
18%
65%
46%
39%
18%
46%
21%
29%
4.7
Stressful life events past year
Death of relative/loved one
Loss of job/Sudden loss of income
Physical abuse or attack
Sexual abuse/rape
Divorce/Family separation
Diagnosis of major illness
Home foreclosure/Eviction
Natural disaster
Recent release from jail/prison
5
19
1
2
8
1
6
1
5

41. Substance Abuse and Homelessness 40
Loss of health insurance 0
Current mental health concern?
Depression
Anxiety
Bipolar
Schizophrenia
Autism
PTSD
50%
7
2
1
2
1
1
Mental health concerned began before homelessness
Mental health concerns began as result of homelessness
12*
2*
* Out of 14 with endorsed mental health concerns

42. Substance Abuse and Homelessness 41
Table 3
Subjects’ Experiences with Drug and Alcohol Use (N = 28)
Measure % Yes
As youth, had many friends who used substances
As adult before homelessness, had many friends who used substances
Since homelessness, has spent more time with substance users
Before homelessness, drugs readily available
Before homelessness, alcohol readily available
Used illegal substances before homelessness
Used alcohol excessively before homelessness
46%
64%
32%
50%
61%
71%
14%
Age of first drug use Mean: 18.2 (5.1). Range: 10-33
Age began excessive alcohol use Mean: 18.0 (4.4). Range: 11-30
Current drug and alcohol use (frequencies)
None
Marijuana
Methamphetamine
26
2
1
Drug/alcohol use has ever caused a problem
Missed work/late for work
Financial problems
Marriage Problems
Separation from family/friends
Legal Problems
Job Loss
57%
14%
14%
7%
22%
43%
11%

43. Substance Abuse and Homelessness 42
Physical Problems
Mental/Behavioral problems
4%
14%
Believes homelessness and drug use are connected
Drug use led me to become homeless
I use drugs because most people I know are using drugs
I use drugs to forget about my situation
I use drugs because there is nothing else to do
I use drugs because they are one of few things that make me feel good
I use drugs because of mental health issue I can’t get adequate care for
8
1
2
5
1
3
4
Believes there is connection between homelessness and alcohol use
Alcohol use led me to become homeless
I use alcohol because most people I know are drinking
I use alcohol to forget about my situation
I use alcohol because there is nothing else to do
Use alcohol because it’s one of few things that makes me feel good
I use alcohol because of mental health issue I can’t get adequate care for
3
0
2
2
0
2
3