Homelessness, Rough Sleeping And Addiction – What Can We Do To End This Spiral Of Destruction?

Addiction to drugs and/or alcohol is both a cause and consequence of homelessness and rough sleepers. The task of tackling homelessness and rough sleeping is one that the government, organisations, charities, community and individuals all share the burden of overcoming.

The issue

Being homeless or sleeping rough is incredibly stressful. There is also a high prevalence of mental health problems amongst the homeless population. It is not uncommon for those traumatised by homelessness to seek solace in drug or alcohol.

Problems with drugs or alcohol can be part of a person’s spiral into homelessness and rough sleeping. Of course, not everyone who has problems with alcohol and/or drugs becomes homeless and not every homeless person has problems with drugs or alcohol. However, levels of drug and alcohol abuse/addiction are relatively high amongst the homeless and rough sleeper population UK wide. Higher than that of those who are permanently housed.

For the purposes of conducting rough sleeping street counts and evidence based estimates, the Ministry of Housing, Communities and Local Government (MHCLG). The UK government defines people who sleep rough as:

  1. People sleeping, about to bed down (sitting on/in or standing next to their bedding) or actually bedded down in the open air (such as on the street, in tents, doorways, parks, bus shelters or encampments).
  2. People in buildings or other places not designed for habitation (such as stairwells, barns, sheds, car parks, cars, derelict boats, stations, or “bashes” which are makeshift shelters often comprised of cardboard boxes).

The definition does not include:

  • people in hostels or shelters
  • people in campsites or other sites used for recreational purposes or organised protest
  • squatters
  • Gypsy travellers/caravans

This definition is used for the purpose of rough sleeping estimates. However, policy, programmes and services currently being developed, designed and delivered recognise that people move in and out of periods of rough sleeping. Rough sleeping can be a transitory state, and many experience a ‘revolving door’ cycle, moving in and out of short-term accommodation.


Imagine that you have lost your job 6 weeks ago and because you are no longer working, you can’t afford to pay your rent so you get kicked out of your home. You move into your car in a quiet car park. No company, no running water, no toilet, no electricity and because of this, you start drinking cheap cider each day to help cope with the constant stress. Your first night it rains, the constant noise of the wind and rain stops you from sleeping properly. In the early hours of the morning, you get cold and your sunroof starts to leak, meaning you start to get wet, cold and mould starts to grow inside your car. 6 weeks later, you have to sell your car as you desperately need the money. You are on the waiting list for accommodation but the list is vast, so you sleep outside on a bench for the first time. You are cold, uncomfortable, the constant noise of cars, the wind, animals, people passing by and the worry of being robbed slowly, hour by hour, wears you down so you start to drink more cider to help you sleep and relax… The story goes on, ever worsening…

CAN YOU SEE WHERE THIS IS GOING!?… This is the true story of the creator of Drink ‘n’ Drugs and the writer of this article.

During 2013-15, 27% reported problematic drug/alcohol use (source: Crisis Skylight Final Report of the University of York evaluation). Two thirds of homeless people cite drug or alcohol use as a reason as to why they first became homeless. Those who use drugs are seven times more likely to be homeless or sleep rough.

In the past few years there has been an increase in the use of new psychoactive substances (formerly known as ‘legal highs’) amongst the homeless/ rough sleeper population. In 2016, the UK government passed legislation (the Psychoactive Substances Act 2016) which made it illegal to sell substances that are capable of producing a psychoactive effect.

The solution

We know that many long-term rough sleepers suffer from a range of health issues including drug and alcohol misuse. For them an effective route out of homelessness is often Housing First. This approach places vulnerable homeless/rough sleepers directly from the street or emergency shelter into permanent independent tenancies. These come with comprehensive but not compulsory support. This works on the assumption that the best way to prepare for independent living is independent accommodation rather than placing someone in a hostel and then supported housing.

According to the UK government, They also face a higher likelihood of dying from injury, poisoning and suicide. It has been estimated that around 35% of people who die whilst sleeping rough die due to alcohol or drugs, compared to 2% in the general population.

People who sleep rough experience some of the most severe health inequalities and report much poorer health than the general population. Many have co-occurring mental ill health and substance misuse needs, physical health needs and have experienced significant trauma in their lives.

The UK Department of Health and Social Care (DHSC) found that people who are homeless are 3.2 times more likely to have an inpatient admission to hospital than the general population. Furthermore, attendance at accident and emergency is at least 8 times higher in the rough sleeping population than the housed population and people who experience both homelessness and alcohol or drug dependency were found to be 28 times more likely to have emergency admissions to hospital.

There are correlations between mental health and a range of housing issues, for example:

  • Stress, anxiety, depression and other mental/physical health needs
  • Poor housing conditions and-or housing insecurity
  • Overcrowding and mental ill-health, particularly for children and young people
  • Financial problems and mental ill-health
  • Self-medication with alcohol and drugs

Substance dependence can be both a cause and consequence of homelessness. Those who are dependent on drugs or alcohol may struggle to retain accommodation due to financial difficulties, problems with behaviour or family relationship breakdown. Homelessness can also be the route to substance dependence.

In terms of substance dependence, homelessness and rough sleeping can affect:

  • Decisions to use for the first time or continue to use, drugs, alcohol or other addictive behaviours
  • Increased likelihood of relapse, overdose and death
  • Increased risk of transmission of blood-borne viruses (BBV’s), especially when injecting drugs
  • Increased risk of a range of other health conditions, including respiratory conditions and other co-morbidities
  • Ulcers or open wounds at injecting sites, leading to injection
  • Access to treatment and willingness to engage with it
  • The ease with which treatment providers can continue to engage with their client and provide treatment
  • The level of support available from family, friends and loved ones

National Drug Treatment Monitoring System (NDTMS) statistics for 2017 to 2018 reported that 20% of people in drug and alcohol treatment have a housing problem to the extent that they are either rough sleeping or at serious risk of homelessness. This is higher for people in treatment for opiates (31%) and even higher for people in treatment for both opiates and new psychoactive substances (59%).

The 2018 to 2019 data for London reports that of the people seen sleeping rough, 42% and 41% had alcohol misuse and drug misuse support needs respectively. Thirty-six % had co-occurring mental health and drug and/or alcohol misuse support needs.

Co-occurring mental ill health and substance dependence is common amongst people who sleep rough. People may use alcohol and/or drugs to self-medicate for their mental ill-health and may also use substances to help with sleeping, pain management and environmental factors such as cold outdoor temperatures or heavy periods of rain.

There is evidence that people experiencing rough sleeping with co-occurring needs find it challenging to engage with and/or experience other barriers to accessing treatment services. It is not uncommon for mental health services to exclude people because of co-occurring alcohol or drug use, a particular problem for those diagnosed with serious mental illness who may also be excluded from alcohol and drug services due to the severity of their mental illness and then become excluded from mental health services because of their substance abuse/addiction.

People in drug and alcohol treatment who have mental ill-health and housing problems are also less likely to successfully complete treatment. The increased mortality amongst people who are homeless or sleeping rough with substance dependence issues is concerning. There has been a substantial increase in drug poisoning deaths of homeless people, from 125 (26% of the total) in 2013 to 190 (32% of the total) in 2017. This is an increase of 52% over 5 years. Deaths from alcohol-specific causes also increased, with these deaths accounting for 10% of the total number of deaths in homeless people in 2017.

“Once the heroin and crack addiction turned me into a homeless prostitute, I pretty much gave up on life. Laying there in a bed just staring into this mirror, I would sometimes see the beautiful little girl I used to be looking back at me,” recalls Lisa S. in her story at HeroesInRecovery.com. “One morning, I reached out to her and decided to save her.”

Lisa S – http://www.heroesinrecovery.com

Other Help And Support

Other services such as hot food handouts, food banks, access to financial benefits and others are also a barrier to many. In some areas, including Bournemouth, benches around the town are given post codes to allow the homeless/rough sleepers to apply for benefits and other vital services. A case in Bristol can be found here: https://www.google.co.uk/amp/s/amp.theguardian.com/uk/2000/oct/21/raekhaprasad

We could also all donate unwanted/unnecessary food or hygiene products to our local food banks or hot meal schemes. Donations can be left in specific locations inside supermarkets if you do want to donate. Aside from food, baby/child products can be donated as well as shower gel, kitchen roll, toilet rolls and others. A list of things you can donate can be found at the end of this article.

In many cities across the UK have similar issues. For example, those rough sleepers in Bournemouth need to access hot meal handouts as it is their only means of accessing food at times yet because they carry around their personal belongings including bedding and some with dogs, means getting to the varying daily locations difficult. Not to mention that these people are already cold, wet, tired and hungry before they have even begun.

We agree with others in this area, including the charity Crisis, that the following needs to be implemented immediately:

Levels of rough sleeping are on the increase across the UK. To end rough sleeping, solutions need to address both accommodation and associated support needs needs to come together as “one package”.

We think that the Government should implement a cross departmental national rough sleeping strategy. This would drive a coordinated approach to reducing and ultimately achieving the goal of ending rough sleeping by removing those currently in that position and prevent others from becoming homeless or sleeping rough in the future.

According to Crisis “We have carried out a feasibility study in Liverpool City region on Housing First to help address rough sleeping in the region. Housing First is an evidence-based approach which supports homeless people with complex needs and histories of entrenched or repeat homelessness to live in their own homes. It provides a stable, independent home as well as intensive personalised support.” Schemes such as these could be implemented nationwide if everybody were “singing from the same hymn sheet”.

The Housing First feasibility study in Liverpool provides a toolkit for other areas looking to implement Housing First in their area. More information from Crisis about their study and plan to end rough sleeping can be found on their website here.

If you can donate some of your time to volunteer then many charities and organisations are always needing help from others, so anything you can do will contribute to the overall bigger picture. Money is another way you can help. Donating money to your local homeless/rough sleeper charities will boost their ability to help others who may have slipped through the gaps and are desperate for help and support. If you want to volunteer or donate money, Google relevant homeless/rough sleeper organisations in your area or contacting your council will also allow you to focus your support in areas where it will be most beneficial. You can also contact your nearest drug and alcohol service who have lists and contact information for vital services in your local area.

Food Bank/Hot Meal Scheme Donation List:

  • Cereal
  • Soup
  • Pasta
  • Rice
  • Tinned tomatoes/ pasta sauces
  • Lentils, beans and pulses
  • Tinned meat
  • Tinned vegetables
  • Tea, coffee and cold drinks such as squash or Ribena
  • Tinned fruit
  • Biscuits
  • UHT milk
  • Fruit juices
  • Snacks such as crisps, cake or chocolate
  • Fruit & vegetables
  • Toilet/kitchen rolls
  • Toothpaste & toothbrushes
  • Shampoo, shower gel and soap
  • Deodorant or body spray
  • Nappies, baby food or baby milk
  • Dog or cat food and/or treats
  • Seasonal items approaching Christmas, Halloween, Easter ect. Contact your food bank or hot meal scheme to see what they will accept and/or need

Published by Drink ’n’ Drugs

Providing useful, relevant, up to date information and support for those suffering from active addiction or those who are in recovery.

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