Evaluation of Substance Abuse Treatment for the Homeless

The homeless create a unique problem for substance abuse and mental health professionals. Many became homeless due to substance abuse problem. They often need immediate shelter in order to undergo treatment for the problems that initially caused their emotional instability. About 20 to 35 percent of the homeless population are believed to have substance abuse-related issues, while from 10 to 20 percent of those are believed to be diagnosed with at least one other mental health diagnosis. Many escape homelessness through living in the homes of generous friends and family; however many substance abusers are one paycheck from homeless status, and have jobs that are in jeopardy due to substance-abusing behavior that effects work performance.

Shelter Issue

• According to The National Healthcare for the Homeless Council, only one-quarter of the substance-abusing people in the United States who need addiction treatment actually receive it. The homeless compound this problem because they are unusually difficult to locate and treat due to their lack of consistency in living arrangements and emotional stability. In order to effectively treat a homeless person for substance abuse, the person must have adequate shelter so that he can begin and maintain a stable lifestyle.

Mandated Treatment

• Mandated treatment is often the best option for the homeless, who may be unable to physically, financially, or emotionally commit to conventional substance-abuse treatment options. According to the National Institute on Drug Abuse, voluntary status is not necessary in order for substance abuse treatment to be effective. In the case of the homeless, voluntary treatment is not always a realistic option until the person has been stabilized through detoxification procedures and sheltered from the general conditions of homelessness and life on the streets. Treatment for other mental health problems may also be necessary.

Engagement

• Both the client and the counseling staff may be challenged by the need for the person to engage in the treatment process. Homeless substance abusers suffer from social isolation and tend to distrust authorities. The homeless person may view counselors and staff members as authority figures. That may lead to disenchantment with the treatment process.

  Multiple needs arising in the treatment of this group, and also making engagement difficult include the need for medical care and psychiatric services, housing, employment, and proper diet and nutrition.

Drop Out Rates

• Substance-abuse treatment dropout rates are higher among the homeless than among the general population. According to research sited by The National Health Care for the Homeless Council, about two-thirds of homeless clients drop out of treatment prematurely. Other estimates say that 80 percent of the homeless do not complete treatment programs. Unfortunately, these figures remain consistent throughout the country.

Defining Treatment Success

• Substance-abuse treatment success definitions may need to change in the case of homeless populations. Recovery may take longer, and include more relapse potential and actual incidences of relapse into drug use and abuse, than are found within the general population. Treatment success for this group should be measured along a scale of improved results in quality and duration of substance-free periods. Recovery should be seen as a lifelong process that often includes instances of relapse and years of developing abstinence skills.