The Unhoused Encounter Significant Barriers To Access Quality SUD Treatment Services

July 15, 2025

Nicolette Dalhamer, Author & CEO, Evolve 2gether LLC, and Founder/President, The Helen VanNatta Memorial Foundation Inc.

Tom O’Connor, Editor & Publisher

Author Nicolette Dalhamer boldly states, “I am a person who has lived through and overcome adversity. I was raised by a single mother—a woman I loved deeply but who struggled with addiction to prescription opioids. My parents divorced when I was just four years old, and from that moment on, my mother became my sole guardian. We often faced severe financial hardship, and things like rent, electricity, and food were never guaranteed.

Young Girl

As a young girl, I did my best to understand my mother’s growing dependence on painkillers. What started as a prescription quickly escalated into a full-blown addiction to OxyContin. By the time I was 13, the reality of her addiction had taken complete control of our lives. I remember countless nights spent trying to wake her up, only to find her locked in her room, high and hallucinating.

One day, I pushed open her bedroom door and found her lying in a puddle of sweat, mumbling incoherently, her body limp and barely responsive. That moment shook me. It was the first time I felt the overwhelming weight of abandonment, like I was watching the only parent I had disappear right in front of me.

Mental Health, Substance Abuse, and Homelessness Connection 

The connection between mental health, SUD, and homelessness in America is undeniably complex. People dealing with mental health problems may turn to substances as a form of self-medication, increasing their risk of addiction. As substance use rises, it can lead to financial hardship, job loss, and broken relationships — all of which raise the chances of ending up unhoused. Conversely, the harsh and often traumatic conditions of homelessness can worsen existing mental health issues and prompt individuals to use substances as a way to escape, creating a destructive cycle. 

This cycle forms a complicated, deeply intertwined set of challenges — a bio-psycho-social-spiritual crisis — that cannot be solved with single, isolated efforts. Instead, it requires integrated, upstream strategies that tackle the root causes of mental health issues, addiction, and housing instability at the same time.

Desmond Tutu once said:

“There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.”

This quote powerfully emphasizes the difference between reactive care and proactive change. “Pulling people out of the river” refers to the crisis responses we often depend on — emergency shelters, short-term detox programs, or one-time meals. While these responses are compassionate and necessary, they are not lasting solutions. Tutu’s metaphorical call to “go upstream” urges us to look further back to examine the systemic and personal factors that cause people to fall into these crises in the first place.

To do that, we must understand and address two urgent realities:

1. Addiction Can Lead to Homelessness

Addiction can destabilize every aspect of a person’s life. The financial burden of maintaining substance use, combined with job loss and broken family ties, can leave individuals without the safety net needed to maintain stable housing. Moreover, addiction often worsens co-occurring mental health issues, making it harder for someone to navigate systems or seek proper care. Once a person becomes unhoused, the journey to recovery becomes even more difficult, as survival is prioritized over treatment, and exposure to risky environments can reinforce substance use behaviors.

2. Homelessness Can Lead to Addiction

The trauma and stress of living without a stable home often push people toward substance use as a way to cope. Limited access to mental health care, constant danger, and the emotional toll of isolation make those living on the streets especially prone to addiction. Without a consistent support system or a safe place to heal, individuals often turn to drugs or alcohol for momentary relief from ongoing emotional and physical pain. Additionally, those experiencing homelessness may be more easily drawn into drug-using networks, increasing the chances of initial and ongoing substance use.

This Vicious Cycle

This vicious cycle — where mental illness leads to addiction, addiction results in homelessness, and homelessness worsens both — calls for a reevaluation of our systems. Currently, much of the U.S. approach to homelessness is reactive. Emergency shelters, food pantries, and sporadic access to healthcare are necessary stopgaps, but they are not solutions. These responses provide immediate relief but rarely address the root causes of crises, both structural and personal.

To truly address the problem upstream, we must ask difficult but essential questions:

• Why are so many people with untreated mental health conditions ending up on the streets?

• Why are individuals with substance use disorders left without reliable, affordable access to evidence-based treatment?

• Why are economic instability, systemic racism, and a lack of affordable housing still driving people into homelessness?

The answers lie not in judgment or pity but in prevention, compassion, and policy reform. 

We must integrate housing with comprehensive services, including:

• Trauma-informed mental health care

• Substance use recovery programs

• 0Permanent supportive housing

• Harm reduction strategies

• Community-based, culturally competent care

Providing someone with a bed for a night or a one-time counseling session isn't enough. 

We need systems that offer ongoing, holistic support—systems that treat people as whole individuals, not as problems to be fixed.

Desmond Tutu’s wisdom reminds us that we cannot keep pulling people out of the river without asking why they’re falling in. If we only focus on rescuing people after they’ve reached crisis, the river will continue to swell with those in despair.

But by acting upstream—with empathy, evidence-based solutions, and sustained investment in human dignity—we can start to dismantle the systems that cause so many to fall through the cracks. In doing so, we will not only reduce homelessness but also significantly lessen the suffering caused by untreated mental illness and addiction in our communities.

Nicolette Dalhamer can be reached at ndalhamer88@gmail.com

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