Young Adults Experiencing Homelessness and Substance Abuse Disorders: Population-

Specific Practices

Sean Morris

Department of Social Work: Appalachian State University

SW 2615: Foundations for Social Justice Practice

Dr. Tonsing

May 4, 2023
 Across America, youth and young adults experiencing homelessness are increasingly

exposed to greater risk. Substance use disorders among young adults experiencing homelessness

(YAEH) are significantly higher than among their housed peers (Green et. al, 2020). Research is

also showing deviations in patterns of substance abuse among YAEH which is placing them at

greater risk of overdose, being victims of violence, and experiencing mental illness (Chassman,

2022). According to Chassman’s et al. report on Illicit Substance use in YAEH nearly one in ten

young adults will experience some form of homelessness annually (2022). This population often

has a history of trauma both leading to and ongoing in the experience of homelessness that places

them at a higher risk for developing reliance on illicit substances. Addressing the issue of this

population requires taking steps to provide trauma-informed care and drug rehabilitation that

addresses the causes of substance abuse.

Historically, people experiencing homelessness have been linked to mental illness,

physical disability, and social marginalization. While abuse of alcohol and opiates has been

common in America since the Civil War, substance use has changed dramatically since the

1990s increasingly representing a greater risk factor for homelessness (Green et. al, 2020).

YAEH currently are more frequently avoiding injection use drugs and alcohol and turning to

stimulants (Green et. al 2020). This change in the status of injection-use drugs is believed to be

correlated to the stigma of contracting HIV/AIDS. This reduction in injection drug use also

correlates to a rise in stimulant use, particularly ecstasy, cocaine, and methamphetamine. The use

of stimulants is especially linked to a history of depressive symptoms, post-traumatic stress

disorders, adverse childhood experiences, and a history of direct victimization (ie. assault,

robbery) (Tabar et. al, 2020). This indicates that substance use among YAEH currently is more

likely an attempt at self-medicating to overcome the inhibitions and negative self-stigma a

history of trauma creates. More importantly, younger generations of people experiencing

homelessness are more likely to have begun abusing substances before the age of 14,

demonstrating substance use arising as a result of adverse childhood experiences. One study

found 88.2% of YAEH respondents had a history of adverse childhood experiences while

presenting for substance abuse treatment (Chassman et. al, 2022).

Young Adults Experiencing Homelessness cope with multi-faceted discrimination. Many people

experiencing homelessness carry with them the stigma of perceived social deviance that limits

their capacity for economic mobility and ability to access social capital. This places YAEH at

greater risk for experiencing substance abuse disorders, as this often presents itself as a way to

self-medicate and relieve oneself of the reality of homelessness. On top of substance abuse

disorders, YAEH are more likely to report a co-occurring psychiatric disorder (Chen et. al,

2011). This discrimination is perpetuated through a series of stereotypes about people who

experience substance use disorders and young “able-bodied” homelessness that create barriers to

housing, employment, and healthcare. This places them in a constant state of risk for

victimization, criminalization, and institutionalization.

The stigma around YAEH exemplifies intersectionality theory and the opposing

conservative and liberal views on welfare recipients. Intersectionality theory is the academic

premise that compounding social identities create differentiating experiences in the social

environment (Hill wt. al, 2021). Intersectionality theory is key to understanding appropriate

interventions within this population as the identity of homelessness, illicit substance user, and the

client's innate social identity interact to create complex barriers to stability. Black men

experiencing homelessness are often labeled as blameworthy and dangerous due to a

combination of American views on race, welfare, and gender identity (Markowitz, 2019). This
combination of social identity and housing status shines a light on American beliefs of how a

person achieves the status of homelessness, rugged individuality, the utilization of social

services, and how race and gender play a role in framing a client's place in the social

environment. In order to fully understand the stigma of a YAEH and substance abuse disorder, it

is necessary to look at clients combining identities both separately and together and to work with

the client on how their identity shapes the oppression they face. Understanding how these social

identities intersect with the experiences of homelessness and substance use provides deeper

insight into the path forward.

The perceived stigma YAEH experiences when utilizing health care resources is essential

for a helping professional to understand in order to tackle the barriers to treatment. Healthcare

settings place YAEH in a vulnerable environment through labeling, interpersonal stigma, and

power differentials. Labeling, often called diagnosis, is a necessary part of the treatment method

but often correlates with discrimination in employment, housing, and negative self-perception

that causes social exclusion and treatment avoidance (Lowe et. al, 2022). Research has

demonstrated a multiplying factor of stigma within populations that have a dual diagnosis of

mental illness and substance use disorders (Lowe et. al, 2022). This stigma is created by a

perception of the language used by providers to describe the symptoms of the client and a

perception of the provider in the client's ability to follow through on complex treatment

programs. A documented phenomenon of hypersensitivity to perceived stigma (Reilly et. al,

2022) demonstrates how a history of trauma and social othering makes providing treatment to

YEAH experiencing substance use disorders complex at an interpersonal level. YAEH have also

documented the “life-saving” effect of positive experiences within the healthcare system, stating

that building rapport and trust between client and provider is critical to providing a full spectrum
of care. YAEH have expressed the importance of being seen as human, being shown empathy,

and providers taking extra steps to fully understand their conditions, especially through outreach

work (Reilly et. al, 2022). This view posits stigma as the primary barrier to effective intervention

and places significance on trust and vulnerability between the worker and client. Building

rapport with clients allows for a more full treatment of clients beyond detox. As the literature

outlined above demonstrates, YAEH is increasingly turning to substances to self-medicate from

a history of trauma and discrimination, this means the healing process is much more complex

than sobriety and re-housing. A worker can build rapport with a client by surrendering power to

the client which humanizes their needs as equally important as the convenience of the worker.

Surrendering power can take the form of outreach work, which meets the client where they are

at, and through recognizing the client as the authority in their affairs and making their voice an

equal part of the treatment procedure as the providers. Combating this stigma and humanizing

the client's needs and history allows for a deeper exploration of determinants of homelessness

and substance use within this population.

The community resources available for YAEH with substance use disorder are vast but

can be broadly categorized into detox, therapy, harm reduction, and housing. Detox or

detoxification is the process of safely reducing substance use, detox is usually available through

hospitals, local health centers, or detox facilities which offer residential treatment options. While

detox can be effective in creating sobriety, therapy works towards creating resilience towards use

through practicing positive coping skills. Therapy works with the client to create stability and

address the causes of the client's afflictions by allowing the client to discuss trauma and ongoing

issues in a safe manner. Harm reduction is the process of providing clients with a safe alternative

to or using illicit substances. Harm reduction can take the form of providing overdose kits, safe
use kits, or exchanging used paraphernalia for safe clean kits (Krawcyzk et. al, 2022). Harm

reduction is arguably the most critical role of social workers, especially outreach workers

because it allows them to demonstrate their commitment to the well-being of the client regardless

of moral judgments. Harm reduction helps reduce overdoses, overdose deaths, and the spread of

diseases amongst people experiencing substance use disorders making addiction less traumatic

and creating supportive relationships. Housing is a critical intervention for YAEH with substance

use disorders. The housing allows clients to have a stable place to build meaningful connections,

and maintain important obligations like employment and healthcare, and reduces clients' risk of

victimization, criminalization, and illicit substance use. Housing for people experiencing

homelessness is limited and often tied to government assistance and vulnerability (Hill et. al,

2022). Younger people experiencing homelessness are generally less likely to receive

government assistance in finding housing due to the stigma of young able-bodied people

experiencing homelessness. Shelters often fill the role of housing in moments of crisis but are

often unavailable in rural areas and ill-equipped to provide adequate care. Collaboration between

shelters, addiction treatment, health departments, and social services are needed to meet the

complex needs of this population. Continuum of Care is a program that brings these services

together to meet these needs, however, this program is limited in its ability to assist this

population due to a lack of financial resources (Continuums of Care). Advocating for proper care

of this population must address the necessary link to assets, overcoming geographic barriers of

outreach, and challenging the social stigma that creates interpersonal barriers to treatment.

YAEH with substance abuse experiences represents a new complex problem in our social

environment. The intersection of different demographics within this population with the

challenges the population faces as a whole creates systems of oppression that prevent adequate
care. It is important for help professionals to remember this population has unique and intricate

needs that must be addressed through rapport building and interdisciplinary collaboration. While

we cannot erase the trauma that homelessness and substance abuse create, we can work hard to

recognize the person within and empower them to find healing.

 Works Cited

Chassman, S., Barman-Adhikari, A., Hsu, H.-T., Ferguson, K. M., Narendorf, S. C., Maria, D.

S.,

Shelton, J., Petering, R., & Bender, K. (2022). Prevalence and Correlates of Illicit

Substance Use Among Young Adults Experiencing Homelessness in Seven Cities Across

the United States. Journal of Drug Issues, 52(4), 488–508.

https://doi.org/10.1177/00220426211049355

Chen, K. W., Banducci, A. N., Guller, L., Macatee, R. J., Lavelle, A., Daughters, S. B., &

Lejuez, C. W.

(2011). An examination of psychiatric comorbidities as a function of gender and

substance type within an inpatient substance use treatment program. Drug and Alcohol

Dependence, 118(2–3), 92–99.

https://doi-org.proxy006.nclive.org/10.1016/j.drugalcdep.2011.03.003

Collins, P. H., da Silva, E. C. G., Ergun, E., Furseth, I., Bond, K. D., & Martínez-Palacios, J.

(2021).

Intersectionality as Critical Social Theory: Intersectionality as Critical Social Theory,

Patricia Hill Collins, Duke University Press, 2019. Contemporary Political Theory,

20(3), 690–725. https://doi-org.proxy006.nclive.org/10.1057/s41296-021-00490-0

Continuums of Care. Continuums of Care | Raleigh, North Carolina USA |. (n.d.). Retrieved May

1, 2023, from https://www.ncceh.org/coc/

Hill, C., Hsu, H., Holguin, M., Morton, M., Winetrobe, H., & Rice, E. (2022). examination of

housing interventions among youth experiencing homelessness: an investigation into

racial/ethnic and sexual minority status. Journal of Public Health, 44(4), 834–843.

https://doi-org.proxy006.nclive.org/10.1093/pubmed/fdab29

Green, B., Lee Kim, F., & Dean, J. D. (2020). Substance Use and Treatment Among Youth

Experiencing Homelessness: 1992–2017. Journal of Adolescent Health, 67(6), 786–792.

https://doi-org.proxy006.nclive.org/10.1016/j.jadohealth.2020.04.019

Krawczyk, N., Allen, S. T., Schneider, K. E., Solomon, K., Shah, H., Morris, M., Harris, S. J.,

Sherman, S.

G., & Saloner, B. (2022). Intersecting substance use treatment and harm reduction

services: exploring the characteristics and service needs of a community-based sample of

people who use drugs. Harm Reduction Journal, 19(1), 1–10. https://doi-

org.proxy006.nclive.org/10.1186/s12954-022-00676-8

Lowe, D. J. E., & Simpkin, E. (2022). Dual Diagnosis Double the Stigma, Double the Trouble.

Psychiatric Times, 39(5), 26–27.

Markowitz, F. E., & Syverson, J. (2021). Race, gender, and homelessness stigma: Effects of

perceived

blameworthiness and dangerousness. Deviant Behavior, 42(7), 919–931. https://doi-

org.proxy006.nclive.org/10.1080/01639625.2019.1706140

Reilly, J., Ho, I., & Williamson, A. (2022). A systematic review of the effect of stigma on the

health of people experiencing homelessness. Health & Social Care in the Community, 30,

2128– 2141. https://doi-org.proxy006.nclive.org/10.1111/hsc.13884

Tabar, M., Park, H., Winkler, S., Lee, D., Barman-Adhikari, A., & Yadav, A. (2020). Identifying

Homeless

Youth At-Risk of Substance Use Disorder : Data-Driven Insights for Policymakers.

Proceedings of the 26th ACM SIGKDD International Conference on Knowledge

Discovery & Data Mining, 3092–3100.

https://doi-org.proxy006.nclive.org/10.1145/3394486.3403360